Blog

Watkins, MD 

According to the Surgeon General, a youth commits

suicide every two hours in our country. In 1997, more

adolescents died from suicide than AIDS, cancer, heart

disease, birth defects and lung disease. Suicide claims

more adolescents than any disease or natural cause.

Adolescents now commit suicide at a higher rate than the

national average of all ages. The rate of adolescent

suicide in adolescent males has tripled between 1960 and

1980. Suicide rates for adolescent females have

increased between two to three fold. There have been

striking increases in suicidal behaviors among African

American males, Native American males and children under

14. Much of the increase can be accounted for by deaths

due to guns. 

Suicidal behavior is the end result of a complex

interaction of psychiatric, social and familial factors.

There are far more suicidal attempts and gestures than

actual completed suicides. One epidemiological study

estimated that there were 23 suicidal gestures and

attempts for every completed suicide. However, it is

important to pay close attention to those who make

attempts. 10% of those who attempted suicide went on to

a later completed suicide. A suicide has a powerful

effect on the individual’s family, school and community.

We must deal with it as a public health crisis in our

schools, clinics and doctors’ offices. 

changes that might be related to the rise in adolescent

suicide include an increased incidence of childhood

depression, decreased family stability, and increased

access to firearms. 

Suicidal behaviors are often associated with depression.

However, depression by itself is seldom sufficient.

Other co-existing disorders, such as attention deficit

hyperactivity disorder, substance abuse or anxiety can

increase the risk of suicide. Recent stressful events,

can trigger suicidal behavior, particularly in an

impulsive youth. Girls may be more likely to make

suicidal attempts, but boys are more likely to make a

truly lethal suicide attempt. 

Risk factors for suicide

research suggests that there are two general types of

suicidal youth. The first group is chronically or

severely depressed or has Anorexia Nervosa.  Their

suicidal behavior is often planned and thought out. The

second type is the individual who shows impulsive

suicidal behavior. He or she often has behavior

consistent with conduct disorder and may or may not be

severely depressed. This second type of individual often

also engages in impulsive aggression directed toward

others. 

Adolescents often will try to support a suicidal friend

by themselves. They may feel bound to secrecy, or feel

that adults are not to be trusted. This may delay needed

treatment. If the student does commit suicide, the

friends will feel a tremendous burden of guilt and

failure. It is important to make students understand

that one must report suicidal statements to a

responsible adult. Ideally, a teenage friend should

listen to the suicidal youth in an empathic way, but

then insist on getting the youth immediate adult help. 

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Checklist from “American Foundation for Suicide

http://www.afsp.org 

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Intervention: 

Intervention can take many forms and should throughout

the different stages in the process. Prevention includes

education efforts to alert students and the community to

the problem of teen suicidal behavior. Intervention with

a suicidal student is aimed at protecting and helping

the student who is currently in distress. Postvention

occurs after there has been a suicide in the school

community. It attempts to help those affected by the

recent suicide. In all cases it is a good idea to have a

clear plan in place in advance. It should involve staff

members and administration. There should be clear

protocols and clear lines of communication. Careful

planning can make interventions more organized, and

effective. 

Prevention often involves education. This may be done in

a health class, by the school nurse, school

psychologist, guidance counselor or outside speakers.

Education should address the factors that make

individuals more vulnerable to suicidal thoughts. These

would include depression, family stress, loss, and drug

abuse. Other interventions may also be helpful. Anything

that decreases drug and alcohol abuse would be useful. A

study by Rich et al found that 67% of completed youth

suicides involved mixed substance abuse.  PTA meetings

family spaghetti dinners can draw in parents so that

they can be educated about depression and suicidal

behavior. “Turn off the TV Week” campaigns can increase

family communication if the family continues with the

reduced TV viewing. Parents should be educated about the

risk of unsecured firearms in the home. Peer mediation

and peer counseling programs can make help more

accessible. However, it is critical that students go to

an adult if serious behaviors or suicidal issues emerge.

Outside mental health professionals can discuss their

programs so that students can see that these individuals

are approachable. 

Intervention with a suicidal

student: Many schools have a written protocol for

dealing with a student who shows signs of suicidal or

other dangerous behavior. Some schools have automatic

expulsion policies for students who engage in illegal or

violent behavior. It is important to remember that teens

who are violent or abuse drugs may be at increased risk

for suicide. If someone is expelled, the school should

attempt to help the parents arrange immediate, and

possibly intensive psychiatric and behavioral

intervention. 

Postvention: An attempted

or completed suicide can have a powerful effect on the

staff and on the other students. There are conflicting

reports on the incidence of a contagion effect creating

more suicides. However, there is no doubt that

individuals close to the dead student may have years of

distress. One study found an increased incidence of

major depression and posttraumatic stress disorder 1.5

to 3 years after the suicide. There have been clusters

of suicides in adolescents. Some feel that media

sensationalization or idealized obituaries of the

deceased may contribute to this phenomenon. 

school should have plans in place to deal with a suicide

or other major crisis in the school community. The

administration or the designated individual should try

to get as much information as soon as possible. He or

she should meet with teachers and staff to inform them

of the suicide. The teachers or other staff should

inform each class of students. It is important that all

of the students hear the same thing. After they have

been informed, they should have the opportunity to talk

about it. Those who wish should be excused to talk to

crisis counselors. The school should have extra

counselors available for students and staff who need to

talk. Students who appear to be the most severely

affected may need parental notification and outside

mental health referrals. Rumor control is important.

There should be a designated person to deal with the

media. Refusing to talk to the media takes away the

chance to influence what information will be in the

news. One should remind the media reporters that

sensational reporting has the potential for increasing a

contagion effect. They should ask the media to be

careful in how they report the incident. Media should

avoid repeated or sensationalistic coverage. They should

not provide enough details of the suicide method to

create a “how to” description. They should try not to

glorify the individual or present the suicidal behavior

as a legitimate strategy for coping with difficult

situations. 

can you say to support a

Diego Suicide Study: Young versus Old Subjects. Arch

Gen Psychiatry 43: 577-582 1986. 

Correlation of Suicidal and Violent Behavior in

Different Diagnostic Categories in Hospitalized

Adolescent Patients, Journal of the American Academy

of Child and Adolescent Psychiatry, 34:7-11 1995. 

al, Suicidal Behavior and the Co-occurrence of

behavioral, emotional and cognitive problems among

adolescents, (in press) Archives of Suicide Research. 

al, Long-Term Impact of Exposure to Suicide: A

Three-Year Controlled Follow-up, Journal of the

American Academy of Child and Adolescent Psychiatry,

35:5-13, 1996. 

the Clinician Predict Suicide? Psychiatric Services:

46:5-13, 1995. 

Psychiatric Press Textbook of Psychiatry, Second Edition.

Chapter on Suicide. 

Foundation for Suicide Prevention 

http://www.afsp.org 

Association of Suicidology