Adolescence is a time of dramatic mental, emotional and social change. This can be a difficult time for anyone, but especially those who are at high risk.
Risk factors for suicide include depression, anxiety, psychiatric disorders and access to lethal means. Protective factors against suicide include close relationships and a supportive community, good problem-solving skills and coping mechanisms, and access to effective health care and therapy.
Risk factors
While the cause of each suicide is unique, there are a number of risk factors that are more common among youth. These include mental health disorders, substance use and family violence. Many suicides occur when young people try to cope with stressors that are too great for them. Specifically, they may experience a breakdown in their coping skills such as severe depression or an episode of psychosis including hallucinations and delusions.
Adolescents are at heightened risk for suicide when they are facing major life changes such as the dissolution of a relationship, moving to a new school or preparing to enter adulthood. The resulting feelings of hopelessness and helplessness can be compounded by poor coping behaviors such as excessive alcohol or drug use, social isolation or spending too much time online.
A community’s risk for suicide also includes poverty, low rates of mental health treatment and weak firearm safety laws. Preventive measures include screening programs, teaching coping skills to youths and providing access to crisis centers and hotlines.
Warning signs
A young person who displays major mood changes, a sudden decline in school performance or a focus on death may be at risk. These symptoms can be a sign of suicidal intent or could indicate an underlying psychiatric illness, such as depression or a trauma and stress disorder. Other risk factors include family history of suicide, alcohol and drug abuse, a history of disciplinary problems in school or at home, and being gay or lesbian in a non-accepting society.
It’s important to take any talk of suicide seriously. This might come up in essays, poems or artwork in school, in text messages with friends, on social media sites, or in everyday conversation. Other warning signs to watch for include planning (giving away treasured items, saying goodbye to loved ones) and acting recklessly. A sudden change in sleep or eating habits is also a concern. If a youth makes a suicide attempt, it’s important to treat this very seriously and get them immediate help.
Treatment
There are many treatment options for youth suicide including psychotherapy with demonstrated benefits in reducing SH and SAs, effective medication treatments for disorders associated with increased risk of suicidal behaviors and emerging care process and triage models for improving emergency evaluation and management of youth presenting with SH and SA risk. A combination of evidence-based psychotherapy augmented with medication may be most helpful for most teens with suicidal thoughts and/or behavior.
All suicide attempts should be taken seriously especially if the youth has made a plan. Don’t dismiss the attempt as attention seeking behavior. Constant supervision with the help of trained professionals is important and the physical safety of the teenager must be assured.
There is a free screening tool available for medical settings called Ask Suicide-Screening Questions (ASQ)1 that can be used to identify those patients who are at high risk of suicide. This tool should be included in the routine workup of every adolescent patient.
Prevention
Suicide is a serious problem among teens and represents a large loss of life and a huge burden on those left behind. There are many ways that individuals can help. Sensitive listening and appropriate advice are important. Restricting access to lethal means is another measure, as are educational programs to educate people on the warning signs and how to react.
In addition, prevention efforts must focus on early detection and treatment of mental health disorders, including those that are responsive to medication, such as schizophrenia and bipolar disorder. Adolescents with these conditions are particularly vulnerable to suicide attempts. All suicide threats should be taken seriously, regardless of whether they are a cry for attention or not.
Parents, educators, school administrators, coaches and extracurricular activity leaders, and friends can all play a role in preventing youth suicide by educating themselves on the risk factors and warning signs of this tragedy and by reaching out to those who need it.