Recognition is increasing that suicide in young people poses an important public health challenge. Suicide in prepubertal children is very rare, but it increases for both genders in each of the adolescent years (McClure, 1994). In England and Wales, for example, the 1990 suicide rates per million for males and females aged 15 to 19 years were 57 and 14 respectively (McClure, 1994). Mortality rates in this age group were higher only for accidents. Since the Second World War, there has been an increase in male youth suicide rates in most European countries and in North America. In England and Wales, the suicide rate of males aged 14 to 24 years increased by 78% between 1980 and 1990! (Hawton, 1992). This increase is particularly striking when seen in comparison to the stable rates for other age groups and for young females (Diekstra, Kienhorst, & De Wilde, 1995).

Based on hospital statistics, it is estimated that the rate of nonfatal suicide attempts is 50 to 100 times higher than fatal attempts (Flisher, Ziervogel, Chalton, Leger, & Robertson, 1993). Evidence is emerging that the increase in rate of completed suicide is accompanied by an increase in the rate of attempted suicide (Hawton, Fagg, Simkin, Bale, & Bond, 1997). The rates of 15–24-year-olds presenting at the general hospital in Oxford with deliberate self-harm increased by 194% for males and 36% for females between 1985 and 1995 (Hawton et al., 1997).