Changes in child suicide rates and characteristics during the COVID-19 pandemic in England

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ABSTRACT INTRODUCTION Since the start of the COVID-19 pandemic inequalities around child mortality are likely to have increased. Suicide in young people has risen in many countries over the last 10 years, and suicide in particular may have been expected to increase over the course of the lockdown, as rates of mental health needs increased. AIM 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. METHODS Child deaths from suicide, reported to the National Child Mortality Database, occurring between 1st April 2019 and 31 st March 2023 were identified, and linked to demographic data, death-review data and routine Hospital Episodes Statistics (HES) data (preceding the death). Routine HES data was used to identify mental health disorders and self-harm events. 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 likely due to suicide, 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 (p=0.863) or method (p=0.199) changed over the period (p=0.863). 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 Asian (IRR 0.52 (0.41-0.65)), Black (IRR 0.31 (0.21-0.44)) and Mixed/Other ethnicity (IRR 0.73 (0.60-0.89) children. Only a recorded diagnosis of self-harm was more common before the death than in the preceding control periods (OR 8.99 (4.27-18.94)). CONCLUSION 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 and a recorded diagnosis of mental health disorder does not appear to predict suicide in the subsequent month, there was a strong association with self-harm events.

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