Suicide and suicidal behavior

Definition

Suicide is the act of ending one's own life. Suicidal behavior are thoughts or tendencies that put a person at risk for committing suicide.

Description

Suicide, attempted suicide, and thoughts of committing suicide are, as of the early 2000s, growing problems among adolescents in the United States and much of the world. It is the third leading cause of death among 15 to 19 year olds in the United States and the sixth leading cause of death among 10 to 14 year olds. About 2 percent of adolescent girls and 1 percent of adolescent boys attempt suicide each year in the United States. Another 5 to 10 percent of children and teens each year come up with a plan to commit suicide.

Psychologists have identified the teenage years as one of the most difficult phases of human life. Although they are often seen as a time in which to enjoy life, hang out with friends, and perform other activities that adults would not usually do, the teenage period can be difficult. Many changes in the human mind take place during puberty . Apart from facing the onset of sexual maturity, teenagers must also make key decisions about their future, develop their identities, change schools, and meet new friends. They may have to cope with a wide range of personal and social challenges. Many young people have difficulty dealing with stress these experiences may elicit.

The most common reasons for suicide or suicidal behavior among children and adolescents involve personal conflict or loss, most frequently with parents or romantic attachments. Family discord, physical or sexual abuse, and an upcoming legal or disciplinary crisis are also commonly associated with completed and attempted suicide. Adolescents who complete suicide show relatively high suicidal intent, and many are intoxicated at the time of death. The most serious suicide attempters leave suicide notes, show evidence of planning, and use an irreversible method, such as a gunshot to the head. Most adolescent suicide attempts, though, are of relatively low intent and lethality, and only a small number of these individuals actually want to die. Usually, suicide attempters want to escape psychological pain or unbearable circumstances, gain attention, influence others, or communicate strong feelings, such as anger or love.

Suicidal behavior is rare in children prior to puberty, probably because of their relative inability to plan and execute a suicide attempt. Psychiatric risk factors, such as depression and substance abuse, become more frequent in adolescence , contributing to the increase in the frequency of suicidal behavior in older children. Some view the transition from primary to middle school as particularly stressful, especially for girls. Also, parental monitoring and supervision decrease with increasing age, so that adolescents may be more likely to experience emotional difficulties without their parents' knowledge.

Repeated suicide attempts are common, but rates vary. Follow-up studies ranging from one to 12 years found a re-attempt rate among adolescents of 5 to 6 percent per year, with the greatest risk within the first three months after the initial attempt. Factors associated with a higher re-attempt rate included chronic and severe psychiatric disorders, such as depression and substance abuse; hostility and aggression; non-compliance with treatment; poor levels of social skills; family discord, neglect, or abuse; and parental psychiatric disorders.

Highest risk

Four out of five teenagers who successfully commit suicide are male, but the average female teenager is prone to attempt suicide four more times during her teen years than the average male. White teenage males are more likely to commit suicide than other ethnic groups, but as of the early 2000s teenage suicide among blacks is also increasing. Teenagers who have unsuccessfully tried to commit suicide in the past are more likely to attempt suicide in the future. The odds increase after each failed attempt. There are two groups of teens that are at a particularly high risk for committing suicide: Native Americans, and gay, lesbian, bisexual, and transgendered teens.

In Native American, including Native Alaskan, youth ages 15 to 24 years, suicide is the second leading cause of death, according to a 2001 survey by the Bureau of Indian Affairs. The survey also showed that 16 percent of Native American youth attempted suicide in the preceding year. Among Native American high school students, suicide attempts were most associated with poor school performance, poor physical health, a history of family or friends who committed or attempted suicide, family problems, and physical and sexual abuse.

Gay and bisexual male teens, which represent about 10 percent of the male teen population, are six to seven times more at risk for attempting suicide than their heterosexual peers. Several surveys show gay and lesbian youth account for 30 percent of all suicides among teens, according to the U.S. Department of Health and Human Services. Yet most studies of teen suicide have not been concerned with identifying sexual orientation.

A 1997 study by the Massachusetts Department of Education found that 46 percent of high school students who identified themselves as gay, lesbian, or bisexual, had attempted suicide in the past year compared to 8.8 percent of their heterosexual peers. Of the gay, lesbian, and bisexual teens, 23.5 percent required medical care as a result of their suicide attempt compared to 3.3 percent of heterosexual students who attempted suicide.

Common problems

The following are common risk factors for teenage suicide:

• Psychological problems: Depression, previous attempts at suicide, and having received psychiatric care in the past.
• Personal failure: Unmet high standards set by the teen or parents, including failing grades in school or poor performance in sports.
• Recent loss: Death of a close friend or family member, divorce , abandonment by a parent, pregnancy, and the breakup with a boyfriend or girlfriend.
• Substance abuse: Abuse of alcohol and other drugs as forms of self-medication for overwhelming depression. A combination of depression, substance abuse, and lowered impulse control can lead to suicide or attempted suicide. Substance abuse in other family members can also lead to suicide.
• Household guns: Easy access to a gun. Children of law enforcement officers have a much higher suicide rate because of the accessibility of guns in their houses. The most common method of suicide among teens is gunshot.
• Violence: Violence against the teen either at home or outside the home, including physical, emotional, or sexual abuse, or bullying. Violence at home or against the youth teaches teens that the way to resolve conflict is through violence, and suicide is the ultimate act of self-violence.
• Communication problems: The inability to discuss anger or other uncomfortable feelings with family members or friends. These feelings can include loneliness, rejection, and awareness of one's gay or bisexual sexual orientation.

Parental concerns

Parents who are concerned that their child is or may be suicidal should seek help immediately, such as from a psychiatrist, psychologist, or counselor. Therapists and counselors can listen to the child talk about his or her problems and may be able to suggest ways to cope which the teen will find useful.

There are a number of ways parents can help children and teens deal with loneliness, depression, and suicidal feelings. First, they can let the child do the talking, and listen carefully. They can let the child know they take his or her feelings and thoughts seriously. They can try to identify the root of the problem. Second, they can ask direct questions, such as "Are you thinking of committing suicide?" or "Are you thinking of ending your life?" Third, they can stay with the child. Parents should not leave their child alone if the child says he or she wants to commit suicide. By staying with the child, the parent may be protecting the child's life.

When to call the doctor

Many doctors recommend that teenagers be taken to a hospital immediately after they express the desire to commit suicide. At the least, immediate psychological help should be sought. There are many methods, both medical and psychological, of helping teenagers who consider committing suicide. Most teenagers who think of suicide believe their problems are too hard to solve or too embarrassing to talk about, so it is important for their helpers to show they are trustworthy and able to listen. Seeing a psychologist is widely recommended as well. A psychologist may be able to improve a teenager's vision of life by listening to the young person and conveying optimism regarding the future.

Doctors recommend that helpers not ask the teenager's reason for thinking of suicide; rather, helpers should listen and wait for the teenager to trust enough to talk openly about the problem. Helpers should, however, be understanding of the teenager's situation. Doctors also recommend that helpers not mention "reasons for living," as doing so might generate more depressing thoughts in the teenager.

There are many telephone hot lines available, on national, state, and local levels, to help teenagers who are considering suicide. Two national, 24-hour, toll-free suicide hotlines are: 800–784–2433 and 800–999–9999. Gay, lesbian, bisexual, or transgendered teens thinking of suicide can get help at 800–850–8078.

Resources

BOOKS

Empfield, Maureen, and Nicholas Bakalar. Understanding Teenage Depression: A Guide to Diagnosis, Treatment, and Management. New York: Owl Books, 2001.

King, Robert A., et al. Suicide in Children and Adolescents. Cambridge, UK: Cambridge University Press, 2003.

Spirito, Anthony, and James C. Overholser. Evaluating and Treating Adolescent Suicide Attempters: From Research to Practice. New York: Academic Press, 2002.

Wallerstein, Claire. Need to Know: Teenage Suicide. Portsmouth, NH: Heinemann Educational Books, 2003.

PERIODICALS

Eckert, Tanya L., et al. "Adolescent Suicide Prevention: School Psychologists' Acceptability of School-based Programs." School Psychology Review (Winter 2003): 57–76.

Fritz, Gregory K. "Prevention of Child and Adolescent Suicide." The Brown University Child and Adolescent Behavior Letter (September 2001): 8.

Norton, Patrice G. W. "Prevention Plan Reduces Teen Suicide Attempts." Clinical Psychiatry News (May 2004): 44.

Perlstein, Steve. "TeenScreen Flags Adolescents at Risk of Suicide." Clinical Psychiatry News (April 2004): 43.

Portes, Pedro R., et al. "Understanding Adolescent Suicide: A Psycho-social Interpretation of Developmental and Contextual Factors." Adolescence (Winter 2002): 805–814.

ORGANIZATIONS

American Association of Suicidology. 4201 Connecticut Ave. NW, Suite 408, Washington, DC 20008. Web site: http://www.suicidology.org.

Suicide Awareness Voices of Education. 7317 Cahill Road, Suite 207, Minneapolis, MN 55424. Web site: http://www.save.org.

Yellow Ribbon International Suicide Prevention Program. PO Box 644, Westminster, CO 80036. Web site: http://www.yellowribbon.org.

WEB SITES

Columbia University. TeenScreen , 2003. Available online at http://www.teenscreen.org (accessed August 12, 2004).

"Depression and Suicide Page," 2004. Available online at http://www.teenlineonline.org/helparchives/depression.htm (accessed August 12, 2004).

Screening for Mental Health, Inc. "SOS High School Suicide Prevention Program", 2004. Available online at http://www.mentalhealthscreening.org/sos_highschool/ (accessed August 12, 2004).

Ken R. Wells