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Near-Fatal Self-Harm Among Canadian Adolescents.

Rachel Hb Mitchell1, Cornelius Ani2, Claude Cyr3

  • 1Department of Psychiatry, 71545Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada.

Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie
|November 30, 2021
PubMed
Summary

Canadian adolescent self-harm in intensive care units (ICUs) shows females attempt suicide more often, while males have higher mortality. Family conflict is a key trigger, suggesting sex-specific prevention strategies are needed.

Keywords:
adolescentchildrenself-harmsuicide attemptyouth

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Area of Science:

  • Adolescent health
  • Public health
  • Psychiatry

Background:

  • Medically serious self-harm among adolescents is a significant public health concern.
  • Understanding the clinical features and outcomes of intensive care unit (ICU) admissions for self-harm is crucial for targeted interventions.
  • Existing data on adolescent self-harm in Canada requires further detailed analysis, particularly concerning ICU admissions.

Purpose of the Study:

  • To evaluate the clinical characteristics of Canadian adolescents admitted to the ICU for medically serious self-harm.
  • To identify demographic, method-specific, and precipitating factors associated with severe adolescent self-harm.
  • To inform the development of sex-specific suicide prevention strategies for adolescents.

Main Methods:

  • A nationwide survey of 2700 Canadian pediatricians was conducted over two years (January 2017–December 2018) via the Canadian Paediatric Surveillance Program.
  • Data were collected on eligible cases of medically serious self-harm requiring ICU admission.
  • Statistical analyses were performed to compare characteristics between males and females and identify significant associations.

Main Results:

  • Ninety-three cases were identified (73% female; mean age 15.2 years).
  • Overdose (74.2%) and hanging (19.4%) were the most common methods; overdose was more frequent in females, while hanging was more common in males.
  • Females had higher rates of past psychiatric diagnosis, previous suicide attempts, and prior mental health service use. Family conflict was the most frequent precipitating factor (43%).

Conclusions:

  • Canadian adolescent males admitted to the ICU for self-harm have a higher mortality rate, primarily due to hanging.
  • Females exhibit higher rates of suicide attempts and prior mental health care engagement, consistent with broader adolescent and adult populations.
  • A sex-specific approach to suicide prevention, potentially targeting family conflict, is recommended within national strategies for adolescent self-harm.