Adolescent Suicide: New  Statistics: New Insights into the Unthinkable

by Krista Mancarella, MA

 

In 2007, the Center for Disease Control reported that, in 2004, suicide among adolescents between the ages of 10 and 24 years old was the third leading cause of death. The 8.0% increase from 2003 to 2004 was the largest single year increase since 1990. The statistics showed that three of six gender-age groups, which include females age 10-14 and 15-19, along with males age 15-19, increased significantly.
According to a study by Lubell, et al., reasons for the increase in rates included changes in the methods used and gender-specific behaviors. For example, more readily available means of suicide such as hanging/suffocation and poisoning were frequently used, especially in young females. In 2003, 156 females age 10-19 died as a result of hanging/suffocation, while in 2004, that number increased to 244.

Furthermore, according to Lubell’s study, suicide risk assessment for young women is limited, since the focus has been on young men who account for three quarters of the suicide mortality rate.

 

Who is at risk for suicide?
In order to develop prevention strategies, it is the task of mental health professionals to first identify who is at risk and attempt to understand why people may turn to suicide in times of extreme distress. Pfeffer identified three categories of suicide risk factors for children, adolescents and young adults:

Psychopathogical risk factors, which take into account the level of psychopathology with which a youngster is struggling to cope. These include: psychiatric disorders, substance abuse, past suicidal behaviors, behavioral issues (such as impulsivity and aggression), cognitive distortions (such as helplessness) and family history of violence, substance abuse, mood disorders and suicidal behavior.  

Environmental factors leading to potential suicide risk include: various negative life events, adversity, family problems (specifically communication with parents), school problems, disciplinary action, family loss and physical and sexual abuse. Situations in which children have a parent involved with the law, using drugs or alcohol or being abusive to someone in the household also pose a risk.

Biological factors include genetics and individual neurobiological mechanisms.

Societal risk factors, according to Kalafat, take into account the inaccessibility of services to many in need and the accessibility of firearms to potentially suicidal adolescents. Kalafat further states that many adolescents who choose firearms as a method of suicide do not show the high levels of risk factors, as the use of firearms in suicides tends to be more spontaneous.

Furthermore, while the media has to follow guidelines minimizing information released to prevent suicide imitation, adolescents have the opportunity to gain exposure to suicide stories and instructions through the Internet. It has also been documented that adolescents can join group suicides via the Internet, an extremely harmful use of cyberspace.

Why would an adolescent contemplate suicide?
There are many theories associated with why a person may decide to take his/her own life. Orbach discusses some relevant theories taken from many perspectives, including the psychological and medical models, which seek to explain the precipitating factors for suicidal behavior. For example, suicide may serve as an escape from psychological pain or from overwhelming negative emotions brought on by needs that have not been met. Another theory states that suicide is an unconscious wish to join a person who has already died. Suicide may be viewed as a means of coping with life’s difficult challenges through the use of destructive methods such as alcohol or drug use, which eventually may lead to death. An adolescent may feel so helpless and overwhelmed by his/her problems that this pessimistic view of the future and lack of problem-solving abilities also may lead to suicidal behavior.

Orbach further says that, when an adolescent believes that problems, especially serious family issues, cannot be resolved, he/she may see suicide as the only way out. Suicide has also been linked to low self-esteem and an adolescent’s loss of control over emotions and impulses.
Extreme social isolation is also a concern. When an adolescent lacks social support and is isolated from the world, so much so that he/she does not believe that societal norms, including those relating to suicide, apply to him/her, this may perpetuate the act. Furthermore, we cannot discount the medical model where the diagnosis of major depression is seen as the source of suicide.

 

What can we do to prevent adolescent suicides?

Kalafat and Orbach both suggest that increasing awareness, training, education, assessment and programming are suicide prevention strategies.
We must also decrease the availability of means to our children and adolescents, which means decreasing access to lethal paraphernalia. In particular, restricting access to firearms, either by removing them or locking them up securely and unloaded, decreasing the number of medications stored in medicine cabinets, being cautious and aware of products we use in our homes and schools and teaching our children the dangers of drugs and hazardous games are all elements of prevention.
It is important for all professionals who come into contact with adolescents, including medical personnel, teachers, counselors, clergy, community service providers and coaches to be able to identify the warning signs of suicidal behavior and know how to intervene when these signs reveal themselves. Referred to as “Gatekeepers” in the literature, these adults need to be educated on how to assess potential suicidal risk in adolescents and ways of intervening to help the individual.

Kalafat advises that adolescents know how to identify suicidal behaviors in their peers and not be frightened to share concerns with adults. It is the responsibility of adults to provide adolescents who are struggling with a safe haven to share their thoughts and fears and get the help they need. There are specific programs discussed in the references below that address the need for ongoing discussions in the classroom to raise awareness of risks and provide education about appropriate means of handling these situations.
Orbach also surmises that an adolescent’s wish to die is only a temporary state of mind. In fact, while the thought of death is somewhat of a relief, it is also very scary, therefore making the possibility of helping the teenager feasible.


Moreover, Kalafat believes that psychiatric disorders play a significant role in adolescent suicide, and therapy and psychopharmacology have shown to be an effective means of treatment and prevention. When working therapeutically with adolescents who are contemplating suicide, interventions that focus on safety first and foremost are essential. Additionally, interventions focusing on increasing problem-solving skills, self-management skills and increasing self-esteem enhance the social network and resiliency.

As mental health professionals, school personnel, parents and friends, we should look for not only the obvious signs of an individual in distress, but also the silent signs. Do not be afraid to ask if someone has thoughts of hurting him or herself if the signs are there. Bringing the topic to light will only benefit the person suffering. Discussing suicide with someone who has not thought about it will not be harmful or plant the seed of suicidal ideation in him/her. If someone states that he/she has thought about self-harm or suicide, do not let this individual be alone and call an emergency service immediately. Any time someone you care about is in need of help, do not hesitate to call a suicide hotline, a mental health professional or the local emergency room.

References
Kalafat, J. (2005). Suicide. In T. P Gullotta & G.R. Adams (Eds), Handbook of Adolescent Behavioral Problems: Evidence-based Approaches to Prevention and Treatment. (231-254). New York, NY: Springer Science + Business Media
Lubell, K.M., Kegler, S.R., Crosby, A.E. & Karch (2007). Suicide trends among youth and adults aged 10-24 years -- United States, 1990-2004. CDC’s MMWR Weekly dated 9/7/07/ 56(35) (905-908). Retrieved December 19, 2007, from
http://www.Medscape.com/viewarticle/563174
Orbach, I.  (2003). Suicide prevention for adolescents.  In R.A. King and A.E. Apter (Eds), Suicide in Children and Adolescents. (227-250). New York: Cambridge University Press.
Pfeffer, C.R. (2006). Suicide in children and adolescents.  In D. J. Stein, D.J. Kupfer & A.F. Schatzberg (Eds), in The American Psychiatric Publishing
Textbook of Mood Disorders (497-507). Washington, DC: American Psychiatric Publishing, Inc.

Krista Mancarella, MA is a Psychology Intern at KidsPeace from Chestnut Hill College in Philadelphia, PA. She is currently working to complete her doctorate of Clinical Psychology with a concentration in Marriage and Family Therapy. Krista obtained her Master’s Degree in Dance/Movement Therapy from Hahnemann University in 2000. Since then, she has worked in the mental health field, primarily with children and adolescents.