Suicide in Youth
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
Previous suicide attempts
Close family member who has committed suicide.
Past psychiatric hospitalization
Recent losses: This may include the death of a
relative, a family divorce, or a breakup with a
Social isolation: The individual does not have
social alternatives or skills to find alternatives
Drug or alcohol abuse: Drugs decrease impulse
control making impulsive suicide more likely.
Additionally, some individuals try to self-medicate
their depression with drugs or alcohol.
Exposure to violence in the home or the social
environment: The individual sees violent behavior as
a viable solution to life problems.
Handguns in the home, especially if loaded.
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
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.
Preoccupation with death and dying.
Signs of depression
Giving away special possessions and making
arrangements to take care of unfinished business.
Difficulty with appetite and sleep
Taking excessive risks
Increased drug use
Loss of interest in usual activities
Checklist from “American Foundation for Suicide
THE RISK FACTORS FOR TEEN SUICIDE
Previous suicide attempts/current suicidal thoughts
Drug or alcohol abuse
Access to firearms
Signs of depression in teens
Sad, anxious or “empty” mood
Declining school performance
Loss of pleasure/interest in social and sports
Sleeping too much or too little
Changes in weight or appetite
Signs of Bipolar Disorder in
Excessive talkativeness, rapid speech, racing
Frequent mood changes (both up and down) and/or
Exaggerated ideas of ability and importance
Three steps parents can take
Get your child help (medical or mental health
Support your child (listen, avoid undue criticism,
Become informed (library, local support group,
Three steps teens can take
Take your friend’s actions 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.
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
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
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
Calm the immediate crisis situation. Do not leave
the suicidal student alone even for a minute. Ask
whether he or she is in possession of any
potentially dangerous objects or medications. If the
student has dangerous items on his person, be calm
and try to verbally persuade the student to give
them to you. Do not engage in a physical struggle to
get the items. Call administration or the designated
crisis team. Escort the student away from other
students to a safe place where the crisis team
members can talk to him. Be sure that there is
access to a telephone.
The crisis individuals then interview the student
and determine the potential risk for suicide.
If the student is
holding on to dangerous items, it is the highest
risk situation. Staff should call an ambulance
and police and the student’s parents. Staff
should try to calm the student and ask for the
If the student has
no dangerous objects, but appears to be an
immediate suicide risk, it would be considered a
high-risk situation. If the student is upset
because of physical or sexual abuse, staff
should notify the appropriate school personnel
and contact Child Protective Services. If there
is o evidence of abuse or neglect, staff should
contact parents and ask them to come in to pick
up their child. Staff should inform them fully
about the situation and strongly encourage them
to take their child to a mental health
professional for an evaluation. The team should
give the parents a list of telephone numbers of
crisis clinics. If the school is unable to
contact parents, and if Protective Services or
the police cannot intervene, designated staff
should take the student to a nearby emergency
If the student has
had suicidal thoughts but does not seem likely
to hurt himself in the near future, the risk is
more moderate. If abuse or neglect is involved,
staff should proceed as in the high-risk
process. If there is no evidence of abuse, the
parents should still be called to come in. They
should be encouraged to take their child for an
Follow-Up: It is
important to document all actions taken. The
crisis team may meet after the incident to go
over the situation. Friends of the student
should be given some limited information about
what has transpired. Designated staff should
follow up with the student and parents to
determine whether the student is receiving
appropriate mental health services. Show the
student that there is ongoing care and concern
in the school.
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
can you say to support a
student with suicidal thoughts and a low self-esteem?
Listen actively. Teach problem-solving skills
Encourage positive thinking. Instead of saying that
he cannot do something, he should say that he will
Help the student write a list of his or her good
Give the student opportunities for success. Give as
much praise as possible
Help the student set up a step-by-step plan to
achieve his goals.
Talk to the family so that they can understand how
the student is feeling.
or she might benefit from assertiveness training
Helping others may raise one’s self-esteem.
Get the student involved in positive activities in
school or in the community.
appropriate, involve the student’s religious
Make up a contract with rewards for positive and new
Rich et al, San
Diego Suicide Study: Young versus Old Subjects. Arch
Gen Psychiatry 43: 577-582 1986.
Apter et al
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.
Garnefski, N. et
al, Suicidal Behavior and the Co-occurrence of
behavioral, emotional and cognitive problems among
adolescents, (in press) Archives of Suicide Research.
Brent, D.A. et
al, Long-Term Impact of Exposure to Suicide: A
Three-Year Controlled Follow-up, Journal of the
American Academy of Child and Adolescent Psychiatry,
Hughs, D.H., Can
the Clinician Predict Suicide? Psychiatric Services:
Psychiatric Press Textbook of Psychiatry, Second Edition.
Chapter on Suicide.
Foundation for Suicide Prevention
Association of Suicidology
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