Suicidal Behaviour in Adolescents

Worldwide there is about one death every 40 seconds and about one million suicides per year.  Suicide is the leading cause of death worldwide, particularly in younger people.


According to Dr. John Connolly there has been a twelve-fold increase in suicide between 1960 and 2000 in 15 to 34 year olds. The Union of Students in Ireland has estimated that 25 persons per year between the ages of 20 and 24 complete suicide. In data collected during 2002 the National Suicide Foundation Registry found that there was increased Parasuicide by 5.7% in the Midland Health Board, 11.9% in the Mid Western Health Board, 8.5% in the South Eastern Health Board, and 12.7% in the Southern Health Board.  They also pointed out that Parasuicide was highest among young women aged 15 to 19 with 1 per 160 of the total population of 15 to 19 year olds being involved.  Parasuicide rates were higher in urban areas and varied between 63 per 100,000 in Leitrim and 429 per 100,000 in Limerick.  They found that alcohol was involved in 46% of male suicides and 38% of female suicides.  Parasuicide made up 1% of all casualty attendances.  The types of drugs used in overdose include (a) 40% minor tranquillisers, (b) 43% at least one analgesic drug (Paracetamol involved in 30% of drug overdoses), (c) 23% antidepressants (18% SSRI), (d) Paracetamol was involved in 33% of overdoses by women and 23% of overdoses by men.


It is clear that there are major associations between suicidal behaviour and alcohol or drug abuse.  There is a higher risk if there is an easily available method and higher risk in populations of persons who are depressed and persons with schizophrenia.  Hopelessness is closely associated with suicidal behaviour.  Other factors include narcissistic wounds to the personality i.e. shame or public humiliation.  Imitation plays a role for example after Marilyn Monroe’s death. Unemployment and genetic factors are also important.  The social contact factors include anomie, alienation, western industrialised societies, sense of meaningless in life, ‘worship of the Euro’, a history of sexual abuse, drop out from education, and bullying can also be factors.  Other factors include poor problem solving skills, relationship problems and loneliness, as well as having a history of impulsivity and Attention Deficit Hyperactivity Disorder.  Another condition sometimes involved is persons with Asperger’s syndrome, which is a social relationship disorder.  Personality features associated with suicide and behaviour include antisocial behaviour, emotional dysregulation, and depressive personality.


Males are at increased risk of suicide because it is harder for them to find an identity in our society and they often have a sense of being lost.  They have greater difficulties in expressing their feelings particularly emotional feelings and describing interpersonal difficulties.  The female has better verbal skills, better empathy, better interpersonal skills than the male and this is important in reducing completed suicide. The male mind is more of a mechanical mind which is less good at emotional processing.


Almost anything can be a warning sign of suicidal behaviour in adolescents but the following have been noted:  truancy, poor school performance, anxiety and depression, withdrawn behaviour, change in behaviour, sleep disturbance, impulsiveness, and low frustration tolerance.  Protective factors against suicidal behaviour include prior experience of self-mastery and success, good mental health, and healthy socialising and coping strategies, as well as success at school and work.


In assessing the adolescent with possible suicidal ideas or actual suicidal ideas it is important first to listen and then not to panic and to realise that purely legalistic thinking will interfere with one’s ability to listen to the patient.  It is important to ask relevant questions including thoughts and intensions about suicide, plans, wills, available methods, family history of suicide, imitation issues, depression, and hopelessness.  If a school teacher or anybody else becomes aware that an adolescent is suicidal it is important to remain in touch with them to give them a telephone number or mobile and to take action to bring the matter to the attention of their family.  It is one of the few areas were confidentiality to a friend does not apply. Keeping the friend alive is all that matters.  The adolescent will often need to get first in touch with their G.P. and then with a Psychiatrist or Psychotherapist / Counsellor to deal with the matters that are concerning them.  Sometimes these contacts need to be on a daily basis in the early stages of treatment.


In terms of postvention that is dealing with a family post suicide it is important to avoid fault finding or blame. Truthfulness is very important. The family need time to work through the feelings they have in relation to the suicide and this may reduce the likelihood of intergenerational effects later on.


In terms of suicide prevention in schools it is important that adolescents are helped to deal with stress and distress and learn life skills.  They have to be thought to manage stress, loss, how to manage upset of a break-up of a relationship, and academic problems.  Developing problem solving is critical.  Some isolated students also need very much to develop social skills and active programmes to prevent bullying in school are of critical importance.