Dear Editor:

In most industrialized countries, adolescent suicide is one of the primary causes of death. In this study, we analyzed the official data on suicide mortality rates in Italy between 1969 and 1994 for individuals between ages 15 and 19 years.

We used the official data, with causes of death that were extrapolated from national mortality statistics at the Italian National Statistical Institute (ISTAT). The resulting rates represent the number of suicides per 1 million inhabitants of the same sex and age group. The data were then subdivided and compared with each of the national macro areas: northern, central, and southern Italy. The suicide rate for males in the group aged 15 to 19 years in Italy increased from 27.30 per 1 million in 1969 to 48.29 per 1 million in 1994. The rate, however, in females decreased from 23.18 per 1 million in 1969 to 10.80 per 1 million in 1994. While observing the suicide trend in the 3 macro areas, we noted that for males in the north the rate rose from 37.10 to 57.09, in the centre from 22.94 to 38.18, and in the south from 19.49 to 42.46. For females, however, in the north, the rate decreased from 19.09 to 11.10, in the centre from 14.91 to 3.08, and in the south from 30.89 to 13.66.

These data demonstrate that distribution of suicide rates differs in the 3 macro areas. For males, the north is the area with the highest suicide rates. The differences observed in these 3 areas could be attributed to the different territorial distribution of some psychosociocultural aspects that have been identified in international literature as suicide risk factors in adolescents. These include family disintegration (due principally to separation and divorce) and mental disturbances.

The distribution of separations and divorces is not homogenous throughout Italy. In fact, the rates in the north are very high compared with the south (1). For example, in 1997, there were 4.1 separations and 2.3 divorces per 1000 married couples in the whole country; there were 5 separations and 3 divorces in northern Italy, compared with 2.7 separations and 1.2 divorces in the south. Thus, the data for northern Italy comply with the data in the literature—family disintegration is a suicide risk factor in adolescents (2), and higher rates of suicide correspond to a higher separation and divorce rate.

Among adolescents, northern Italy, according to ISTAT, has a higher incidence of mental disorders. The higher suicide rate in the north seems to confirm the relation between psychiatric disturbances and juvenile suicide, as suggested by other researchers (3,4). One should also observe that in the 3 macro areas, the distribution differs for female suicides. Males in the north have the highest rate, whereas females within the same age group in the south have the highest incidence of suicide. McClure (5) affirms that modifications in the social role of females in western countries, which consequently increased their self-esteem, could act as a protective factor. This theory, therefore, could explain the higher prevalence of suicide in females in this area of Italy, where women’s new social roles have been accepted, but with difficulty.

References

1. Zanatta L. Le nuove famiglie. Bologna: Il Mulino; 1997.
2. Gould MS, Shaffer D, Fisher P, Garfinkel R. Separation/divorce and child and adolescence complete suicide. J Am Acad Child Adolesc Psychiatry 1998;37:155–62.
3. Brent DA, Johnson BA, Perper J, Connolly J; Bridge J, Bartle S. Personality disorder, personality traits,

impulsive violence, and completed suicide in adolescents. J Am Acad Child Adolesc Psychiatry 1994;33:1080–6.
4. Marttunen MJ, Aro HM, Lonnqvist JK. Adolescence and suicide: a review of psychological autopsy studies. Eur Child Adolesc Psychiatry 1993;2:10–8.
5. McClure GMG. Suicide in children and adolescents in England and Wales 1960-1990. Br J Psychiatry 1994;165:510–4.