Fatal Self-harm in Children and Adolescents in Cheshire: Coronial and CDOP perspectives
Stephanie Davies, Senior Coroner Officer Cheshire & Dr. Nisar A Mir Consultant Paediatrician Pan-Cheshire CDOP & Assistant Coroner Cheshire
Suicide is one of the leading causes of death in young people in the UK; it accounts for 14% of deaths in the age group 10-19 years. During the period 2014-15 there were a total of 316 childhood (age 10-19) suicide deaths reported in England and Wales1. Increasing number of children and adolescents are being admitted in the hospitals with self-harm; history of proceeding self-harm has been reported in over 50% of the cases of suicidal deaths2.
The coronial standards for defining suicide are that:
- Suicide being a voluntarily act for the purpose of ending one’s life while one is conscious of what one is doing.
- In order to arrive at a conclusion of suicide there must be evidence that the deceased intended the consequence of the act.
In practical terms the coronial conclusion of suicide can only be returned where it is shown that:
- the death has occurred as a result of a deliberate act by the deceased and
- in doing so (and at all material times) he/she intended that the consequence would be his/her own death.
Hence, the coronial statistical data may not reflect the true incidence of suicides in a community especially in children and adolescents. The objective of the current study has been to expend the definition of suicide to include intended fatal self-harm cases and look at the pattern of these deaths across the coronial-CDOP geographical jurisdiction in Cheshire.
We reviewed coronial records of all children reported to the Cheshire coroner with self-inflicted or accidental deaths over a 13 year period (2005-17). We excluded road traffic collisions and deaths where there was no historical or circumstantial evidence of intended self-harm. We also looked at the regional Child Death Overview Panel data (2011-2017) and compared the two periodic cohorts (<2011 & >2010).
A total of 28 children (Male 15; Female 13) were identified; their mean age was 15.47 SD 1.42 (range12-18) years.
The demographic data as shown in Table 1
|Period||N=||pa||M:F||Mean Age ( range)|
|2005-2010||11||1.8||0.84||15.73 SD 1.27 (14-17)|
|2011-2017||17||2.4||1.71||15.27 SD 1.53 (12-17)|
|P = 0.397 (NS)|
The coronial conclusion was: Suicide (58 %), Open (21%), Narrative (13%) and Accidental (8%).
The modus of death was: Hanging (18), Toxicity (4), Fall (3), Train Collision (2) and
2005-2010 11 (hanging 73%) 2011-2017 17 (hanging 59%)
Intention for committing suicide was found in 14 (50%). Pre-fatal risk factors identified were: parental and relationship problems (12), behavioural and mental health issues (9) and educational issues (6)
- Increasing number of children and adolescents are resorting to fatal self-harm
- While there is emergence of younger age group there is no statistical difference in the periodic cohorts
- Domestic, mental health and educational issues are present in over 75% of the cases.
- While hanging is still the leading method, others modes are also emerging and the internet may have a role to play.
- Office for National Statistics (ONS) Suicide in the United Kingdom, 2014 Registrations. Statistical Bulletin 2016:1-33.
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Suicide by children and young people in England. Manchester: University of Manchester, 2016. http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/reports/cyp_report.pdf