There is remarkably little research in this field. Epidemiological studies of suicidal behaviour in children and young people from the care system have previously come mainly from Scandinavia. A Swedish longitudinal national cohort study (ref 2) from last year concluded that every seventh girl (14%) who left long-term foster family care after age 17 was hospitalised after a suicide attempt in her twenties.

This new retrospective cohort study (ref 1) comes from researchers in Manitoba, Canada. They looked back at 11 years of data from medical registers to find out if children and adolescents in the child welfare system are at increased risk of suicide and attempted suicide, compared with those not in care.

8,279 children and adolescents (aged 5–17 years) who spent at least 30 days in the care system from 1997-2006 were compared with a wider population-based control cohort of 353,050 similarly aged children and adolescents in the region not in care. All study participants in the care group had to have been removed from their home. All children studied were similar in terms of age and gender, but unsurprisingly the children in the care group were more likely to come from deprived families.

The outcomes measured were suicide, suicide attempts (defined as those where a diagnosis was recorded following a hospital admission), any inpatient hospital admissions, and other visits to the doctor.

Here’s what they found:

• The overall suicide rate was 0.44 per 1000 person-years in the group in care and 0.08 per 1000 person-years in the group not in care
• Admission for attempted suicide was 4.53 per 1000 person-years in the group in care and 0.75 per 1000 person-years in the group not in care
• Children in care had higher rates of:
  • Suicide and admission for attempted suicide (suicide RR 3.54, 95% CI 2.11 to 5.95, p<0.001; attempted suicide RR 2.11, 95% CI 1.84 to 2.43, p<0.001)
  • Inpatient hospital admissions (inpatient admission RR 1.96, 95% CI 1.74 to 2.20, p<0.001)
  • Outpatient visits to the doctor (outpatient physician visits RR 1.14, 95% CI 1.10 to 1.19, p<0.001)
• Children in care had lower rates after entry into care than before:
  • Admission for attempted suicide (RR 0.27, 95% CI 0.21 to 0.34, p<0.001)
  • Any inpatient hospital admissions (RR 0.68, 95% CI 0.58 to 0.80, p<0.001)
  • Outpatient visits to the doctor (RR 0.89, 95% CI 0.84 to 0.94, p<0.001)

The authors concluded:

Children and adolescents in care were at greater risk of suicide and attempting suicide than those who were not in care. Rates of suicide attempts and hospital admissions within this population were highest before entry into care and decreased thereafter.

Health and social care professionals should be made aware of this research. The care home experience is a prominent risk marker for suicidal behaviour among teenagers and young adults.

If you need help

If you need help and support now and you live in the UK or the Republic of Ireland, please call the Samaritans on 116 123.

If you live elsewhere, we recommend finding a local Crisis Centre on the IASP website.

We also highly recommend that you visit the Connecting with People: Staying Safe resource.

Links

Katz LY, Au W, Singal D, et al. Suicide and suicide attempts in children and adolescents in the child welfare system. CMAJ 2011;183:1977–81.

Berlin M, Vinnerljung B, Hjern A. School performance in primary school and psychosocial problems in young adulthood among care leavers from long-term foster care. Child Youth Serv Rev 2011;33:2489–94. [Abstract]

Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA 2005;294:2064–74.