Teen Suicide: A Growing Concern

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The number of teen suicides increased throughout the 1990’s. But there are steps parents can take to reduce the risk for their child.

Paul, a lonely high-school drop-out, gives his favorite leather jacket to a younger brother. Sarah, a gifted student, fails three classes in one semester. Michael, a 13-year-old with a history of aggressive and delinquent behavior, suddenly becomes quiet and withdrawn. What do these teen-agers have in common? All exhibit behaviors that are warning signs of suicide. In the 1990’s, teens turned to suicide with alarming frequency as a tragic “solution” to their adolescent problems.

Suicide is the third leading cause of death among adolescents (individuals between 10 and 19 years old) and young adults (ages 20 to 24). Only accidents and homicides killed more teens in the 1990’s. According to a report by the U.S. Centers for Health Statistics (NCHS) in Hyattsville, Maryland, the rate of suicide in the 15- to 24-year-old age group almost tripled since 1960. More than 4,300 young people took their own lives in 1996 (the most recent year for which statistics were available) compared with 1,500 in 1960.

Unfortunately, the situation is probably much worse than the statistics suggest, because suicides may be grossly underreported for many reasons. In some cases, a suicide may look like an accident. Coroners often fail to record a death as a suicide if a suicide note has not been found. Families may also attempt to classify a suicide as an accident because of the shame and guilt associated with suicide.

NCHS estimates that 8 to 25 adolescents try unsuccessfully to commit suicide for every one that succeeds. In fact, many teen-agers try to commit suicide at least once before they succeed. A 1998 study by the Centers for Disease Control and Prevention in Atlanta (CDC) reported that 10 percent of teen-agers have attempted suicide. In a survey of high school students, about 65 percent of the students revealed that they had thought about suicide or engaged in suicidal behavior. As many as 13 percent of the teens reported that they had attempted suicide at least once. More than 60 percent of the teens said they knew someone who had attempted suicide.

Boys are at greater risk

Most teen-agers who commit suicide are white males. However, during the 1980’s and 1990’s, the suicide rates of African Ame-rican and Native American teen-age boys rose significantly as well. A 1998 study by the CDC found that the rate of suicide among black male teen-agers more than doubled since 1980. Researchers also found that the gap between black and white teen-age suicides was narrowing—in 1980, the rate for white males ages 10 to 19 was more than twice the rate for black males, but in 1995, the rate for white males was only 42 percent higher. Suicides among black teen-age girls increased also, but those rates were much lower than for boys.

Although teen-age boys are nearly five times as likely as girls to commit suicide, according to NCHS figures, girls are much more likely to attempt suicide. Boys succeed more often, in large part, because they tend to choose more deadly means. In the mid-1990’s, suicide by gunshot accounted for more than 60 percent of all deaths from suicide. Nearly three-fourths of male teen-agers who killed themselves used guns. Individuals who try to commit suicide but do not succeed are more likely to ingest poison or take overdoses of medication, particularly pain relievers, such as aspirin or acetamino-phen. In some cases, teens misjudge the dangers of over-the-counter medications, unintentionally taking an overdose that results in death or disability.

Researchers cite no conclusive cause for the rise in teen suicides. Some believe that the rise can be blamed on the increasing availability of deadly weapons. They point to a 1998 study by the CDC that reported that roughly 1 in 5 teen-agers carries a weapon. According to psychologists, other leading factors include the splintering of community and family support networks, the rise in alcohol and drug use, and the adoption of coping behaviors in which suicide is more commonly used in response to depression and hopelessness.

Why do some teens attempt suicide?

For many teens, presuicidal behavior represents a cry for help. If that cry is left unanswered, the teen-ager could seek a deadly solution to what he or she sees as an insolvable problem. Many factors can place an adolescent at risk for a suicide attempt. Teens may be impulsive or may abuse substances, which further limit their judgment. They may experience low self-esteem or an emotional problem, such as depression. Having a history of suicide in the family or a friend who has committed suicide makes depression more likely and can demonstrate that suicide is an option for escaping a painful situation. Family disruption or family conflict may add to a teen’s isolation and reduce sources of support. When such problems exist, additional stress in school or a personal disappointment may be the “last straw,” precipitating a suicidal act.

According to psychologists, suicidal thoughts and behaviors arise from problems in coping that are often associated with one or more psychological conditions such as depression, anxiety, bipolar disorder (manic depression), and schizophrenia. Such disorders are often overlooked and undiagnosed, particularly early in life. As a result, most teens who kill themselves have never been diagnosed with a mental illness and have never received mental health treatment.

Different types of depression

Depression is the emotional disorder most commonly associated with suicidal behavior. While all teen-agers experience sadness, grief, frustration, and disappointment from time to time, sometimes sadness becomes so intense and severe that it interferes with a person’s ability to lead a normal, productive life. When such sadness persists for weeks and months, the problem has progressed to the emotional disorder of depression and should be treated.

Depression is an illness with both emotional and physical symptoms. In fact, many of the behavioral changes that are considered warning signs of suicide are actually symptoms of depression. These include changes in eating and sleeping habits, anxiety, inability to concentrate, a tendency to be uncommunicative, and a pervasive sense of hopelessness. In addition, recent research has demonstrated alterations in brain chemistry in people with psychiatric illnesses such as depression and schizophrenia. Medications to treat these disorders act to alter the abnormal brain chemistry, resulting in improved mood or thinking.

Researchers studying the link between heredity and depression have found that the rate of depression is higher among people who have relatives who are depressed than among those who do not. This finding suggests that the tendency to develop the condition may be inherited. For example, studies have shown that identical twins—who have an identical genetic makeup—have higher rates of suicidal behavior than fraternal (nonidentical) twins, who do not have identical genes. This genetic factor may help explain why suicides are more common in some families than in others.

The role that families play

In addition to depression, other psychological problems are more often present in the families of suicidal adolescents than in the families of other teen-agers. These problems include addictive and abusive behaviors. One result of such a family situation is that the teen receives little parental care or support. Dysfunctional families may teach the wrong lessons about how to cope and may fail to provide necessary security and emotional support. Consequently, the teen is deficient in just those coping and problem-solving skills necessary for dealing with the challenges of growing up.

In addition, factors such as poor self-esteem, depression, and behavioral problems often lead to withdrawal and social isolation from family and peers. Lack of peer acceptance further isolates the troubled teen and contributes to his or her despair. A young person in such a situation may feel unwanted by family and friends. Lacking the skills needed to cope with his or her problems, the teen may feel more hopeless and depressed. Such feelings can lead to a vicious cycle in which the teen alienates others and withdraws, becoming more and more isolated from possible sources of support. Many suicidal teens run away from home and have a history of delinquency and problems with the law. Studies have shown that teen-agers in prison are at particularly high risk for suicide.

Teen-agers who have strong emotional attachments to their parents, on the other hand, are much less likely to attempt suicide. A 1997 study published in the Journal of the American Medical Association found that teens who feel loved, understood, and paid attention to by their parents were more likely to avoid high-risk behaviors regardless of whether they came from a one- or two-parent household.

Other factors involved in teen suicide

Researchers have found that a least a third of adolescents who committed suicide were intoxicated at the time and many more were under the influence of drugs. According to experts, all teen-agers who abuse drugs or alcohol are at increased risk of suicidal behavior. Some teens who drink alcohol or take drugs may be attempting to mask their feelings of hopelessness and despondency. These substances also heighten impulsivity and aggression and weaken an individual’s ability to make good judgements and cope with everyday life. Ironically, some substances that are abused may heighten depression. Alcohol or other drug use can therefore promote risky or self-destructive behaviors or may be a symptom of underlying emotional problems. Thus, in either case, substance use significantly adds to a teen’s risk of suicide.

Both the academic and social aspects of school play a major role in the lives of most adolescents, and many suicidal teen-agers have trouble in school. They tend to be emotionally withdrawn from their classmates, with under-achievement and poor scholastic performance characterizing their presuicidal behavior. Some of these teens may have experienced academic problems early in life because of a learning disability, attention-deficit disorder, or a behavioral problem. Early academic frustrations can evolve into more serious conduct and delinquency problems when the child reaches adolescence.

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Other suicidal young people feel highly pressured to do well in school. They set unrealistic expectations for themselves and sink into despair when they fail to meet these goals. Even if they are academically capable, such depressed and potentially suicidal adolescents are rarely pleased with their performance. This ill-perceived sense of failure often increases despair and hopelessness and may lead the adolescent to fear further loss of recognition from parents or others who expect excellence.

Other triggers of Suicide

The suicide of a family member or friend can serve as a trigger to a troubled teen who had been contemplating suicide. Adolescents are often highly suggestible and eager to imitate others as they search to establish their own identity. So for vulnerable adolescents, who lack positive role models and tend to have low self-esteem, the influence of another person’s suicide can be profound. Studies of teens who have experienced the suicide of a family member or friend have shown that adolescents may develop depressive psychiatric disorders that result in recurrent, longstanding depression and presuicidal behavior. Some theorists have suggested that adolescents who experience the suicide of a family member or friend are at double the risk of suicide. These teens are not only burdened with the disturbing emotional effect of the death, but they have also witnessed a graphic demonstration that suicide is an option.

Some researchers claim that celebrity suicides trigger suicidal behavior in teens. These experts say that sensationalistic or romanticized presentations in the media—particularly if the reports include details about the method the celebrity used to commit suicide—can provoke vulnerable teens to kill themselves. For example, several copy-cat suicides followed the 1994 suicide of Kurt Cobain of the rock group Nirvana. In 1997, two teen-age girls in France told friends that they planned to commit suicide like Cobain. The girls shot themselves in the head while listening to a Nirvana tape. Media reports are not thought to provoke suicide in people who are not already at risk, but they may suggest means or encourage imitation in teens who are already disturbed.

Doctors emphasize that possession of one of the risk factors for suicide does not mean that a teen-ager will attempt suicide. In fact, many individuals with one or more risk factors never exhibit suicidal behavior. Generally, doctors believe that suicidal risk accumulates with the number of risk factors. Thus, depression combined with substance abuse, a conduct disorder, and family problems poses a far greater threat than any one of these factors alone.

The warning signs of suicide

Prediction and intervention have become important goals in suicide prevention. According to the American Academy of Child and Ado-lescent Psychiatry, approximately three-fourths of all teen-agers who consider suicide give verbal or behavioral clues to a family member or friend before committing suicide. Some teen-agers directly threaten to kill themselves by saying such things as “You won’t have to worry about me much longer.” Others may be more vague, saying that they are tired of being a burden to their family and friends. They may talk about life as “hopeless” or complain of feeling “helpless.” Still others may express their intent in poetry, essays, or art.

In addition, major behavioral changes may indicate an individual is considering suicide. The teen’s grades may fall, or he or she may lose interest in sports or other extracurricular activities. The teen may withdraw from friends and family and eat or sleep much more or much less than normal. Friends and family members may notice that the teen no longer cares about personal appearance. The teen may suddenly become more rebellious, angry, or violent. He or she may also engage in risk-taking behavior, such as reckless driving or drug and alcohol abuse.

Making final arrangements is another behavioral clue that a teen is considering suicide. For example, a teen-ager may give away his or her treasured possessions or write drafts of a suicide note.

Previous suicide attempts are, perhaps, the most important warning of suicidal risk. Studies have found that 4 out of 5 people who kill themselves have previously attempted suicide.

Help and treatment for suicidal teens

Doctors recommend that any sign of suicide be taken seriously. Psychologists warn against offering simple solutions to a seriously depressed person. Pat advice to “snap out of it” is not helpful and trivializes the distress and hopelessness the teen is experiencing.

Parents or teachers who recognize warning signs of suicidal behavior in a teen should express support and concern. Through sympathetic discussion, a parent or friend may convince the troubled teen that someone cares. Limiting the teen’s isolation may open avenues for additional support and treatment.

Friends of the troubled teen may pick up on suicidal signs before parents and teachers. Suicide prevention programs advise teens not to be afraid to talk to a friend who may be contemplating suicide. Experts say that friends should listen, ask questions, and find out how their friend feels and why those feelings persist.

Friends and family, however, are limited in their abilities to alter self-destructive behavior. When the risk of suicide exists, doctors emphasize that a teen needs the professional help available at a suicide-prevention center or a mental health clinic. Parents, teachers, or friends who recognize suicidal behavior should never leave the troubled teen alone until they receive medical treatment. The person trying to help the teen can call a crisis hotline, a local mental health association, or the teen’s family doctor. A friend of the suicidal teen should also alert a parent, school counselor, or other trusted adult.

Medications and therapies

For teen-agers in the throes of a suicidal crisis and for those suffering from serious depression that could lead to suicide, there are a number of medications and therapies that are effective in relieving symptoms. Antidepressant medications help regulate mood, sleep, and appetite symptoms. Other medications can stabilize mood in bipolar disorders or treat the disturbed thinking and perceptions in psychotic conditions such as schizophrenia. Drug therapy, however, may take several weeks to be effective and must therefore be combined with other immediate mental health treatments.

Doctors have found that short-term crisis intervention is sometimes helpful in dealing with troubled teens. A single intervention, however, is usually inadequate to treat the underlying problems that put a person at risk for suicide. Therefore, suicidal teens need consistent, ongoing mental health support. When a teen-ager’s life is at risk, hospitalization may be necessary.

Therapists design a treatment program depending on the nature of the problem and the situation or setting in which the adolescent lives. Teens diagnosed with depression, for example, may take antidepressant medication and attend an individual or a group counseling session. Group counseling helps teens realize that they are not alone in their situation. It also allows them to practice new coping strategies and problem solving skills with their peers. Some teens require social skills training to increase their confidence or to reduce inappropriate behaviors. Lonely, withdrawn teens are often helped by a program that gradually increases their participation in activities. Suicidal teens who also have a drug or alcohol abuse problem may need to enter a drug rehabilitation program.

Unfortunately, not all interventions succeed. Some teens commit suicide even in places such as psychiatric hospitals that are designed to provide intensive treatment and supervision. A person who is determined to commit suicide may find a way to do so despite the best efforts of the people who try to help.

Coping with suicide

When a teen does commit suicide, friends, family members, and other people who were close to the teen will likely suffer intense feelings of grief and guilt. Some survivors blame themselves for not recognizing the teen’s despair or for failing to help. Others may feel guilty because the teen’s suicide appeared to have been caused by a specific event, such as a humiliation or disappointment, in which the survivor played a part. However, doctors agree that most suicides cannot be linked to a single occurrence, but rather take place only after an individual loses his or her ability to cope with everyday problems.

Mental health experts agree that the best way to prevent suicide is to prevent the problems that lead to suicidal behavior. Parents and other adults can act as role models, teaching young children effective ways to solve life’s problems and cope with stress. Adults should become familiar with the stresses in their teen’s lives and be certain that parental and personal expectations are realistic. Adults should also know the warning signs of suicidal behavior, so that they can identify problems early, when treatment may be most effective.

Most importantly, doctors say, parents need to communicate openly with their teen-agers. Parents should encourage their teens to talk about the problems in their lives and listen attentively and empathetically when their children speak.

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