Pre-teens and teenagers are by nature vulnerable to mental health problems. They are undergoing a period of constant changes and transitions.
Some of these are directly related to important life events such as relationship break-ups, peer rejection and family conflict. Others are the result of a general environment of trauma and discrimination.
Risk Factors
There are a number of factors that increase youth suicide risk. These include: having a mental health condition like depression or mania; history of alcohol or drug use; and a family history of violence, including sexual abuse. A person who has a psychotic illness such as schizophrenia also is at greater risk for suicide because they may hear voices or have other delusions that lead them to believe that death is the only way out of their troubles.
Other risk factors for youth suicide include being socially isolated, having a high-risk relationship with another teen or adult, or having an unhealthy way of dealing with strong feelings (e.g., expressing them through aggressive or impulsive behavior). A history of being abused by a caregiving adult is also a major factor. Finally, a traumatic experience can trigger a suicide attempt. For example, a video showing the shooting of an unarmed black person by a police officer might prompt a suicide attempt by a young man or woman who feels helpless, hopeless and trapped.
Signs
Teens who think about suicide often show warning signs that parents and school staff should watch for. These include sudden changes in behavior, thoughts or feelings that are not normal for the child or teen. Also, be alert for changes in sleep patterns or eating habits. Also, look for a pattern of withdrawing from friends and family, increased absenteeism at school, and themes of death or suicide in classroom drawings, homework or journal writing.
Some teens are at greater risk of suicide than others, such as those who have access to lethal means like weapons and medicines, have a history of mental health problems or a physical illness or disability, have family conflicts, have been bullied or have had prior suicidal attempts. But, all teens who think about or attempt suicide should be treated with respect and expert care. Treatment may involve family therapy and a stay in an inpatient psychiatric hospital, depending on the situation.
Treatment
Youth suicides are often triggered by important life events such as death of family members, loss of a friend or lover, relationship conflicts, school related problems and career uncertainty. These are normal developmental tasks that most teens manage successfully without severe mental health difficulties but for some youths, the stressors become too great and depression or a suicidal ideation develops.
A comprehensive treatment approach for youths who are at risk includes psychiatric medications, psychotherapy and family therapy. Especially for youths who are at high risk for suicide, a multi-disciplinary team needs to be involved.
Various types of psychotherapy have been shown to reduce suicide rates. The therapist should take an ecological perspective to help the adolescent and family members identify personal, familial, community, neighborhood and cultural risk factors as well as protective factors. The adolescent must also understand his or her own thoughts, emotions and behaviors as a contributing factor to the crisis situation. This will reduce shame and guilt feelings as well as help the therapist to formulate a case conceptualization for treatment.
Prevention
The good news is that suicide is preventable. Pediatric health clinicians, youth workers in schools and community settings, family members, friends, peers, teachers and school administrators, coaches and leaders of extracurricular activities, mentors, service providers and many others can help prevent suicide.
The key is to reduce risk factors and strengthen protective factors. These include healthy relationship patterns with parents (not a constant source of conflict) and other adults, restriction of access to lethal means of self-harm, religious and cultural beliefs that discourage and support instincts for self-preservation, good problem-solving abilities, strong connections with friends and family and a sense of purpose.
In addition, all youth should be offered appropriate and timely psychiatric care. Major psychiatric disorders, such as schizophrenia and bipolar disorder and eating disorders, including anorexia nervosa often first present in adolescence and are associated with suicide. Drug induced psychoses, such as hallucinations and delusions also increase suicide risk in adolescents. All suicidal thoughts and attempts should be taken seriously.