Prevalence of Attempted and Completed Suicide in Children 8-15 years of age in Fiji Central Division

Introduction
Suicide is defined as a self-destructive act deliberately carried out where there is a clear expectation of death. The American Psychiatric Association has included Suicidal behaviour disorder as part of the DSM 5th edition. Suicide is a global public health issue and it is among the top twenty leading causes of death worldwide with more deaths due to suicide than to malaria, breast cancer, or war and homicide. The global suicide mortality rate in 2016 was 10.5 per 100,000. Suicide is a growing concern globally and in Pacific island countries. It is perceived from cases admitted in CWMH that there are increasing numbers of attempted and completed suicide in Fiji, however, to date there have been limited studies in the Pacific islands. Therefore the aim of this study was to describe the prevalence and pattern of attempted and completed suicide in children 8-15 years of age in Fiji Central Division.
Method
A retrospective descriptive study was performed by reviewing police reports and admission folders in the past 5 years from January 2015 to December 2019. The prevalence rate of suicide in children aged 8-15 years was determined. The most commonly used method of committing suicide; immediate precipitating factors and fatality rate of suicide were also evaluated. Data were tabulated using Microsoft Excel 2013 version and statistical analysis was performed using SPSS and chi-square tests. Univariate and bivariate logistic regression was done for gender, ethnicity and method of suicide. Results
There was a total of 47 children who had attempted or completed suicide on police reports and admission folders. The mean age was 13.4, 43% were boys and 57% were girls. A total of 53,461 children in the age group 8-15 years live in Fiji Central division which was used (denominator) to calculate the prevalence rate of attempted and completed suicide. The completed suicide rate in 2015 was 16.8 and a decline to 9.3 per 100,000 in 2019 which was lower than the global suicide rate of 10.5 in 2016. Findings were limited due to likely underreporting and poor documentation. Of those who attempted and completed suicide, 55% attempted suicide and 45% completed suicide. Poisoning (62%) was the most commonly used method of suicide whereas hanging was the 2nd most common method of suicide with a higher mortality rate of 80% (OR 10.2; p <0.002). The majority (43%) of the immediate precipitating factors for suicide were defined as unknown in the police records while conflict, educational difficulties and bullying were clearly listed with a frequency of 38%,17% and 2% respectively. Females are more likely to attempt suicide whereas males have a higher number of completed suicides.
Conclusion
Attempted and Completed suicide in children (8-15 years) in Fiji Central Division was slightly lower than the global suicide rate but considering that global rates are mainly in the adult population this rate in children is alarming and is a serious concern for a small Pacific Island country like Fiji. The issue of suicide must be addressed comprehensively through multi-sectorial organizations to institute effective preventative measures to minimize the loss of lives at this very young age.