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