Suicide in children and young people: Can it happen without warning?

Background: Parents bereaved by suicide often say the death of their loved one happened out of the blue. It is common for suicide in young people to be preceded by a number of indications of risk, including self-harm, the communication of suicidal ideas, and recent contact with services. We examined whether there is a group of young people who die by suicide without explicit warning signs, and if they indicate risk indirectly, through other suicide risk factors. Methods: Using national mortality data, we identified a three-year UK national case series of deaths by suicide in people aged 10-19. We extracted information on the antecedents of suicide from coroner inquests and other official investigations into these deaths. Results: There were 595 suicides by young people between 2014 and 2016. We obtained data for 544 (91%). Around a third (n = 161, 30%) had no known history of suicidal ideas or self-harm. This group also had low rates of other risk factors for suicide, including substance misuse, a mental health diagnosis, recent adverse life events, and of contact with services. Limitations: We relied on information provided to inquests and other investigations: under-reporting, especially on sensitive issues, is likely. Families and other witnesses may have under-reported warning signs that suggest they could have intervened. Conclusion: Suicide after minimal warning appears to be relatively common in young people. Suicidal ideas may develop rapidly in this age group and crisis services should therefore be widely available. Future prevention cannot rely on explicit expressions of risk.