Suicides are increasing at an alarming rate among Canadian girls, with hanging, strangulation and other forms of suffocation now the predominant methods used by children and adolescents – regardless of sex – to kill themselves.

It’s a disturbing phenomenon that researchers speculate may be linked to the increasing popularity of the “choking game”, raising the possibility that unintentional strangulation deaths from the “game” – in which children strangle themselves or friends in order to cut off the flow of blood and oxygen to the brain and induce a euphoric high – are being recorded as suicides, say the authors of the report, which also suggests the Internet may be fuelling the trend.

The landmark study by the nation’s public health agency spans nearly 30 years and shows traditional patterns of suicide among young people in Canada are changing: Overall, while suicide rates for boys and male teens remained stable or decreased over the study period, the proportion of girls dying by their own hand is increasing.

Suicide rates for girls aged 10 to 14 increased 50 per cent, from 0.6 per 100,000 in 1980, to 0.9 per 100,000 in 2008. And among girls aged 15 to 19, the rate nearly doubled – from 3.7 to 6.2 per 100,000 during the same period.

Young female deaths by suffocation increased by an annual average of eight per cent in both age groups, researchers from the Public Health Agency of Canada report in this week’s issue of the Canadian Medical Association Journal.

Suicide is the second leading cause of death – after unintentional injuries such as car crashes – among young Canadians aged 10 to 19; in 2008, there were 233 suicides among 10- to 19-year olds, accounting for 20.4 per cent of all deaths for that age group.

By way of comparison, suicides accounted for 1.5 per cent of all deaths in Canada during the same year.

Overall, the researchers found deaths from suicide among 10 to 19 year olds – encompassing both boys and girls – dropped by more than a third over the past three decades, from 37.7 per 100,000 in 1980, to 10.7 in 2008.

But when they broke the numbers down further, by age, sex and the method used, a troubling story emerged: “Among female children and adolescents (those aged 10 to 19), overall suicide rates have increased, with suffocation becoming the most common method used,” the researchers report.


Among their findings:

– In 2008, the suicide rate among 10 to 14 year olds was 1.2 per 100,0000, accounting for 25 deaths, or 10 per cent of all deaths, in this age group; 88 per cent were the result of suffocation

– Among 15 to 19 year olds, the overall suicide rate in 2008 was 9.2 per 100,000, accounting for 23 per cent of all deaths. Suffocation was also the primary means, accounting for 73 per cent of suicides in boys (102 deaths) and 78 per cent of suicides in girls (53 deaths).


– Suicide rates among boys aged 10 to 14 showed no significant change during the 29-year study period; in 2008, the overall rate was 1.6 per 100,000, and suffocation here, too, was the primary method. Suicide rates among males aged 15 to 19 decreased, from 12 to 12.1 per 100,000. While suicides involving guns began to decline in the early 1990s, suicides by suffocation increased every year. By 1994, suffocation had overtaken firearms as the leading method of suicide for this age group.

– For girls, deaths by suffocation increased by an average of eight per cent each year, while deaths from guns and poison decreased.

The study wasn’t designed to answer why the trends are moving the way they are, or why suicide by suffocation is increasing, said co-author Robin Skinner, a senior epidemiologist at the public health agency.

In a study published in 2010, British researchers who interviewed 12 men and 10 women who had survived a near-fatal suicide attempt – eight of whom had attempted hanging – found those who chose hanging expected a “certain, rapid and painless death with little awareness of dying.” Hanging, the researchers said, was considered a “clean” and simple method that wouldn’t damage their body “or leave harrowing images for others” – perceptions that need to be changed to help prevent suicides by hanging, they suggested.

But the Canadian researchers also raise the popularity of the the choking game – also called blackout, scarfing and space monkey.

Children use computer cords, belts, ropes, the cloth paper towel dispensers in school washrooms or even their bare hands to choke themselves. Another variation involves a child holding their breath and having a friend “bear hug” their chest in order to hyperventilate into a high.

But the “game” can turn deadly, Skinner and McFall say, “if the participant being choked is physiologically susceptible or if the pressure is not released quickly enough after the loss of consciousness.”

Children who unintentionally die while playing the choking game might be misclassified as suicides, they said, “especially if the ‘game’ is played alone.”

Other researchers have suggested these deaths aren’t likely to account for a substantial portion of the recent increases in suicides by hanging or self-suffocation.

Seven years ago, Sharron Grant’s 12-year-old son Jesse died after playing the choking game alone in his bedroom. He had learned it at summer camp the year before.

“My son was probably typical of kids who are doing this. He was a higher achiever, an A student, he hated smoke and drinking,” said Grant, of GASP (Games Adolescents Shouldn’t Play), a website that can be found at –

Jesse and his younger brother were playing a video game when he got up and went to his room because it wasn’t his turn. He used the cord from his Xbox. He had been gone only 10 minutes when Sharron found him dead in his room.

Meanwhile, “pro-suicide” websites, chat rooms and blogs may also be playing a role, Skinner and her co-author Steven McFaull note. “Cybersuicide” sites provide explicit details on various ways to commit suicide, ranking how effective one method is over another, the amount of pain involved and estimated time to death.

In a related commentary, Montreal cultural psychiatrist Dr. Laurence Kirmayer says that while the Internet may increase suicidal thinking in vulnerable people and ultimately even influence the method people choose, economic and social factors play a much larger role.

The suicide rate for Aboriginal youth aged 10 to 19 is three to five times that for non-Aboriginal young people, he said. That means that up to a quarter of the total deaths by suicide in this age group may be attributed to Aboriginal youth.

“Economic inequities may expose young people to a wide range of stressors and negative life events in their families and communities, as well as diminish their own hopes and expectations for a positive future with meaningful opportunities for work and life,” Kirmayer said.