Main results-There were positive correlations (Spearman rank order) between rates of attempted suicide and suicide rates in both sexes. The correlations only reached statistical significance for male subjects: regional suicide rates, r = 0.65, p < 0.02; national suicide rates, r = 0.55, p < 0.02. Conclusions-Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates. (J Epidemiol Community Health 1998;52:191-194) Suicidal behaviour is increasingly becoming a phenomenon associated with young people. Findings from the current WHO/EURO Multicentre Study of Parasuicide indicate that while there are pronounced diVerences between attempted suicide rates in diVerent centres, in most of the 16 participating centres in 13 European countries the highest rates are in 15-24 year old female young adults.1-3 Rates are also relatively high in young male subjects, although peak rates are more usually in the 25-34 year age group. There is evidence from some countries that attempted suicide rates in young people have increased since the mid 1980s.4 5 There has also been a considerable narrowing of the female to male ratio of rates in the young, the usual marked female excess becoming steadily less pronounced, largely because of a disproportionate increase in male rates. 5In contrast with attempted suicide, suicide rates are generally higher in male subjects than female subjects, and the highest rates of suicide are usually found in older age groups. 6 There have, however, been important changes in this pattern in recent years, many countries having experienced a noticeable rise in suicide rates in young male subjects. Suicide has become a leading cause of death in the young, and in some countries (for example, Sweden) it is now the most common cause of death in 15-24 year olds. In other countries (for example, England and Wales) it is second only to road traYc accidents.While there are considerable diVerences between attempted suicide and suicide in terms of the characteristics of the people involved and their motives, the two phenomena are also strongly linked. Thus, people who attempt suicide are at high risk of eventual suicide and nearly half of those who kill themselves have a history of previous attempts. 7What is not known is the extent to which rates of suicide and attempted suicide are correlated, especially at the international level. In this paper we examine the statistical relation between attempted suicide and suicide rates in 15-24 year olds across European countries. The data on attempted suicide were derived from the epidemiological part of the WHO/ EURO Multicentre Study of Parasuicide. (table 1). In most of the centres the monitoring study is ongoing. The results reported here concern the first four years of the study, 1989-1992. In each of the participating centres data are collected on suicide attempts by residents of the centre's catchment area age...

For young suicide attempters, follow-up and adequate aftercare are very important if repetition and risk of suicide are to be reduced. This applies particularly to those who have already made more than one attempt.

In a European, multicenter, double-blind study, 244 adolescents, 13 to 18 years old, with major depression were randomized to treatment with citalopram (n = 124) or placebo (n = 120). One third of the patients in both groups withdrew from the study. No significant differences in improvement of scores from baseline to week 12 between citalopram and placebo were found. The response rate was 59% to 61% in both groups according to the Schedule for Affective Disorders and Schizophrenia for school-aged children-Present episode version (Kiddie-SADS-P) (depression and anhedonia scores < or =2) and Montgomery Asberg Depression Rating Scale (MADRS) (> or =50% reduction). Remission (MADRS score < or =12) was achieved by 51% of patients with citalopram and 53% with placebo. A post hoc analysis revealed that more than two thirds of all patients received psychotherapy during this study. For those patients not receiving psychotherapy, there was a higher percentage of Kiddie-SADS-P responders with citalopram (41%) versus placebo (25%) and a significantly higher percentage of MADRS responders and remitters with citalopram (52% and 45%, respectively) versus placebo (22% and 19%, respectively). Mild to moderate treatment-emergent adverse events were reported in 75% citalopram and 71% of placebo patients, most commonly headache, nausea, and insomnia. Serious adverse events occurred in 14% to 15% in both groups. Suicide attempts, including suicidal thoughts and tendencies, were reported by 5 patients in the placebo group and by 14 patients in the citalopram group (not significant) with no pattern with respect to duration of treatment, time of onset, or dosage. In contrast, the suicidal ideation (Kiddie-SADS-P) single item showed worsening more frequently in the placebo (18%) than in the citalopram group (8%).

Data on recommended care for young people aged 15±19 years after attempted suicide from nine European research centres during the period 1989±1992 were analysed in terms of gender, history of previous suicide attempt and methods used. Altogether 438 suicide attempts made by 353 boys and 1,102 suicide attempts made by 941 girls were included. Analyses of the total data from all centres showed that young people with a history of previous suicide attempt and those using violent methods had signi®-cantly higher chance of being recommended aftercare than ®rst-time attempters or those choosing selfpoisoning. There were no signi®cant dierences of being recommended care between genders. Logistic regression analyses of the material were performed and the results were similar. Both having previous attempted suicide (odds ratio 2.0, 95% CI 1.53±2.61) and using``hard'' methods (odds ratio 1.71, 95% CI 1.49±1.96) were signi®cantly associated with increased possibility of being recommended aftercare. When individual centres were analysed, large disparities of recommended care after suicide attempts were found and there were no uniform criteria of recommending care for young suicide attempters in Europe.

The course of the psychiatric in-patient treatment received by 34 young people aged 15-24 years before their deaths from suicide was studied retrospectively on the basis of medical records. The quality of the care that they were given was appraised in terms of continuity, an important aspect of the care of young individuals during a period of dynamic development. There were two suicides among patients in child psychiatric care and 32 suicides among those in adult psychiatric care. Continuity of child psychiatric care was satisfactory, while the striking discontinuity in adult psychiatric care, in terms of contacts with doctors, therapists and other staff, with from 3 to 30 different doctors being involved during the period of care, may have been a factor contributing to the suicidal outcome in these cases. In total, 20 of the 34 young people had reported previously known suicide attempts, and notes concerning suicidal communication were mentioned in all but three of the records, while in only three of the records had any form of suicide-risk assessment been noted at the last care session before the suicide. Information about the suicidal process was thus available for most of these records but, as a rule, suicidal analyses were nevertheless lacking.