Socio-demographic profile and medico-legal aspects of child suicide deaths in Sri Lanka; A multi-center retrospective study

Abstract

Background: Child suicide (CS) is a significant public health concern influenced by various psychosocial factors, and this study examined its demographic patterns, methods, and risk factors. Method: Data from postmortem reports of suicidal deaths of victims aged less than 18 years, conducted from 2020 to 2025 in six medico-legal units in the Central, Northern and Sabaragamuwa provinces of Sri Lanka, was collected and analyzed. Results: In the 39 cases of CS considered, 26 (66.7%) were males and the median age of the sample was 16 years. At the time of suicide, 31 (79.5%) were attending school. Three victims (7.7%) were engaged in manual labor while 2 (5.1%) were institutionalized. Regarding the family structure, 28 victims (71.8%) lived in a nuclear family. The most common suicide method was hanging (36, 92.3%), followed by poisoning (n=2; 5.1%) and gunshot injury (n=1; 2.6%). One case (2.6%) was categorized as a complex suicide where a combination of cuts and a shotgun injury was employed. In 34 cases (87.2%), the victim was found dead or declared dead on admission to a hospital. The most suspected triggers for suicide were family conflicts (n=10; 25.6%), academic pressure (n=7; 17.9%), and romantic relationship issues (5, 12.8%), while in 11 (28.2%), the reason remained unknown. The home of the victim was the most common location for suicide (n=26; 66.7%), with the victim's bedroom being the preferred location (20, 51.3%). A verbal or written suicidal intent had been expressed in 9 cases (23.1%). Other associated factors included substance abuse (n-=4; 10.3%), psychiatric illness (n=4; 10.3%), previous self-harm (n=4; 10.3%), a family history of suicide (n=5; 12.8%), and suicide among peers (n=2; 5.1%). Conclusions: Male adolescents are more vulnerable, while hanging is the most employed method, and suicidal acts are committed mostly at home. Prevention programs should target especially those who are having domestic, academic, and relationship issues.