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Suicidal behavior is defined as a preoccupation or act that is focused on causing one's own death voluntarily. An intent to cause one's death is essential in the definition. Suicidal ideation refers to thoughts of suicide or wanting to take one's own life. Suicidal behavior refers to actions taken by one who is considering or preparing to cause their own death. Suicide attempt usually refers to an act focused on causing one's own death that is unsuccessful in causing death. Suicide refers to having intentionally caused one's own death.
What causes adolescents to attempt suicide?
Adolescence is a stressful developmental period filled with major changes - body changes, changes in thoughts and changes in feelings. Strong feelings of stress, confusion, fear and uncertainty, as well as pressure to succeed and the ability to think about things in new ways influence a teenager's problem solving and decision making abilities. For some teenagers, normal developmental changes, when compounded by other events or changes in their families such as divorce or moving to a new community, changes in friendships, difficulties in school or other losses can be very upsetting and can become overwhelming. Problems may appear too difficult or embarrassing to overcome. For some, suicide may seem like a solution. As many as 12 to 25 percent of older children and adolescents experience some form of thoughts about suicide (suicidal ideation) at one time or another. When feelings or thoughts become more persistent, are accompanied by changes in behavior or specific plans for suicide, the risk of a suicide attempt increases.
What is known about teen suicide?
Over the last several decades, the suicide rate in young people has increased dramatically. In 1996, suicide was the third leading cause of death in 15 to 24 year olds and the fourth leading cause of death in 10 to 14 year olds. According to the National Institute of Mental Health (NIMH), reliable scientific research has found the following:
- There are an estimated eight to 25 attempted suicides to one completed suicide - with the ratio even higher in youth.
- The strongest risk factors for attempted suicide in youth are depression, substance abuse and aggressive or disruptive behaviors. In fact, out of 100,000 adolescents, 2,000 to 3,000 will have a mood disorder, of which eight to 10 will commit suicide.
The Surgeon General's Call To Action To Prevent Suicide, 1999, reported the following:
- Among persons aged 15 to 19 years of age, firearm-related suicides accounted for 62 percent of the increase in the overall rate of suicide from 1980 to 1997.
- Males under the age of 25 are much more likely to commit suicide than their female counterparts. The 1996 gender ratio for people aged 15 to 19 was 5:1 (males to females).
The Centers for Disease Control and Prevention (CDC) reports the following:
- Males are four times more likely to die from suicide than females.
- Females are more likely to attempt suicide than males.
Suicide risk factors vary with age, gender and cultural and social influences and may change over time. Risk factors for suicide frequently occur in combination with each other. The following are some suicide risk factors that may be present:
- One or more diagnosable mental or substance abuse disorders
- Impulsive behaviors
- Undesirable life events or recent losses (i.e., death, parental divorce)
- Family history of mental or substance abuse disorder
- Family history of suicide
- Family violence, including physical, sexual or verbal/emotional abuse
- Prior suicide attempt
- Firearm in the home
- Exposure to the suicidal behavior of others, including family, peers, in the news or in fiction stories
Warning signs of suicidal feelings, thoughts, or behavior:
Many of the warning signs of possible suicidal feelings are also symptoms of depression. Observations of the following behaviors by parents and care givers may be helpful in identifying adolescents who may be at risk of attempting suicide:
- Changes in eating and sleep habits
- Loss of interest in usual activities
- Withdrawal from friends and family members
- Acting out behaviors and running away
- Alcohol and drug use
- Neglect of personal appearance
- Unnecessary risk-taking
- Preoccupation with death and dying
- Increased physical complaints frequently associated with emotional distress such as stomach aches, headaches and fatigue
- Loss of interest in school or schoolwork
- Feelings of boredom
- Difficulty concentrating
- Feelings of wanting to die
- Lack of response to praise
- Indicates plans or efforts toward plans to commit suicide, including the following:
- Verbalizes "I want to kill myself," or "I'm going to commit suicide"
- Gives verbal hints such as "I won't be a problem much longer," or "If anything happens to me, I want you to know ...."
- Gives away favorite possessions; throws away important belongings
- Becomes suddenly cheerful after a period of depression
- May express bizarre thoughts
- Writes one or more suicide notes
Threats of suicide communicate desperation and a cry for help. Always take statements of suicidal feelings, thoughts, behaviors or plans very seriously. Any child or adolescent who expresses thoughts of suicide should be evaluated immediately.
The warning signs of suicidal feelings, thoughts or behaviors may resemble other medical conditions or psychiatric problems. Always consult your child's physician for a diagnosis.
Treatment for suicidal feelings and behaviors:
Specific treatment for suicidal feelings and behaviors will be determined by your child's physician based on:
- Your teen's age, overall health and medical history
- Extent of your teen's symptoms
- Seriousness of the attempt
- Your teen's tolerance for specific medications or therapies
- Expectations regarding future suicide risk
- Your opinion or preference
Any adolescent who has attempted suicide requires an initial physical evaluation and treatment until the teen is physically stable. Mental health treatment for suicidal feelings, thoughts or behaviors begins with detailed evaluation of events in the adolescent's life during the two to three days preceding the suicidal behaviors. A comprehensive evaluation of the adolescent and family contributes to decisions regarding treatment needs. Treatment recommendations may include individual therapy for the adolescent, family therapy, and, when necessary, hospitalization to provide the adolescent a supervised and safe environment. Parents play a vital supportive role in any treatment process.
Prevention of suicide:
Recognition and early intervention of mental and substance abuse disorders is the most effective way to prevent suicide and suicidal behavior. Studies have shown that suicide prevention programs most likely to succeed are those focused on identification and treatment of mental illness and substance abuse, coping with stress and controlling aggressive behaviors.
Suicide is a tragic and potentially preventable public health problem. In 1999, the Surgeon General of the United States announced a Call To Action To Prevent Suicide by introducing a strategy for Awareness, Intervention, and Methodology (AIM). The plan includes research initiatives, conferences and evaluation of the effectiveness of current prevention programs. The National Center for Injury Prevention and Control (NCIPC) is already working to raise awareness of suicide as a serious public health problem. Consult your child's physician for more information.