Suicide rates for adolescents have shown a substantial increase over the past 30 years, but there is little information regarding the clinical status of adolescents who end their lives. In the adult literature, one avenue to understanding the psychologic condition immediately prior to the self-destructive act has been the study of suicide notes, and the present study constitutes the first systematic investigation of notes left by children or adolescents. Records of death were examined in the Office of the Coroner, City of Montreal, and all suicides between ages 10 and 20 were identified for the years 1978 to 1982. Seventeen individuals who left notes were identified, comprising 10% of the population of suicides. Suicides who left notes did not differ from the total group in age and sex distribution but were more likely to choose shooting as a method. The content of the notes was studied in terms of 11 variables which had proven characteristic of suicide notes in the adult literature, and the results were compared to those reported for adults. In general, our results support a psychoanalytic perspective which understands suicide as resulting from an ambivalent attachment to an object, loss of the object, internalization, and the direction of aggression against the self. Cases appeared to fall into two clusters. Older adolescents were more concrete, left specific instructions, did not address the note, did not give a reason for the act, and tended to choose intoxication as a method. Younger adolescents were less concrete, less likely to leave specific instructions, addressed the note to their parents, explained the act, and chose firearms as the method of self-destruction. Implications for a developmental understanding of suicide are discussed.
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