The typical picture of a youth at risk for suicide is a depressed young person living in poverty and surrounded by family conflict. However, many people at risk for suicide are not like this at all.
Parents, teachers and other adults should be aware of sudden changes in a child’s behavior, including themes involving death or suicide.
Risk Factors
Some of the most common risk factors for suicide include mental health issues such as depression, anxiety or substance abuse, a family history of suicide and having access to lethal means like a firearm. In addition, kids who talk about suicide or make threats are more at risk. Studies also show that kids who have tried to kill themselves before are at a higher risk than those who haven’t.
Adolescence is a time of significant personal, emotional and social change and it’s not surprising that some life events can trigger an intolerable amount of mental anguish. A typical example is conflict with a parent, boy/girl friend or other significant figure.
A number of publications have found that work-related suicide risks are also common in youths. For example, being laid off or dismissed from a job can be a major stressor for many youths as it threatens financial stability. Other work-related risk factors can include a feeling of disconnection from others and loneliness.
Suicide Ideation
Suicide ideation (SI) is a complex phenomenon that varies in intensity, duration, and character. It can range from fleeting wishes of falling asleep and never waking up to intense preoccupations with self-annihilation fueled by delusions. It is a common occurrence in the general population and often appears in a waxing and waning manner, making it difficult for healthcare professionals to document in a binary yes/no fashion.
Anyone who has a history of SI or is preoccupied with suicide should be evaluated immediately by a medical professional. Having these thoughts does not mean that someone is crazy or weak, but that they are going through a severe emotional period and need help.
People who are considered chronic suicide risks typically have a plan for how they will kill themselves and the means to carry out the plan. They may also be showing active warning signs like giving away possessions or saying goodbye to family and friends.
Suicide Attempts
Whether or not a youth has genuine suicidal intentions, every threat should be taken seriously. Threats and suicide attempts are a cry for help – if ignored, the crisis may escalate.
Adolescents who have major psychiatric illnesses such as schizophrenia, bipolar affective disorder and anorexia nervosa are at particularly high risk of suicide. These conditions are often treated successfully, but the demands of adolescence, relationship conflicts and poor coping skills can make them more difficult to manage.
The use of alcohol and drugs is a significant risk factor in youth suicide. These substances can provide a temporary escape from distresses but the addiction can quickly become overwhelming. Other warning signs include a change in behavior – becoming more withdrawn, irritable or anxious, sleeping less or changing eating patterns. It is also important to be vigilant about any access to weapons or potentially dangerous medications.
Treatment
Youth should be treated by mental health professionals, including psychologists and psychiatrists who specialize in adolescent mental illness. Treatment includes medication, family therapy and experiential therapies.
Adolescents who are considering suicide should not be kept alone and should be taken to a hospital or another specialized mental health facility immediately. These facilities offer residential, partial hospitalization and intensive outpatient treatment.
The prefrontal cortex, which controls judgment and decision-making, doesn’t fully develop until a person is in his mid-20s. This developmental delay makes teens and young adults more vulnerable to depression and suicidal thoughts than older people are.
Youths who are depressed may develop psychotic episodes, a state of mind that causes hallucinations or delusions, which can be dangerous and lead to self-harm or suicide. Symptoms to watch for include a change in mood, giving away possessions and erratic behavior. Those with lived experience, such as those who have struggled with suicidal thoughts themselves or have supported loved ones at risk, should be a part of the implementation team for any program to address suicide in youths.