Youths who are socially isolated, impulsive or drink alcohol and/or use drugs have increased suicide risk. Youths with major psychiatric illness have increased suicide risks as well.
All suicidal threats should be taken seriously. It is never a good idea to dismiss them as “troubled teen behavior.” Teens tend to be more impulsive than older adults because the prefrontal cortex doesn’t fully develop until adulthood.
Risk Factors
There are many risk factors that contribute to youth suicide. The most obvious is a severe and persistently depressed mood or the use of drugs that cause a break from reality (drug induced psychosis). Major psychiatric disorders such as schizophrenia, bipolar disorder and anorexia nervosa have their onset in adolescence and often carry increased risks for suicide.
The absence of communication in a family (either direct or indirect) is another major risk factor. A youth who makes a suicide threat should be taken very seriously. Whether or not the threat is genuine, it can lead to suicide attempts, which in turn may increase the risk for a full-blown suicide.
Other risk factors include a history of suicide or non-suicidal self-injurious behavior, a family history of psychiatric illness and a past episode of trauma. Access to lethal means of suicide should always be considered as part of a suicide risk assessment. For example, youths who live in rural areas are at a higher risk for suicide because of the relative ease to obtain a firearm.
Symptoms
Many teens who attempt suicide do so after experiencing severe depression. Adolescents with this illness need one-on-one counselling and medical treatment to help them overcome their depression and learn effective ways of coping. Guidance counsellors at schools and crisis centres, which can be found in most communities, offer a range of services for youth who are distressed.
It’s important to take any talk of suicide seriously. Although it’s common for teenagers to think about suicide, if they say they want to die or try to hurt themselves, it’s a cry for help. They should never be ignored or told to “just get over it.” Teens who have tried to kill themselves in the past are at an even higher risk of suicide. Other warning signs are a change in behavior or appearance, becoming distant from family and friends, a lack of interest in activities they usually enjoy, or making erratic decisions. They may also start sleeping more or less than usual and eat differently.
Treatment
Several randomized trials suggest that school-based prevention programs can reduce suicide attempts among adolescents. A comprehensive approach includes youth awareness, gatekeeper training and screening and encouragement of adaptive coping and help-seeking.
A key element in preventing youth suicide is good, ongoing medical and mental health care. A teenager who appears sad and withdrawn or is acting differently from normal should be evaluated for depression and suicide risk. Watch for changes in sleep patterns or eating habits. A sudden increase in alcohol or drug use can also be a red flag.
Some major psychiatric disorders (such as schizophrenia and anorexia nervosa) carry a significant risk of suicide in adolescence. For example, a young person with schizophrenia may hear voices that seem to be telling them to kill themselves (auditory hallucinations) even though they do not want to die. The development of effective treatments for these conditions is an important priority.
Prevention
As a community, it’s our responsibility to work together to prevent youth suicide. Educators, school officials and parents should be familiar with risk factors and warning signs for suicide and be prepared to identify and refer students who are suicidal.
All suicide threats should be taken seriously and not trivialized as attention seeking behavior. Whether the intent is genuine or not, a suicide attempt signals that the person does not think they can cope. Therefore, after any suicide attempt, proper assessment and intervention by a qualified professional should occur.
Youth suicide prevention strategies include screening programs designed to identify high-risk adolescents and young adults; peer support programs; and crisis centers and hotlines. In addition, school board policy should address procedures for addressing suicidal students. It is also important to provide training for school and community gatekeepers who can be critical in identifying at-risk youth and referring them to appropriate mental health services. These may include educators, school administrators, school counselors and social workers and local mental health specialists.