Background to the Research

• As NI recovers from 30 years of violence, political focus has moved to address social issues in the post-conflict environment. In particular, the suicide rates in NI have steadily increased over the last three decades leading to the new recognition of suicide as a major public health issue in the region.
• In 2006 the NI Suicide Prevention Strategy was launched with the strategic aim: 'To reduce the NI suicide rate, particularly among young people and those most at risk.' However, no specific mention is made of young people who live in state care and previous research has shown that this marginalized group of young people are particularly vulnerable.
  

Research Approach

• This study aimed to establish prevalence of suicidal behaviour and self-harm in a group of young people, aged between 10 and 15 years, living in state care in NI (n=165) and compare and contrast the emotional and behavioural status, as measured by the SDQ, of the young people displaying self-harm and suicidal behaviour against the comparison group of their peers in residential care.
• The population was identified from the social work administrative database (SOSCARE) and, from this, a purposive sample was selected of young people living in residential care and foster care who were between the ages of 10 and 15 years of age, including both those who had a previous history of living in care and those who had no such history. A total of 259 adolescents met this entry criteria and, over the period of one year, it was possible to collect data on a sample of 165 adolescents (64%) via an analysis of social work case file data and through follow up questionnaires and/or interviews with social workers. The teacher's version of the SDQ was completed by the young person's social workers. Cases were anonymized and recorded by SOSCARE number only.
  

Main Findings

• Of the 165 young people involved in this study, 86 (52.1%) were male and 79 (47.9%) were female. A total of 74 (44.8%) were living in residential care homes, with the same number, 74 (44.8%), living in non-relative foster care; a further 17 (10.3%) were being fostered by relatives. The most frequently cited reason for the young person being in care was neglect (23.6%).
• Over the course of their lifetime, a total of 17 of the 165 young people (10.3%) were recorded as having made an attempt at ending their own life. Of the 17 attempted suicides, eight were attempted by males and nine by females. A total of 21 young people (12.7%) were recorded as having engaged in self-harm at some point in their life. Of these, eight were male with the remaining 13 being female.
• No instances of completed or successful suicide were recorded in this group of young people. It is particularly poignant that two of the young people who attempted suicide had parents who had also attempted suicide.
• It was found that 49.6% of the young people scored within the abnormal range of the SDQ Total Difficulties score. In addition, statistically significant (Spearman's rank) correlations between a lifetime suicide attempt were found in four of the five elements of the social worker-completed SDQ, as well as the overall total difficulties score. The conduct problem scale was significant at the 0.01 level (r=0.266), while the other scales - emotional symptoms, (r=0.164), hyperactivity (r=0.162) and social skills (r=-0.198) - were significant at the 0.05 level. No significant correlation was found between lifetime suicide attempt and peer problems (r=0.125; r=0.113). The total SDQ score was correlated at the 0.01 level with a suicide attempt (r=0.236).
• With regard to deliberate self-harm, statistically significant correlations were found on the SDQ emotional symptoms score (r=0.278, p=0.00) and to a lesser extent on the conduct problem scale (r=0.193; p=0.13). No significant correlations were found between self-harm and social skills r=-0.084; p=0.287), hyperactivity (r=0.97; p=0.218) and peer problems (r=0.147; p=0.062). The total SDQ was correlated at the 0.01 level with self-harm (r=0.237).
  

Conclusions

• This study has found that self-harm and suicidal behaviour are significant issues for adolescents living in state care. The United Nations (1989) Convention on the Rights of the Child affords children looked after by the state special protection' (Article 20). Professionals and policy makers should be aware of the special vulnerabilities of this group of young people.
• As this group of young people have significant contact with the health and social services, potential opportunities exist for widespread intervention programmes to prevent suicidal and self-harming behaviour and to develop the therapeutic potential of the experience of being 'looked after' in state care.
• Future studies should utilize more comprehensive psychiatric assessments, incorporate the actual voices of young people and develop a longitudinal element in order to examine the severity and chronicity of these issues throughout young people's care careers. The emotional, behavioural and mental health needs of this at-risk group must be appropriately identified if effective care plans and therapeutic interventions are to be developed and implemented.
• Website http://www.internurse.com/cgi-bin/go.pl/library/issues.html?journal_uid=33