Ideation Trajectories and Suicide Attempts in Adolescents With Psychiatric Disorders in the Maule Region. Chile

Background

Adolescent suicide is a major problem in public health worldwide and due to the multi-dimensionality of factors involved (biological, genetic, psychiatric, economic, socio-demographic, family-related and cultural), its study is complex. Within the general population, the global suicide rate is 10.6 deaths for every 100,000 inhabitants (13.5 men and 7.7 women) and in the Americas it comes up to 9.8 deaths for every 100,000 inhabitants (15.1 men and 4.6 women). In Chile, the suicide rate is 10.6 deaths for every 100,000 inhabitants (17.2 men and 4.0 women) being above average regarding other countries in the Americas.

For adolescents, suicide is the second cause of premature death among people ranging from 15 to 29 and the third for the 15-19 age group. Also, within the group of 10 to 24 there are more deaths from suicide than traffic accidents, cancer, and cardiac diseases. In Chile, 60% of deaths among adolescents are caused by external reasons (suicide and homicide). Deaths to suicide among Chilean adolescents have presented a sustained increase in the last 15 years (55% between 1999-2005), being the second country within the Organization for Economic Co-operation and Development (OECD) with the highest percentage variation. In a recent study which compared the suicide rate among adolescents from 10 to 19 in countries belonging to the OECD, Chile had the fourth highest suicide rate with 5.36 deaths for every 100,000 inhabitants. When divided into sub-groups, Chile had the highest rates from 10 to 14 in both men and women with 2.23 deaths for every 100,000 inhabitants; and in the group of 15 to 19 the third highest rates in males and the fourth in females with 15.87 and 6.32 deaths for every 100,000 inhabitants, respectively.

Adolescence is a critical period of vulnerability for the development of suicidal behavior. During this stage, suicidal behavior shows unstable and fluctuating patterns; ideation without suicide attempts may appear, subjects can go from ideas to plans and make an attempt, there are those who try just once while others try repeatedly, and there are others who, in spite of their vulnerability, do not develop such behavior. Suicide rates vary according to gender and age, being higher among men than women, while ideation and suicide attempts are more frequent among women rather than men. It is estimated that for each completed suicide in young people, there are from 100 to 200 suicide attempts. Also, suicidal thoughts have been associated to later attempts and their repetition. It is estimated that a third of adolescents with suicidal thoughts will try during the following year. Evidence shows that lifetime the suicidal ideation rate is 12.1% in adolescents from 13 to 18; on the other hand, 7.4% of young people from 10 to 24 have reported at least one suicide attempt within the last 12 months with a greater prevalence of attempts among women (9.3%) than men (5.1%). In Chile, 23.7% of adolescents ranging from 13 to 18 presented suicidal ideation and 9% tried in the last 12 months.

The Chilean Health Ministry [MINSAL in Spanish] projected a rate of 12 deaths for every 100,000 inhabitants for adolescents from 10 to 19 for the year 2020. According to the sanitary objectives for the 2011-2020 decade, the MINSAL got determined to diminish this projected rate by 15%. However, in Chile there are still various limitations and challenges regarding the study of suicidal behavior among adolescent population. Considering the risk of onset of suicidal thoughts and attempts during adolescence and the variability in their evolution, it becomes necessary to make an early and timely identification of high-risk clinical sub-groups. The analysis of both their patterns along a timeframe and the influence and interaction of specific factors could meet such objective.