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