Suicidal behavior is defined as a preoccupation or act that is focused on causing one's own death voluntarily. An intent to cause one's death is essential in the definition. Suicidal ideation refers to thoughts of suicide or wanting to take one's own life. Suicidal behavior refers to actions taken by one who is considering or preparing to cause his/her own death. Suicide attempt usually refers to an act focused on causing one's own death that is unsuccessful in causing death. Suicide refers to having intentionally caused one's own death.
Adolescence is a stressful developmental period filled with major changes - body changes, changes in thoughts, and changes in feelings. Strong feelings of stress, confusion, fear, and uncertainty, as well as pressure to succeed, and the ability to think about things in new ways influence a teenager's problem solving and decision making abilities.
For some teenagers, normal developmental changes, when compounded by other events or changes in their families such as divorce or moving to a new community, changes in friendships, difficulties in school, or other losses can be very upsetting and can become overwhelming. Problems may appear too difficult or embarrassing to overcome. For some, suicide may seem like a solution.
As many as 12 to 25 percent of older children and adolescents experience some form of thoughts about suicide (suicidal ideation) at one time or another. When feelings or thoughts become more persistent, are accompanied by changes in behavior or specific plans for suicide, the risk of a suicide attempt increases.
Suicide is the third leading cause of death in 15 to 24 year olds. According to the National Institute of Mental Health (NIMH), reliable scientific research has found the following:
- There are as many as eight to 25 attempted suicides to one completed suicide - with the ratio even higher in youth.
- The strongest risk factors for attempted suicide in youth are depression, substance abuse, and aggressive or disruptive behaviors.
The Centers for Disease Control and Prevention (CDC) reports the following:
- Males are four times more likely to die from suicide than females.
- Females are more likely to attempt suicide than males.
- Firearms are used in over half of youth suicides.
Suicide risk factors vary with age, gender, and cultural and social influences and may change over time. Risk factors for suicide frequently occur in combination with each other. The following are some suicide risk factors that may be present:
- one or more diagnosable mental or substance abuse disorders
- impulsive behaviors
- undesirable life events or recent losses (i.e., death, parental divorce)
- family history of mental or substance abuse disorder
- family history of suicide
- family violence, including physical, sexual, or verbal/emotional abuse
- prior suicide attempt
- firearm in the home
- exposure to the suicidal behavior of others, including family, peers, in the news, or in fiction stories
Many of the warning signs of possible suicidal feelings are also symptoms of depression. Observations of the following behaviors by parents and care givers may be helpful in identifying adolescents who may be at risk of attempting suicide:
- changes in eating and sleep habits
- loss of interest in usual activities
- withdrawal from friends and family members
- acting out behaviors and running away
- alcohol and drug use
- neglect of personal appearance
- unnecessary risk-taking
- preoccupation with death and dying
- increased physical complaints frequently associated with emotional distress such as stomach aches, headaches, and fatigue
- loss of interest in school or schoolwork
- feelings of boredom
- difficulty concentrating
- feelings of wanting to die
- lack of response to praise
- indicates plans or efforts toward plans to commit suicide, including the following:
- verbalizes "I want to kill myself," or "I'm going to commit suicide."
- gives verbal hints such as "I won't be a problem much longer," or "If anything happens to me, I want you to know ...."
- gives away favorite possessions; throws away important belongings
- becomes suddenly cheerful after a period of depression
- may express bizarre thoughts
- writes one or more suicide notes
Threats of suicide communicate desperation and a cry for help. Always take statements of suicidal feelings, thoughts, behaviors, or plans very seriously. Any child or adolescent who expresses thoughts of suicide should be evaluated immediately.
The warning signs of suicidal feelings, thoughts, or behaviors may resemble other medical conditions or psychiatric problems. Always consult your adolescent's physician for a diagnosis.
Specific treatment for suicidal feelings and behaviors will be determined by your adolescent's physician based on:
- your teen's age, overall health, and medical history
- extent of your teen's symptoms
- seriousness of the attempt
- your teen's tolerance for specific medications or therapies
- expectations regarding future suicide risk
- your opinion or preference
Any adolescent who has attempted suicide requires an initial physical evaluation and treatment until he/she is physically stable. Mental health treatment for suicidal feelings, thoughts, or behaviors begins with detailed evaluation of events in the adolescent's life during the two to three days preceding the suicidal behaviors. A comprehensive evaluation of the adolescent and family contributes to decisions regarding treatment needs. Treatment recommendations may include individual therapy for the adolescent, family therapy, and, when necessary, hospitalization to provide the adolescent a supervised and safe environment. Parents play a vital supportive role in any treatment process.
Recognition and early intervention of mental and substance abuse disorders is the most effective way to prevent suicide and suicidal behavior. Studies have shown that suicide prevention programs most likely to succeed are those focused on identification and treatment of mental illness and substance abuse, coping with stress, and controlling aggressive behaviors.
According to the American Foundation for Suicide Prevention (AFSP), it is important to learn the warning signs of teenage suicide in order to prevent an attempt. Maintaining open communication with your teenager and their friends provides an opportunity for helping as needed. If a teen is talking about suicide, he or she must receive an immediate evaluation.
- Warning signs for teen depression:
- feelings of sadness or hopelessness
- declining school performance
- loss of pleasure/interest in social and sports activities
- sleeping too little or too much
- changes in weight or appetite
- nervousness, agitation or irritability
- substance abuse
- Steps parents can take:
- Keep medications and firearms away from children.
- Get your child help (medical or mental health professional).
- Support your child (listen, avoid undue criticism, remain connected).
- Become informed (library, local support group, Internet)
- Steps teens can take:
- Take your friend's behavior and discussion of suicide seriously.
- Encourage your friend to seek professional help, accompany if necessary.
- Talk to an adult you trust. Don't be alone in helping your friend.
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Online Resources of Adolescent Medicine