What We know About Teen Suicide
Suicide is a topic few people want to discuss but it is a serious problem and there is no way to prevent it without talking about it, understanding it, and addressing its root causes. Suicide is defined as a “fatal, self-inflicted act with the explicit or inferred intent to die” (Child and Adolescent Suicidal Behaviour).
Statistics about Teen Suicide from the Canadian Mental Health Association:
Approximately 500 Canadian youth (age 10-24) die by suicide each year.
Suicide is the second leading cause of death among youths between the ages of 15 and 19, after accidents.
Suicide among preadolescent children is rare, although it does happen.
Males die from suicide more often than females, and are more likely to employ such methods as hanging and firearms.
Females attempt suicide 3 to 4 times more often than males, and are more likely to use poisoning and cutting.
Aboriginal and Metis youth have 4 to 5 times greater rates of suicide than non-aboriginal youth.
LGBTQ youth are 4 times more likely to attempt suicide than heterosexual youth.
Transgender youth are most at risk, with up to 10% reporting having made a suicide attempt within the preceding year; it is thought that the stigma associated with being transgender is a significant stressor.
90% of adolescents who commit suicide have a history of mental illness including depression, substance use disorder, or conduct disorder which is characterized by non-compliant, antisocial, and impulsive behaviour.
Adolescent Stress
Adolescence is a stressful time for everyone. For parents, there are the changes in their child’s body and behaviour which can seem startling and surprising, new demands being made for independence, greater insistence on autonomous decision making, the fears concerning driving, drugs, alcohol, and sex, and the arguments about money and clothes, and friends.
For adolescents, in addition to all of the afore-mentioned challenges, there are hormonal changes, with new and intense feelings, and considerable worries about how to function in the world, separate from their parents. Teens have to establish their own identities, form independent relationships, organize their schedules, make decisions about new opportunities and temptations, and negotiate a place for themselves among a large group of peers, all competing and attempting to do the same things.
Most adolescents cope one way or another, especially if they enjoy good mental health, have close relationships with their parents and peers, and feel connected to their school community. However, vulnerable adolescents who struggle with depression, sexual orientation or gender identity, become dependent on drugs or alcohol, feel alienated from their peers, and/or engage in risky or illegal behaviour, may begin to feel hopeless and helpless. If their predicaments persist, and no one intervenes, these adolescents may become self-destructive, even suicidal, especially if they experience a noxious event such as the loss of a friend, a breakup of a romantic relationship, family conflict, fear of exposure for embarrassing or illegal behaviour, or being bullied.
The more problems and risk factors an adolescent experiences, the greater the risk of suicide. Each risk factor increases, exponentially, the likelihood of a suicide attempt.
Suicidal Ideation
Suicidal ideation or suicidal thoughts occur on a continuum. Passive thoughts of death such as ‘I wish I were dead so I wouldn’t have to write my exam’ or ‘they’d be sorry if I were dead’ are quite common; one in five adolescents report having these. Some adolescents have suicidal thoughts with a plan but no intent to follow through, for example, ‘I’d like to kill myself but I couldn’t do that to my family.’ A small minority of adolescents have frequent, intense thoughts of suicide with a plan, means, an intent to complete, and a belief that others would be better off if they did complete. The more specific and more intense the suicidal ideation, the more likely it is that the individual will make a suicide attempt.
Contrary to myth, suicide is rarely impulsive or sudden. People who kill themselves think about it for a long time and usually talk about suicide with others. According to the Canadian Mental Health Association, “eight out of ten people who die by suicide gave some, or even many, indications of their intentions.”
The Difference Between Self-harm and Suicide
Non suicidal self-injury (NSSI) “involves stereotyped and repetitive self-harm (such as superficial cutting), with the goal not to die, but to relieve negative emotion or obtain social reinforcement (Treating Depressed and Suicidal Adolescents, p.44). Non-lethal self-injury is intended to manage negative emotions such as anger or numbness; the act of causing physical pain is experienced as soothing or distracting from emotions which otherwise seem both intolerable, and unrecognized by others. This behaviour is often an attempt by teens to ameliorate and communicate distress, albeit in a dysfunctional way.
Suicide is intended to end feelings of intolerable pain, where there is no hope that the pain can be alleviated in any other way. The individual who wants to end his or her life is convinced that the pain is not going away, that the future is as bleak as the present, and that ‘nothingness’ is preferable to what they experience.
What is complicated is the fact that many people who self-injure also attempt suicide. It should never be concluded that a young person who engages in non- lethal self-harm presents a low risk for suicide. Individuals who self-harm are experiencing acute distress, and require immediate attention.
Predictors of Suicide
A previous suicide attempt
Suicide by a family member
A plan to carry out the suicide
Access to the means of suicide
Frequent, intense thoughts of suicide
Substance use
Feelings of hopelessness, purposelessness, and pessimism about the future
Feelings of being a burden to others, that others would be better off without him or her
Withdrawal, preoccupation
Giving away personal possessions
What about the successful, popular teen who suddenly, inexplicably commits suicide?
We occasionally hear about or read about, a very talented teen or young adult who commits suicide and it seems so frightening and mysterious because there doesn’t seem to be any explanation. Why would a successful young person with her whole life ahead of herself, choose to die? The answer is usually that he or she experienced serious depression, and feelings of worthlessness and failure, despite others’ admiration. There sometimes is little correspondence between ‘external’ measures of success and an individuals’ feelings of self-worth. Talented, attractive people who are perfectionistic and place unrealistic demands upon themselves to be brilliant and outstanding, can be crushed by a disappointing result, a failure, or an embarrassment. The reason people don’t know about their struggle with their mental health is because they are ashamed of it and hide it from everyone, even those closest to them. Investigations, after the fact, reveal the suffering, loneliness, and hopelessness these young people endured before they committed a desperate act. They were not the happy people they pretended to be.
How do you know if an adolescent is considering suicide? ASK THEM.
It used to be believed that if children were informed about sex, they would be more likely to engage in sexual activity. Subsequent research demonstrated overwhelmingly, that children and teens with knowledge about sex, birth control, and reproduction, and who had people to talk to about these topics were less likely to engage in very young or risky sexual behaviour. In the same way, people worry today that discussing suicide with young people will inspire, encourage, or stimulate thoughts of suicide or suicide attempts. There is no evidence that this is so, and every expert in the field of suicide prevention recommends that teachers, parents, friends, doctors, coaches, and mental health professionals ask teens who show symptoms of distress if they have considered harming themselves, how often, in what way, and to what end.
Contagion:
In rare circumstances, young people commit suicide in an apparent attempt to imitate or recreate the suicide of someone else. It seems that this is more likely when the suicide is presented as romantic or idealistic. Recent protocols for the press which prohibit details about the method of suicide and other particulars make this much less likely. Also, schools are now very sensitive to their students’ distress when a peer commits suicide and they offer counselling, support, and time to grieve.
Experts suggest asking the following questions:
Do you think about dying?
Do you have hope that things will get better?
How would you end your life?
How close have you come to ending your life?
Do you have a way to end your life?
Is there anything that stops you from ending your life?
How to move forward?
Increase the availability of mental health services in schools
Teach suicide and suicide prevention as part of a mental health curriculum in schools
Make mental health and suicide prevention a national health care priority
Sadly, there are people, who despite care and treatment, want to die and will die. It is believed, however, that the majority of those who commit suicide, especially in youth, might have been successfully treated and gone on to lead happy and productive lives. It is incumbent on us to do all we can, to save as many as we can.
Resources
Websites:
Canadian Mental Health Association: www.cmha.ca
Centre for Suicide Prevention: csp@suicideinfo.ca
Canadian Paediatric Society: www.cps.ca
Kids Help Phone: www.kidshelpphone.ca
Publications available on websites:
Canadian Mental Health Association: “Understanding suicide and finding help.”
Centre for Suicide Prevention, “After a student suicide.”
Centre for Suicide Prevention: “Transgender people and suicide.”
Canadian Paediatric Society: “Suicidal ideation and behaviour.”
Books:
David N. Miller, Child and Adolescent Suicidal Behaviour, School-Based Prevention, Assessment, and Intervention, The Guilford Press, 2011.
“Suicidal Ideation and Behaviour” in David A. Brent, Kimberly D. Poling, and Tina R. Goldstein, Treating depressed and Suicidal Adolescents, A Clinician’s Guide, The Guilford Press, 2011.
About the Author
Janet Morrison, M.A., C. Psych Assoc. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.