| INTRODUCTIONSuicide is one of the commonest | | | | absence of suicide risk. |
| causes of death among young people. The | | | | |
| latest mean worldwide annual rates of suicide | | | | "Those problems weren't enough to commit |
| per 100,000 are 0.5 for females and 0.9 for | | | | suicide over," is often said by people who |
| males among 5-14-year-olds, and 12.0 for | | | | knew a completed suicide. You cannot assume |
| females and 14.2 for males among | | | | that because you feel something is not worth |
| 15-24-year-olds. Suicide is the sixth leading | | | | being suicidal about, that the person you are |
| cause of death among children aged 5-14 | | | | with feels the same way. It is not how bad |
| years, and the third leading cause of death | | | | the problem is, but how badly it's hurting |
| among all those 15-24 years old. In most | | | | the person who has it.2. Remember: suicidal |
| countries, males outnumber females in youth | | | | behavior is a cry for help. |
| suicide statistics. There are far more | | | | |
| suicidal attempts and gestures than actual | | | | Myth: "If someone is going to kill himself, |
| completed suicides. One epidemiological study | | | | nothing can stop him." The fact that a person |
| estimated that there were 23 suicidal | | | | is still alive is sufficient proof that part |
| gestures and attempts for every completed | | | | of him wants to remain alive. The suicidal |
| suicide. Though female teens are much more | | | | person is ambivalent - part of him wants to |
| likely to attempt suicide than males, male | | | | live and part of him wants not so much death |
| teens are more likely to actually kill | | | | as he wants the pain to end. It is the part |
| themselves. The suicide rate among young | | | | that wants to live that tells another "I feel |
| teens and young adults has increased by more | | | | suicidal." If a suicidal person turns to you |
| than 300% in the last three decades.RISK | | | | it is likely that he believes that you are |
| FACTORS FOR SUICIDEContrary to popular | | | | more caring, more informed about coping with |
| belief, suicide is not an impulsive act but | | | | misfortune, and more willing to protect his |
| the result of a three-step process: a | | | | confidentiality. No matter how negative the |
| previous history of problems is compounded by | | | | manner and content of his talk, he is doing a |
| problems associated with adolescence; | | | | positive thing and has a positive view of |
| finally, a precipitating event, often a death | | | | you.3. Be willing to give and get help sooner |
| or the end of a meaningful relationship, | | | | rather than later. |
| triggers the suicide. The major, empirically | | | | |
| proven risk actors for suicide among | | | | Suicide prevention is not a last minute |
| adolescents are detailed below.PERSONAL | | | | activity. Unfortunately, suicidal people are |
| CHARACTERISTICSPsychopathology: | | | | afraid that trying to get help may bring them |
| | | | more pain: being told they are stupid, |
| More than 90% of youth suicides and around | | | | foolish, sinful, or manipulative; rejection; |
| 60% of younger adolescent suicide victims | | | | punishment; suspension from school; written |
| have had at least one major psychiatric | | | | records of their condition; or involuntary |
| disorder. The most prevalent disorder in | | | | commitment. You need to do everything you can |
| adolescent suicide victims is depressive | | | | to reduce pain, rather than increase or |
| disorders. Depression that seems to quickly | | | | prolong it. Constructively involving yourself |
| disappear for no apparent reason is a cause | | | | on the side of life as early as possible will |
| for concern, and the early stages of recovery | | | | reduce the risk of suicide.4. Listen. |
| from depression can be a high risk period. | | | | |
| Substance abuse, conduct disorder, | | | | Give the person every opportunity to |
| posttraumatic stress disorder and panic | | | | unburden his troubles and ventilate his |
| attacks are the other disorders found to be | | | | feelings. You don't need to say much and |
| common in this population.Previous suicide | | | | there are no magic words. If you are |
| attempts: | | | | concerned, your voice and manner will show |
| | | | it. Give him relief from being alone with his |
| A history of prior suicide attempts is one | | | | pain; let him know you are glad he turned to |
| of the strongest predictors of completed | | | | you. At times everyone feels sad, hurt, or |
| suicide, especially in boys. One quarter to | | | | hopeless. You know what that's like; share |
| one third of teen suicide victims have made a | | | | your feelings. Let the child know he or she |
| previous suicide attempt.Cognitive and | | | | is not alone. Avoid arguments and advice |
| personality factors: | | | | giving. If the child's words or actions scare |
| | | | you, tell him or her. If you're worried or |
| Hopelessness, poor interpersonal problem | | | | don't know what to do, say so.5. ASK: "Are |
| solving ability and aggressive impulsive | | | | you having thoughts of suicide?" |
| behaviour have been linked with | | | | |
| suicidality.Biological factors: | | | | Myth: "Talking about it may give someone the |
| | | | idea." People already have the idea; suicide |
| Some teens are at greater risk for suicide | | | | is constantly in the media. If you ask a |
| because of their biochemical makeup. | | | | despairing person this question you are doing |
| Abnormalities in the function of serotonin, a | | | | a good thing for them: you are showing him |
| neurotransmitter, have been associated with | | | | that you care about him, that you take him |
| suicidal behaviour.FAMILY | | | | seriously, and that you are willing to let |
| CHARACTERISTICSFamily history of suicidal | | | | him share his pain with you. You are giving |
| behaviour: | | | | him further opportunity to discharge pent up |
| | | | and painful feelings. If the person is having |
| Teens who kill themselves have often had a | | | | thoughts of suicide, find out how far along |
| close family member who attempted or | | | | his ideation has progressed.6. If the person |
| committed suicide.Parental psychopathology: | | | | is acutely suicidal, do not leave him alone. |
| | | | |
| High rates of parental psychopathology, | | | | If the means are present, try to get rid of |
| particularly depression and substance abuse, | | | | them. Detoxify the school or home.7. Urge |
| have been found to be associated with | | | | professional help. |
| completed suicide and suicidal ideation and | | | | |
| attempts in adolescents. Moreover, family | | | | Persistence and patience may be needed to |
| cohesion has been reported to be a protective | | | | seek, engage and continue with as many |
| factor for suicidal behaviour among | | | | options as possible. In any referral |
| adolescents.ADVERSE LIFE | | | | situation, let the person know you care and |
| CIRCUMSTANCESStressful life events: | | | | want to maintain contact.8. No secrets. |
| | | | |
| Life stressors such as interpersonal losses | | | | It is the part of the person that is afraid |
| and legal or disciplinary problems are | | | | of more pain that says "Don't tell anyone." |
| associated with completed suicide and suicide | | | | It is the part that wants to stay alive that |
| attempts in adolescents. The anniversary of a | | | | tells you about it. Respond to that part of |
| loss can also evoke a powerful desire to | | | | the person and persistently seek out a mature |
| commit suicide.Physical abuse: | | | | and compassionate person with whom you can |
| | | | review the situation. Distributing the |
| Childhood physical abuse has been found to | | | | anxieties and responsibilities of suicide |
| be associated with increased risk of suicide | | | | prevention makes it easier and much more |
| attempts in late adolescence and early | | | | effective.Interventions with a suicidal |
| adulthood.SOCIOECONOMIC AND CONTEXTUAL | | | | student:Schools should have a written |
| FACTORSSchool and work problems: | | | | protocol for dealing with a student who shows |
| | | | signs of suicidal or other dangerous |
| Difficulties in school, neither working nor | | | | behavior. The following steps may be |
| being in school, dropping out of high school | | | | effective in dealing with a student who |
| and not attending college pose significant | | | | expresses active suicidal intent.1. Calm the |
| risks for completed suicide.Contagion | | | | immediate crisis situation. Do not leave the |
| Imitation: | | | | suicidal student alone even for a minute. Ask |
| | | | whether he or she is in possession of any |
| Teens are more likely to kill themselves if | | | | potentially dangerous objects or medications. |
| they have recently read, seen, or heard about | | | | If the student has dangerous items on his |
| other suicide attempts. Evidence continues to | | | | person, be calm and try to verbally persuade |
| amass from studies of suicide clusters and | | | | the student to give them to you. Do not |
| the impact of the media, supporting the | | | | engage in a physical struggle to get the |
| existence of suicide contagion. The impact of | | | | items. Call administration or the designated |
| suicide stories on subsequent competed | | | | crisis team. Escort the student away from |
| suicides appears to be greatest for | | | | other students to a safe place where the |
| teenagers.PREVENTION STRATEGIESYouth suicide | | | | crisis team members can talk to him. Be sure |
| prevention strategies have primarily been | | | | that there is access to a telephone.2. The |
| implemented within three domains - school, | | | | crisis individuals then interview the student |
| community, and health are systems. This | | | | and determine the potential risk for suicide. |
| article reviews the school-based | | | | |
| programs.SCHOOL-BASED SUICIDE PREVENTION | | | | a. If the student is holding on to dangerous |
| PROGRAMSSchool based suicide prevention | | | | items, it is the highest risk situation. |
| programs include both curricula components to | | | | Staff should call an ambulance, the police |
| teach students about these warning signs and | | | | and the student's parents. Staff should try |
| what to do, as well as non-curricula | | | | to calm the student and ask for the dangerous |
| components such as peer groups, hot lines, | | | | items. |
| intervention services and parent training. | | | | |
| Prevention includes education efforts to | | | | b. If the student has no dangerous objects, |
| alert students and the community to the | | | | but appears to be an immediate suicide risk, |
| problem of teen suicidal behavior. | | | | it would be considered a high-risk situation. |
| Intervention with a suicidal student is aimed | | | | If the student is upset because of physical |
| at protecting and helping the student who is | | | | or sexual abuse, staff should notify the |
| currently in distress. Postvention occurs | | | | appropriate school personnel and contact the |
| after there has been a suicide in the school | | | | police. If there is no evidence of abuse or |
| community. It attempts to help those affected | | | | neglect, staff should contact parents and ask |
| by the recent suicide. In all cases it is a | | | | them to come in to pick up their child. Staff |
| good idea to have a clear plan in place in | | | | should inform them fully about the situation |
| advance. It should involve staff members and | | | | and strongly encourage them to take their |
| administration. There should be clear | | | | child to a mental health professional for an |
| protocols and clear lines of communication. | | | | evaluation. The team should give the parents |
| Careful planning can make interventions more | | | | a list of telephone numbers of crisis |
| organized, and effective.The goals of school | | | | clinics. If the school is unable to contact |
| based suicide prevention programs are to:* | | | | parents, and if the police cannot intervene, |
| Increase awareness | | | | designated staff should take the student to a |
| | | | nearby emergency room. |
| * Promote identification of students at high | | | | |
| risk of suicide and suicide attempts | | | | c. If the student has had suicidal thoughts |
| | | | but does not seem likely to hurt himself in |
| * Provide knowledge about the behavioral | | | | the near future, the risk is more moderate. |
| characteristics ("warning signs") of teens at | | | | If abuse or neglect is involved, staff should |
| risk for suicide. | | | | proceed as in the high-risk process. If there |
| | | | is no evidence of abuse, the parents should |
| * Provide information to students, teachers | | | | still be called to come in. They should be |
| and parents on the availability of mental | | | | encouraged to take their child for an |
| health resources | | | | immediate evaluation. |
| | | | |
| * Enhance the coping abilities of | | | | d. Follow-Up: It is important to document |
| teenagersEducation: | | | | all actions taken. The crisis team may meet |
| | | | after the incident to go over the situation. |
| Education may be done in a health class, by | | | | Friends of the student should be given some |
| the school counselor or outside speakers. | | | | limited information about what has |
| Education should address the factors that | | | | transpired. Designated staff should follow up |
| make individuals more vulnerable to suicidal | | | | with the student and parents to determine |
| thoughts. Education regarding the ill effects | | | | whether the student is receiving appropriate |
| of drug and alcohol abuse would be useful. | | | | mental health services. Follow-up is crucial, |
| PTA meetings can be used to educate parents | | | | because most suicides occur within three |
| about depression and suicidal behavior. | | | | months of the beginning of improvement in |
| Parents should be educated about the risk of | | | | depressive symptoms, when the youth has the |
| unsecured firearms in the home. Outside | | | | energy to carry out plans conceived earlier. |
| mental health professionals can discuss their | | | | Regularly scheduled supportive counseling |
| programs so that students can see that these | | | | should be provided to teach the youth coping |
| individuals are approachable. Education on | | | | mechanisms for managing stress accompanying a |
| the following topics will be useful:Warning | | | | life crisis, as well as day-to-day |
| signs of suicide:* Preoccupation with death | | | | stress.Role of the teachers:Teachers play an |
| and dying | | | | especially important part in prevention, |
| | | | because they spend so much time with their |
| * Signs of depression | | | | students. Along with holding parent-teacher |
| | | | meetings to discuss teenage suicide |
| * Taking excessive risks | | | | prevention, teachers can form referral |
| | | | networks with mental health professionals. |
| * Increased drug use | | | | They can increase student awareness by |
| | | | introducing the topic in health classes.Some |
| * The verbalizing of suicide threats | | | | schools have automatic expulsion policies for |
| | | | students who engage in illegal or violent |
| * The giving away of prized personal | | | | behavior. It is important to remember that |
| possessions | | | | teens who are violent or abuse drugs may be |
| | | | at increased risk for suicide. If someone is |
| * The collection and discussion of | | | | expelled, the school should attempt to help |
| information on suicide methods | | | | the parents arrange immediate and possibly |
| | | | intensive psychiatric and behavioral |
| * The expression of hopelessness, | | | | interventions.Role of the peers:Peers are |
| helplessness, and anger at oneself or the | | | | crucial to suicide prevention. According to |
| world | | | | one survey, 93% of the students reported that |
| | | | they would turn to a friend before a teacher, |
| * Themes of death or depression evident in | | | | parent or spiritual guide in a time of |
| conversation, written expressions, reading | | | | crisis. Peers can form student support groups |
| selections, or artwork | | | | and, once educated themselves, can train |
| | | | others to be peer counselors.Adolescents |
| * The scratching or marking of the body, or | | | | often will try to support a suicidal friend |
| other self-destructive acts | | | | by themselves. They may feel bound to |
| | | | secrecy, or feel that adults are not to be |
| * Acute personality changes, unusual | | | | trusted, and this may delay needed treatment. |
| withdrawal, aggressiveness, or moodiness | | | | Ideally, a teenage friend should listen to |
| | | | the suicidal youth in an empathic way, but |
| * Sudden dramatic decline or improvement in | | | | then insist on getting the youth immediate |
| academic performance, chronic truancy or | | | | adult and professional help.Role of the |
| tardiness, or running away | | | | parents:Parents need to be as open and as |
| | | | attentive as possible to their adolescent |
| * Physical symptoms such as eating | | | | children's difficulties. The most effective |
| disturbances, sleeplessness or excessive | | | | suicide prevention technique parents can |
| sleeping, chronic headaches or stomachaches, | | | | exercise is to maintain open lines of |
| menstrual irregularities, apathetic | | | | communication with their children. Sometimes |
| appearanceSudden changes in behavior that are | | | | teens hide their problems, not wanting to |
| significant, last for a long time, and are | | | | burden the people they love. It is extremely |
| apparent in all or most areas of his or her | | | | important to assure teens that they can share |
| life (pervasive) are more specific than | | | | their troubles, and gain support in the |
| presence of isolated signs. However, it | | | | process. Parents are encouraged to talk about |
| should be noted that many completed suicides | | | | suicide with their children, and to educate |
| had only a few of the conditions listed | | | | themselves by attending parent-teacher or |
| above, and that all indications of | | | | parent-counselor education sessions and from |
| suicidality need to be taken seriously in a | | | | nearby libraries or the internet. Once |
| one person to another person situation.Signs | | | | trained, parents can help to staff a crisis |
| of depression in teens:* Sad, anxious or | | | | hotline in their community. Parents also need |
| "empty" mood | | | | to be involved in the counseling process if a |
| | | | teen has suicidal tendencies. These |
| * Declining school performance | | | | activities may both alleviate parents' fears |
| | | | of the unknown and assure teenagers that |
| * Loss of pleasure/interest in social and | | | | their parents care.Postvention/crisis |
| sports activities | | | | intervention:The rationale for school-based |
| | | | postvention/crisis intervention is that a |
| * Sleeping too much or too little | | | | timely response to a suicide is likely to |
| | | | reduce subsequent morbidity and mortality in |
| * Changes in weight or appetiteFactors | | | | fellow students, including suicidality, the |
| associated with repeated self harm:* Previous | | | | onset and exacerbation of psychiatric |
| self harm | | | | disorders, and other symptoms related to |
| | | | pathological bereavement.The school should |
| * Personality disturbance | | | | have plans in place to deal with a suicide or |
| | | | other major crisis in the school community. |
| * Depression | | | | The administration or the designated |
| | | | individual should try to get as much |
| * Alcohol or drug misuse | | | | information as soon as possible. He or she |
| | | | should meet with teachers and staff to inform |
| * Chronic psychosocial problems and | | | | them of the suicide. The teachers or other |
| behaviour disturbance | | | | staff should inform each class of students. |
| | | | It is important that all of the students hear |
| * Disturbed family relationships | | | | the same thing. After they have been |
| | | | informed, they should have the opportunity to |
| * Alcohol dependence in the family | | | | talk about it. Those who wish should be |
| | | | excused to talk to crisis counselors. The |
| * Social isolation | | | | school should have extra counselors available |
| | | | for students and staff who need to talk. |
| * Poor school recordHow to support a student | | | | Students who appear to be the most severely |
| with suicidal thoughts and a low | | | | affected may need parental notification and |
| self-esteem?* Listen actively. Teach | | | | outside mental health referrals. Rumor |
| problem-solving skills | | | | control is important. There should be a |
| | | | designated person to deal with the media. |
| * Encourage positive thinking. Instead of | | | | Refusing to talk to the media takes away the |
| saying that he cannot do something, he should | | | | chance to influence what information will be |
| say that he will try. | | | | in the news. One should remind the media |
| | | | reporters that sensational reporting has the |
| * Help the student write a list of his or | | | | potential for increasing a contagion effect. |
| her good qualities. | | | | They should ask the media to be careful in |
| | | | how they report the incident. Media should |
| * Give the student opportunities for | | | | avoid repeated or sensationalistic coverage. |
| success. Give as much praise as possible | | | | They should not provide enough details of the |
| | | | suicide method to create a "how to" |
| * Help the student set up a step-by-step | | | | description. They should try not to glorify |
| plan to achieve his goals. | | | | the individual or present the suicidal |
| | | | behavior as a legitimate strategy for coping |
| * Talk to the family so that they can | | | | with difficult situations.It is imperative |
| understand how the student is feeling. | | | | for crisis interventions to be well planned |
| | | | and evaluated; otherwise, not only may they |
| * He or she might benefit from assertiveness | | | | not help survivors, but they may potentially |
| training | | | | exacerbate problems through the induction of |
| | | | imitation.CONCLUSIONSuicide attempts and |
| * Helping others may raise one's | | | | completed suicides among adolescents are |
| self-esteem. | | | | problems of increasing significance. School |
| | | | staff, parents, and health professionals |
| * Get the student involved in positive | | | | should be sensitized about the risk factors |
| activities in school or in the community. | | | | and warning signs of suicide, and about the |
| | | | ways to deal with suicidal |
| * If appropriate, involve the student's | | | | adolescents.FURTHER READING* Gould, M.S., |
| religious community. | | | | Greenberg, T., Velting, D.M. & Shaffer, D. |
| | | | (2003) Youth suicide risk and preventive |
| * Make up a contract with rewards for | | | | interventions: a review of the past 10 years. |
| positive and new behaviors.What can be done | | | | Journal of the American Academy of Child and |
| to help someone who may be suicidal?:1. Take | | | | Adolescent Psychiatry, 42, 4, 386-405. |
| it seriously. | | | | |
| | | | * Hawton, K. & James, A. (2005) Suicide and |
| Myth: "The people who talk about it don't do | | | | deliberate self harm in young people. British |
| it." Studies have found that more than 75% of | | | | Medical Journal, 330, 891-894. |
| all completed suicides did things in the few | | | | |
| weeks or months prior to their deaths to | | | | * |
| indicate to others that they were in deep | | | | |
| despair. Anyone expressing suicidal feelings | | | | * |
| needs immediate attention. | | | | |
| | | | * Shahul Ameen, M.D., is a psychiatrist |
| Myth: "Anyone who tries to kill himself has | | | | based in Ranchi, India. |
| got to be crazy." Perhaps 10% of all suicidal | | | | |
| people are psychotic or have delusional | | | | He edits (a portal for mental health |
| beliefs about reality. Most suicidal people | | | | professionals) and |
| suffer from the recognized mental illness of | | | | |
| depression; but many depressed people | | | | (a portal on mental health for the |
| adequately manage their daily affairs. The | | | | consumers). |
| absence of "craziness" does not mean the | | | | |