Systematic Review of Self-Harm and Suicide in Children and Young People in the Care of the State

Children and young people who have experience of being in the care of the state are a vulnerable population. Entry into state care is associated with numerous adverse health, social, and economic outcomes across the life-course (Viner and Taylor, 2005; Simkiss, 2012). There is evidence to suggest that status as a looked after child or young person (e.g. residing in children’s homes; foster care; youth detention centres) predicts self-harm, suicide ideation and suicide (Meltzer and Lader, 2005; Storey et al., 2005; Katz et al., 2011). However, there remains limited systematic synthesis of the evidence in this area, in addition to a dearth of understanding around the causal pathways to self-harm and suicidality. There is some evidence to suggest that this population are a higher risk by virtue of the fact that they have been subjected to numerous adverse life events prior to entering care (Katz et al.,2011), whilst other research highlights the public care system’s lack of ameliorative effect. This paper presents a systematic review of the prevalence of self-harm and suicide in children and young people who have experience of being in the care of the state, along with associated risk and protective factors.

Methods: A systematic review was conducted of international studies that empirically examine suicide ideation; self-harm (with and without suicidal intent); para-suicide and suicide in children and young people who have experience of being in the care of the state. The population was restricted to those aged 25 and under.  All studies designs were included. Appraisal and synthesis of the included papers is currently being finalised.

Results: The results of the systematic review will be presented in two sections: 1) meta-analysis of the prevalence of self-harm and suicide in children and young people who have experience of being in the care of the state 2) narrative synthesis of the risk and protective factors associated with self-harm and suicide. These include: the stability of care placements; age of entry into care; relationships with birth family.

Conclusion: Elicitation of the higher prevalence of suicide and self-harm in children and young people who have experience of being in the care of the state compared to the general population highlights their vulnerability. Identification of pertinent risk and protective factors is instructive in informing future theoretically informed prevention and intervention.