Suicide and self-harm in Tasmanian children and adolscents

Objectives: To examine rates of suicide by Tasmanians less than 20 years of age, to compare them with rates for Australia as a whole, and to report a clinical study of child and adolescent self-harm in Tasmania. Design: Australian Bureau of Statistics data on suicides by 0-19-year-olds in Tasmania and Australia and population estimates were used to calculate and compare suicide rates for the period 1965-1991. The self-harm study involved 36 females and 16 males presenting to the accident and emergency department of a general hospital. They were studied by means of structured interview and scales of personal/family functioning and beliefs. Controls were individually matched with patients with no psychiatric condition. Results: During 1965-1991, the suicide rate in Tasmanian males aged 15-19 years was higher than that of mainland Australian males and had increased during the last 10 years of this period. Suicide rates for males, both in Tasmania and mainland Australia, were higher than the corresponding rates for females. Among females aged 10-14 years or 15-19 years, the rates for Tasmania were not different from those of the mainland counterparts. The rate for 15-19-year-old Tasmanian females was higher during the last decade of the study period than in earlier years. Common motivations for self-harm were to die or to escape an impossible situation, rather than to attract the attention of others. Most adolescents had serious personal and interpersonal problems, usually involving family dysfunction, including parental separation, physical abuse and lack of a family confidant, when compared with controls. Ingestion of medication (most frequently paracetamol was the most common method of self-harm. Conclusions: The suicide rate in 15-19-year-old Tasmanian males is higher than the mainland rate and rising. Self-harm in adolescence is associated with serious personal and interpersonal problems which must be identified before effective counselling can begin. The formation of multidisciplinary teams for the immediate assessment and support of self-harming adolescents and their parents is recommended.