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Rates of Completed Suicide for Young People Continue to Rise
by Dr. Darrell Stolle
Amidst a decline in suicide rates in the general population of the United States, rates of completed suicides for young people continue to rise, with ever-younger victims appearing in the statistics. According the US Public Health Service (1999), the rate of suicide among adolescents and young adults has tripled over the last forty years.
It is currently the third leading cause of death among 15-24 year-olds (exceeded only by accidental death and homicide), and more disturbingly, the fourth leading cause of death among children between the ages of 10-14. At the same time, it is estimated that 2 million young people attempt suicide each year, with about 700,000 seeking medical attention after an attempt.
Risk Factors
No single personality characteristic has been described that explains all suicides. Additionally, the number of factors associated with completed suicides is diverse. While it is possible to identify general factors associated with completed suicide, they are differentially affected by intrapersonal characteristics, including gender, race and sexual orientation (Lippencott/Williams & Wilkins, 2001; Popenhagen & Qualley, 1999).
For example, the number of males that complete suicides outnumber females by a ratio of 5:1, while the number of females that attempt suicide (unsuccessfully) outnumber males by a ratio of 2:1. Gay and lesbian adolescents account for as many as 30% of adolescent completed suicides, and 30% of all attempted suicides, making sexuality one of the more distinguishable risk factors (McFarland, 1998).
Ninety percent of adolescents who completed suicide suffered from a pre-existing psychiatric disorder, half of who had been struggling for at least two years (Lippencott/Williams & Wilkins, 2001).
For females, a major depressive disorder was most prevalent, while several mood disorders accompanied by disruptive disorders and substance abuse were most prevalent in males.
Other risk factors that have been identified include:
o Previous attempts
o Family history of suicide
o Impulsive or aggressive tendencies
o Barriers of access to mental health care
o History of sexual abuse
o Easy access to lethal methods (guns, medication, poison, etc.)
Clinical Presentation
Early detection is the key to preventing suicide, and to a great degree, it depends on one's ability to recognize the danger signs. Suicidal adolescents are usually in such great pain that they can only imagine one way to escape it. Some of events that precipitate suicidal behavior include loss of romantic relationship, trouble in school, with the law, or at home.
It's important to remember events that seem trivial to some observers, are perceived as catastrophic and insurmountable by those contemplating suicide. Additionally, shame, guilt and loss accompanied by low self-esteem and/or confusion about what to do increase the likelihood that an adolescent will seek a fast way out.
Popenhagen and Qualley (1998) discuss the verbal, behavioral, situational and syndromatic signs that constitute a framework for detecting suicidal behavior. What follows is a brief summary of their discussion.
Verbal: Look for statements such as:
o "This is the last straw, I can't take it anymore".
o "Don't bother grading my test, because it won't matter anymore after tomorrow."
o "Nobody cares- everyone would be better off without me".
o "I wonder what it would be like to not be here".
Behavioral
o The most direct behavioral clue is a suicide attempt.
o Making out a will, or signs that one is putting their affairs in order.
o Saying goodbye to family and friends.
o Considering purchase of casket or gravesite.
o Sudden change in attitude or behavior (i.e., extreme irritability, excessive guilt, difficulty in communication, or sudden relief from stress.)
o Impulsive behavior.
o Poor decision making skills.
o Increased risk taking behaviors.
Situational:
These ecological conditions might be associated with increased risk:
o Loss of romantic relationship.
o Death of loved one.
o Alienation or marginalization.
o Unexpected change in life (divorce, move, etc.).
o Accumulating insurmountable debt.
Syndromal:
o Changes in appetite
o Loss of sleep
o Extreme lack of energy
o Low self-regard
o Major depression
If one suspects a student is contemplating suicide based on any combination of the above conditions, it is imperative that suspicions be queried- talking about suicide with a youth who is considering it doesn't make it more likely to happen- in fact, it actually serves as a deterrent. Questions like, "Are you thinking about suicide?" "Do you want to die?" or "How and when do you plan to kill yourself?" allow people to better understand the severity of potential, and determine how and when to intervene.
Adolescent suicide is one of the most complex and urgent problems faced by schools today. It is certainly a larger issue than can be adequately addressed in this summary. To gain a more comprehensive understanding of the problem, please visit the following web sites:
U.S. Public Health Service, The Surgeon General's Call To Action To Prevent Suicide. Washington, DC: 1999
American Foundation for Suicide Prevention
Reporting on Suicide: Recommendations for the Media
ACE-Network
American Academy of Child and Adolescent Psychiatry
References
Copenhagen, M.P. & Quelled, R.M., (1998). Adolescent suicide: detection, intervention and prevention. Professional School Counseling,1,30-35.
Lippencot/Williams, & Wilkins, M. (2001) Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 40, p 24.
McFarland, W.P., (1998). Gay, lesbian and bisexual student suicide. Professional School Counseling, 1, 26-30.
http://www.umt.edu/ders/safeschools/articles/suicide.htm
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