The risk factors

Research has identified four main factors that distinguish young people who make suicide attempts from other young people:

social and educational disadvantage

a history of exposure to multiple family and parental disadvantages during childhood and adolescence

the development during adolescence of significant mental health problems or adjustment difficulties

exposure to a serious or stressful life event immediately prior to the suicide attempt. Although some risk factors for indigenous youth and taitamariki mirror in part those of non-indigenous people other specific risk factors are as follows:

the impact of institutional factors (eg mainstream education systems, prison)

cultural and historical factors (eg social dislocation and breakdown of whanau support and cultural identity).

The presence of mental health, substance use and behavioural disorders

Research has consistently suggested that approximately 90% of young people, who die by suicide or make suicide attempts will have had a recognisable (but not necessarily recognised) mental disorder at the time.

The three mental disorders most commonly associated with suicidal behaviour are:

depressive disorders-present in almost three quarters of those making suicide attempts

alcohol, cannabis and other drug abuse-present in over one-third of those making suicide attempts

significant behavioural problems (such as conduct disorders and antisocial behaviours) - present in one-third of young people making suicide attempts.

In many cases those making serious suicide attempts will have more than one of these disorders.

Cultural depression

In the international literature on indigenous youth suicide there is increasing support for the existence of a form of cultural depression (Keri Lawson-Te Aho, 1998). This has been variously called sub-clinical depression, accumulative stress, cultural grief and collective post-traumatic stress disorder. Indigenous mental illness is thought to be related to the outcomes of trying to live in two worlds and fitting neither, coupled with histories of cultural genocide over which indigenous peoples have been unable to exercise sufficient control. This reflects the notion of intergenerational, collective cultural suffering.

Risk factors common to other problems

The risk factors for suicidal behaviour are very similar to risk factors for other psycho-social problems, including for example, depressive disorders, substance use disorders, conduct disorder and youth offending behaviours.

Causal or correlated factors

The interplay of these disorders is complex. For example research has shown that while cannabis use is correlated with suicidal behaviour it does not appear to be causative. Likewise there is considerable debate whether unemployment is a cause of suicide and mental disorders or whether suicide and unemployment both arise from similar causal factors.

A typical profile of a young person at risk of suicide

A typical profile of a young person most at risk is:

they live or has lived in a family environment that is subject to multiple stresses, including abuse and other difficulties

they have, at a relatively early age, developed adjustment problems that span and include depression, alcohol and other drug use disorders and behavioural difficulties

at the time of the suicide or suicide attempt, the young person is likely to have been exposed to a significant stress (most commonly involving the breakdown of a supportive emotional relationship or problems with the law).

Indigenous profile

Some research has suggested that the pattern of youth suicide for indigenous youth does not ?fit? the profile promoted for non-indigenous youth (Lawson-Te Aho, 1998). There is a need to understand why Maori are highly represented in the suicide statistics.

Cultural alienation and historical factors

International evidence shows that cultural alienation is a valid explanation for indigenous experiences of being at high ?risk? for drug abuse, alcohol, mental health problems including depression suicide and other adverse behaviours.

Despite a shortage of in-depth research looking at the particular features of Maori suicide, there is evidence that cultural alienation is a significant risk factor for suicide in addition to the risk factors noted above. Keren Skegg et al link cultural alienation of young Maori to increased suicide risk. Mason Durie maintains that a secure Maori identity will act to protect against poor health even in the presence of adverse socio-economic conditions.

Cultural alienation may also place young Pacific people born in New Zealand at increased risk.

Keri Lawson Te-Aho states that the historical impacts of colonisation on indigenous peoples reflect the removal and breakdown of cultural institutions that would have once modified and controlled individual behaviour for collective benefit and for individual good. She notes that the historical facts of removal of land, the forced impoverishment of Maori, and the removal of Maori control over their destinies has had a profound effect on contemporary Maori society (see A Review of the Evidence: Kia Piki te Ora o te Taitamariki).

Prison as a risk factor

There is debate around whether incarceration is in itself a risk factor for suicide. It is not clear if being imprisoned can be isolated as a risk factor, or if those who are imprisoned are, as a group, more likely to already be at higher risk due to other risk factors, such as depressive or conduct disorders or alcohol and drug abuse disorders. This issue is an important consideration for policy development for the youth justice system and related sectors (health and social welfare).

Sexual Orientation

There is growing international evidence to confirm that young gay, lesbian and bisexual people have higher rates of suicidal behaviour, arising from lack of support for their sexual orientation and the discrimination they face.

Cumulative risk

Research has shown that the more the risk factors the individual is exposed to the more at risk of suicide he/she is. This research shows that serious suicide attempt behaviour and completed suicide are not simply a consequence of a current mental health problem, or a current stressful life event, but rather represents the culmination of negative life events (Fergusson and Horwood, 1998).

Protective factors for suicide

A range of factors appear to have the capacity to protect people who might otherwise be at risk of suicide. These include coping skills, feelings of self-esteem and belonging, connections to family or school, secure cultural identity, supportive family/whänau, hapü and iwi, responsibility for children, and social support. However, while protective factors may act as buffers they do not simply cancel out risk factors. Rather they may limit the negative impact of risk factors when appropriately linked-in with other preventative strategies.

Population risk factors

Other than those factors which affect particular individuals or groups, there appear to be factors which affect the population?s suicide rate as a whole. While there has been little research undertaken on this issue in New Zealand, drawing on overseas findings such factors may include economic circumstances, the availability of lethal methods of suicide (such as guns), the normalisation of suicide, media portrayal of suicide, cultural changes affecting rates of marital breakdown, war, religion, urbanisation, and social policies relating to issues such as imprisonment, employment or the position of young people.

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