Youth Suicide: Risk Factors and Prevention

Facts and Statistics

Teenagers attempt suicide roughly 10 times more frequently than adults, although their fatality rate of 11.1 per 100,000 people is about the same as adults'. This is the third leading cause of death among 15-19 year-olds. For this age group, there were 5,174 motor-vehicle deaths in 1994, compared to 1,948 suicides.

According to U.S. national data released in September 1991, about one million teens (out of about 25 million) attempt suicide each year, of which an estimated 276,000 sustained injuries serious enough to require medical treatment.

Some other estimates (these are total, not per-year) are considerably higher: 3% of elementary-school, 11% of high-school, and 17% of college students. However, "Most were low-lethality attempts for which medical or other attention was not sought. Accordingly, the vast majority of [these] suicide attempts will not be uncovered by investigations dealing solely with clinical or medically identified populations." Thus, estimates or calculations of teenage suicide-attempt rates are particularly unreliable.

About four times more girls than boys make suicide attempts, but boys are much more likely to die: about 11% of (reported) males' attempts were fatal, compared to 0.1% of females', a ratio of more than 100:1. This also gives a ballpark average of about 50 attempts for every fatality in this age group.

This low fatality rate might be taken to mean that most of these adolescents don't want to kill themselves (true) and that there is generally one or more "warning" attempts before a lethal one (not true). In a study from Finland, only 30 percent of male, and 68 percent of female suicides 13 to 22 years old had made a previous (known) suicide bid. This suggests that many of these lethal first-time-attempters intended to die.

Compared to those of older people, adolescents' suicide-attempt statistics show two significant differences. First the fatality rate for boys is a hundred times that of girls, a much greater gender difference than with any other age group. The immediate reason is clear enough: most teenage girls use relatively low-lethality methods like drugs and wrist cuts, while a substantial number of boys use guns and hanging. The reasons behind these choices are not known.

Second, the fatality rate among adolescents, less than 2%, is much lower than that among the elderly, variously reported to be between 25% and 50%. This may be because the young, however miserable, usually have more reason for optimism about the future than do the old, who are too often without friends, family, job, and health.

Nevertheless, their suicide rate is increasing, and approaching the national average.

This corresponds to about 2000 suicides among 15-19 year-olds per year. While it's true that the suicide rate is substantially higher among old people, suicide is a relatively more frequent cause of death in the young, who have few deaths from illness. That's why it's the third leading cause of death among 15-24 year-olds, but ranks ninth or tenth for those 55-74.

The reasons for this rise are also in dispute. Besides the usual social rationales (e.g. higher divorce rates), "Some statistics indicate that suicide attempts among younger persons have not increased, but the methods and means they are using are more lethal, making the attempts more successful," says CDC's [centers for Disease Control] Dr. Alexander E. Crosby.

Risk Factors Related to Adolescent and Youth Suicide

Mental health professionals have identified those factors that pose the greatest risk to adolescents and youth suicides. Youths who attempt and commit suicide generally have several risk factors, which are combined with the ready availability of a lethal means and the lack of suitable sources of help.

Social and economic environments

The family is one of the earliest and most significant influences in a young person's development. There have been numerous studies of family troubles associated with youth suicidal behavior, including early parental loss, parental mental health problems, parental abuse and neglect, and a family history of suicide. In addition to chronic family troubles, there are usually precipitant events closer in time to a suicide attempt, many of which involve the family. These precipitants include serious conflicts with family members or divorce of parents, perceived rejection by one's family, and failure of family members to take an adolescent's talk about suicide seriously.

The school constitutes an important influence on youth. It is therefore not surprising that a history of school problems and the stress of disruptive transitions in school are potential risk conditions for youth suicidal risk behavior, as well as failure, expulsion, and overwhelming pressure to succeed.

Bullying is an extremely serious problem in schools and can result in the victims becoming depressed and suicidal, and even taking their own lives.

The influence of peers on young people's behavior can sometimes be greater than that of family and school. There is a risk of copycat suicidal behavior in adolescents who have been exposed to a peer's suicide. This contagion effect is most pronounced for vulnerable youths who tend to identify strongly with someone who has committed suicide in their environments or in mass media. Common precipitating events in youth suicidal behavior include rejection from peers, the breakup of a significant relationship, or the loss of a confidant. Furthermore, adolescents and young people who fail to act when confronted with a suicidal peer, by dismissing it as insignificant or failing to inform an adult, can increase the risk of suicide.

Poverty in children and youth heightens the risk conditions for suicide, including school problems and failures, psychiatric disorders, low self-esteem, and substance abuse, all of which can increase vulnerability to suicide and suicidal behavior.

Physical environment

Having immediate and easy access to lethal means to kill oneself increases the risk that a suicide will occur. Firearms are common methods of male suicides in the United States, and young women are increasingly using guns to kill themselves. Having such an instantly lethal method available increases the risk that vulnerable young people may kill themselves impulsively.

Additional risk factors

The researcher Jerome Motto suggested that the increased use of alcohol and drugs might have been a significant factor related to the rise of youth suicide since the 1970s. According to David Brent, at least one-third of adolescents who kill themselves are intoxicated at the time of their suicide and many more are likely to be under the influence of drugs.

A history of previous suicide attempts and the presence of a psychiatric disorder are among the most important and well-established risk factors for youth suicidal behavior. As many as 10 percent of suicide attempters eventually die in a later suicide attempt. Depression is a major mental health problem associated with suicide. In addition, impulsive behavior, poor problem-solving and coping skills, alcoholism, and homosexual orientation also increase the likelihood of suicidal behavior.

Prevention

No single risk factor alone is sufficient to result in a suicide. Youths who attempt and commit suicide generally have several risk factors that are combined with the ready availability of a lethal means and the lack of suitable sources of help.

Primary prevention consists of actions to prevent suicidal behavior before people develop a high-risk or a suicidal crisis. Most youth and adolescent suicide prevention programs have focused on school-based activities where adolescents receive training in identifying signs of suicide risks and how to best react to suicidal peers. Some programs also identify resources to help with suicide and encourage young people to talk with adults if they feel that they or their friends are feeling suicidal. Young people are specifically encouraged not to keep a "secret" confession of suicidal intentions to themselves. Controversy surrounds the usefulness and effects of school-based suicide prevention programs. Few programs have been the subject of rigorous evaluations and not all programs have had positive results. Research indicates that programs that provide a variety of resources within the school and community, including specially trained teachers, mental health services and counselors, and information and training for parents, may be of more benefit in preventing suicidal behavior.

In addition to school-based programs, many primary prevention approaches have focused on key persons who may come in contact with potentially suicidal youth. These persons, called "gatekeepers," include school staff, child welfare workers, community volunteers, coaches, police, family doctors, and clergy members. Training usually involves information on taking suicide threats seriously and asking specific questions to assess suicide risk, identifying behavior changes that may indicate increased suicide risk, better identification and treatment of depression and other mental health problems, and providing information about resources to help with suicide and other community youth problems.

Emergency Help

If you or someone you know is in immediate danger because of thoughts of suicide

Please call 911

There is help for you. Stay on the phone with the operator and wait for help to arrive.

Do not hesitate to call. Your life is extremely valuable, and people care about you.

Please reach out for help. Never act on your thoughts of suicide. Never… Remember, when you die, you cannot change your mind. And if your attempt fails, you might become physically or mentally impaired for all your remaining life!

Sources and Additional Information:

http://www.deathreference.com/Sh-Sy/Suicide-over-the-Life-Span.html

http://www.a1b2c3.com/suilodge/facovr1b.htm

http://www.suicide.org/bullying-and-suicide-information.html

http://www.suicide.org/teen-suicide-and-youth-suicide.html

http://www.cdc.gov/ncipc/dvp/suicide/youthsuicide.htm

Main Causes of Depression

Some types of depression run in families, indicating that a biological vulnerability to depression can be inherited. This seems to be the case especially with bipolar disorder. Studies have been done of families in which members of each generation develop bipolar disorder. The investigators found that those with the illness have a somewhat different genetic makeup than those who do not become ill. However, the reverse is not true. That is, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will develop the illness. Apparently, additional factors, possibly a stressful environment, are involved in its onset and protective factors are involved in its prevention.

Major depression also seems to occur in generation after generation in some families, although not as strongly as in bipolar I or II. Indeed, major depression can also occur in people who have no family history of depression.

An external event often seems to initiate an episode of depression. Thus, a serious loss, chronic illness, difficult relationship, financial problem, or any unwelcome change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder.

Nothing in the universe is as complex and fascinating as the human brain. The over 100 chemicals that circulate in the brain are known as neurochemicals or neurotransmitters. Much of our research and knowledge, however, has focused on four of these neurochemical systems: norepinephrine, serotonin, dopamine, and acetylcholine. In the new millennium, after new discoveries are made, it is possible that these four neurochemicals will be viewed as the "black bile, yellow bile, phlegm, and blood" of the 20th century.

Different neuropsychiatric illnesses seem to be associated with an overabundance or a lack of some of these neurochemicals in certain parts of the brain. For example, a lack of dopamine at the base of the brain causes Parkinson's disease. Alzheimer dementia seems to be related to lower acetylcholine levels in the brain. The addictive disorders are under the influence of the neurochemical dopamine. That is to say, drugs and alcohol work by releasing dopamine in the brain. The dopamine causes euphoria, which is a pleasant sensation. Repeated use of drugs or alcohol, however, desensitizes the dopamine system, which means that the system gets used to the drugs and alcohol. Therefore, a person needs more drugs or alcohol to achieve the same high feeling. Thus, the addicted person takes more substance but feels less and less high.

The different types of schizophrenia are associated with an imbalance of dopamine (too much) and serotonin (poorly regulated) in certain areas of the brain. Finally, the depressive disorders appear to be associated with altered brain serotonin and norepinephrine systems. Both of these neurochemicals may be lower in depressed people. Please note that abnormalities of these neurochemicals are "associated with" instead of "caused by," because we really don't know whether low levels of neurochemicals in the brain cause depression or whether depression causes low levels of neurochemicals in the brain.

What we do know is certain medications that alter the levels of norepinephrine or serotonin can alleviate the symptoms of depression. Some medicines that affect both of these neurochemical systems appear to perform even better or faster. Other medications that treat depression primarily affect the other neurochemical systems. The most powerful treatment for depression, electroconvulsive therapy (ECT), is certainly not specific to any particular neurotransmitter system. Rather, ECT, by causing a seizure, produces a generalized brain activity that probably releases massive amounts of all of the neurochemicals.

Women are twice as likely to become depressed as men. However, scientists do not know the reason for this difference. Psychological factors also contribute to a person's vulnerability to depression. Thus, persistent deprivation in infancy, physical or sexual abuse, clusters of certain personality traits, and inadequate ways of coping (maladaptive coping mechanisms) all can increase the frequency and severity of depressive disorders, with or without inherited vulnerability.

The effect of maternal-fetal stress on depression is currently an exciting area of research. It seems that maternal stress during pregnancy can increase the chance that the child will be prone to depression as an adult, particularly if there is a genetic vulnerability. It is thought that the mother's circulating stress hormones can influence the development of the fetus' brain during pregnancy. This altered fetal brain development occurs in ways that predispose the child to the risk of depression as an adult. Further research is still necessary to clarify how this happens. Again, this situation shows the complex interaction between genetic vulnerability and environmental stress, in this case, the stress of the mother on the fetus.

What are the main factors that cause depression?

There are a number of factors that may increase the chance of depression, including the following:

• Abuse. Past physical, sexual, or emotional abuse can cause depression later in life.


• Certain medications. For example, some drugs used to treat high blood pressure, such as beta-blockers or reserpine, can increase your risk of depression.


• Brain Chemistry Imbalance. Depression is believed to be caused by an imbalance in the neurotransmitters which are involved in mood regulation. Neurotransmitters are chemical substances which help different areas of the brain communicate with each other. When certain neurotransmitters are in short supply, this may lead to the symptoms we recognize as clinical depression.


• Female Sex Hormones. It has been widely documented that women suffer from major depression about twice as often as men. Because the incidence of depressive disorders peaks during women's reproductive years, it is believed that hormonal risk factors may be to blame. Women are especially prone to depressive disorders during times when their hormones are in flux, such as around the time of their menstrual period, childbirth and perimenopause. In addition, a woman's depression risk declines after she goes through menopause.


• Conflict. Depression may result from personal conflicts or disputes with family members or friends.


• Death or a loss. Sadness or grief from the death or loss of a loved one, though natural, can also increase the risk of depression.


• Genetics. A family history of depression may increase the risk. It’s thought that depression is passed genetically from one generation to the next. The exact way this happens, though, is not known.


• Major events. Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced, or retiring.


• Other personal problems. Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can lead to depression.


• Physical conditions. Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions.


• Poor Nutrition. A poor diet can contribute to depression in several ways. A variety of vitamin and mineral deficiencies are known to cause symptoms of depression. Researchers have also found that diets either low in omega-3 fatty acids or with an imbalanced ratio of omega-6 to omega-3 are associated with increased rates of depression. In addition, diets high in sugar have been associated with depression.


• Personality. People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.


• Substance abuse. Nearly 30% of people with substance abuse problems also have major or clinical depression.

Sources and Additional Information:

http://www.medicinenet.com/depression/page3.htm

http://www.webmd.com/depression/guide/causes-depression

http://www.depression.com/causes_of_depression.html

http://depression.about.com/od/causes/tp/commoncauses.htm

http://www.depression-guide.com/depression-causes.htm