768 - Changes in Child Suicide Rates and Characteristics During the COVID-19 pandemic in England

Publication Number: 768.4178

David Odd, Cardiff University, Axbridge, England, United Kingdom; Duleeka Knipe, University of Bristol, Bristol, England, United Kingdom; Tom Williams, University of Bristol, Bristol, England, United Kingdom; Sylvia Stoianova, University of Bristol, Bristol, England, United Kingdom; prathiba Chitsabesan, Pennine Care NHS Foundation Trust, Manchester, England, United Kingdom; Karen Luyt, University of Bristol, Bristol, England, United Kingdom

Background: Since the start of the COVID-19 pandemic inequalities around child mortality are likely to have increased, and suicide in particular may have increased over the course of the lockdown, and suicide in CYP has risen in many countries over the last 10 years.

Objective: The aim of this work was to report any changes, and characteristics of children dying of suicide in England, before, and during the COVID pandemic.

Design/Methods: Child deaths, reported to the National Child Mortality Database, occurring between 1st April 2019 and 31st March 2023 that were categorised as suspected suicide. Each case was reviewed, and linked to demographic data (including measures of local deprivation), the method of suicide, if the child identified as LGBT+ or had evidence of gender identity issues, and routine Hospital Episodes Statistics (HES) data.
Temporal trends across the time period were quantified, alongside any changes in sociodemographic characteristics. Using Case-Cross Over methodology, we investigated the relative risk of suicide, after recent HES-coded events.

Results: In total there were 498 deaths, identified as due to suicide or self-harm, during the 4 year period. Overall risk of death by suicide was 14.31 (13.08-15.63) per 1,000,000 CYP per year. Overall, there was little evidence that risk changed over the period (ptrend=0.863), but there was evidence that the relationship between deprivation and suicide risk was different between ethnic groups (both p< 0.001), with decreasing deprivation associated with increasing risk of suicide in white children (IRR 1.12 (1.03-1.21)), and decreasing risk in CYP of Asian (IRR 0.52 (0.41-0.65)), Black (IRR 0.31 (0.21-0.44)) and Mixed/Other (IRR 0.73 (0.60-0.89) backgrounds) (Figure). Method of suicide did not appear to differ across the 4 years (p=0.199). ADHD, ASD, Eating Disorder, PTSD, Mood Disorder or Schizophrenia events were not more common before the death, than in the preceding control periods, but Self-Harm events were (p < 0.001).

Conclusion(s): In England, suicide rates do not appear to be increasing, and the methods of suicide remain static. However, the role of deprivation and suicide risk appears to be different between children of different ethnic groups, and while hospital admission with a many psychiatric events does not appear to predict suicide in the subsequent month, there was a strong association with self-harm events.

Figure. Risk of Suicide per 100,000 person years (5-17 year olds), by local deprivation; split by ethnic group.