Preventing suicides

Statistics for 1990-91 show a suicide rate in Canada of 13 per 100,000, with four times more men than women completing the act, but more women attempting it. For children under age 14, the suicide rate is very low, rising at age 14-19 to 11-13 per 100,000 for males and one to three per 100,000 for females. Of those who try to kill themselves, one in 25 succeeds, and there are repeat tries in six to 16 per cent of suicide attempters. A suicide attempt may be a call for help or represent a final gesture of hopelessness and the decision to “end it all.” Of methods used in Canada, firearms top the list for males, followed by suffocation (hanging, drowning), piercing with a sharp instrument and poisonings. In females, poisonings are the most frequent method, followed by hanging, jumping from heights and suffocation.

Suicides are especially common among aboriginal populations. Death by suicide among Canada’s native Indian population is almost four times higher than for the rest of Canada, half the suicides being in the 15-24 age range, sometimes occurring in clusters. One suicide often sets the stage for more – perhaps by making it appear as “permissible” behavior. Contributing factors are the loss of traditional values, religion and culture; alcoholism, dysfunctional families and poor adult role models.

Adolescence is an especially vulnerable period

Adolescence is a particular danger time for suicide as it’s a period of change and challenge. One U.S. study found that 1020 per cent of 15-19 year-olds had “some suicidal thoughts and intentions;”a French study of 13-16 years olds found that one in 20 boys and one in 10 girls frequently “thought about suicide.” In an Ontario survey, the prevalence of suicidal behavior or thoughts was 5-10 per cent in boys, 10-20 per cent among girls.

Those most at risk for committing suicide:

* native populations, such as Indians, Metis and the Inuit;

* the bereaved – those who have suffered the recent loss of a close family member or friend;

* alcohol and other substance abusers;

* those from dysfunctional homes with a disrupted family life or hostile relationships;

* persons with a history of previous suicide attempts or with relatives who committed suicide;

* isolated people with no social support network (family, spouse, friends, church group);

* those with a major depressive illness.

Factors commonly linked to suicide

Conditions thought to play a role in suicide include: unemployment, broken homes, low morale, social chaos and mental illness. Retrospective studies show that up to 80-90 per cent of suicides had definable psychiatric problems such as major depression (not just sadness), bipolar disorder (manicdepression), anxiety disorders or schizophrenia. Substance abuse, especially of alcohol, may contribute by undermining personal functioning and social relationships and by encouraging impulsive, self-destructive acts.

Social factors also count. Isolated individuals without a network., of supportive friends are at the highest risk. Some experts call suicide a “deficiency disease” – a lack of close friendships and social connections. Among adolescents, low self-esteem and anxiety arising from the changes experienced often lead to thoughts of self-destruction. Given their inexperience, young people may not realize that disappointments and setbacks are part of everyday life and can be overcome. Poor job prospects, marriage breakdown, moving house and family violence are also known to increase suicide risks. Only now are we beginning to recognize sexual abuse as a cause of suicide. Besides stressful life events and emotional fluctuations, means of self-destruction close at hand – such as firearms or potentially toxic medications – increase suicide rates.

Another risk factor is “contagion,” following knowledge or publicity about suicide in others, especially eminent persons or schoolmates. Media publicity about suicide is often followed by a “rash” or cluster of teen suicides – maybe because it seems to make the behavior “condoned” or persuades vulnerable youngsters to mimic it. Repeated or sensationalized media stories of suicide have a greater impact in precipitating more suicides than a single report about the incident.

Warning signs or markers for suicide

Talk of suicide is often a plea for help and should never be taken lightly. Studies reveal that two thirds of successful suicides had hinted at their intention before carrying it out. Any expressed wish to end life must be taken seriously and never dismissed as an idle threat. At the slightest hint, seek professional help. Far from being impulsive “spur-of-the-moment” actions, most suicides are carefully planned. Yet parents often remain oblivious to their youngster’s suicidal thoughts, less aware of their dejected feelings than peers. Physicians, families and teachers should be on the alert for signs of suicidal intent sadness, hopelessness, lack of energy, loss of interest in friends, school or hobbies, irritability, conduct disorders (such as truancy), emotional disturbances and mood swings. Be particularly suspicious when someone’s previously gloomy mood suddenly changes to cheerfulness without sufficient reason. This is often a sign that the person has finally resolved to commit suicide and is relieved that the decision is made.

There is a growing recognition that even children aged five to six can already harbor suicidal ideas. In many teens who attempt suicide, a vulnerability already present in childhood is exacerbated by the demands of adolescence and by family conflicts (if the parents fail to deal adequately with the teenager’s developmental process). The background scenario may include alcoholic or abusive parents, unwanted stepparents, divorce or death of a cherished person. However, many suicide attempters (and completers) are not “social misfits” but ordinary, anxious teenagers. They may feel increasingly distanced from the family, friends and society – becoming “loners.” The final triggering event may be a failed exam, loss of a boy/girlfriend, a broken friendship or a family quarrel. Family cohesion appears to be a protective influence. The easiest way to ferret out suicidal thoughts is to ask whether the teenager has ever thought of “ending it all.” Don’t be afraid to raise the question for fear of putting ideas into the person’s head. Some may come right out and confess suicidal intent, most will talk about other forms of distress. Encourage adolescents to speak about what’s troubling them. Try asking:

* Have you ever felt that life is “not worth living?”

* How long has the feeling been there? Is it increasing in intensity?

* Have you formed any specific plans for killing yourself?. Access 10 firearms greatly increases suicide risks Access to means of suicide, especially firearms, will endanger those at risk and can help them to succeed in killing themselves. Owners of firearms should weigh their reasons for keeping a gun at home against the possibility that it might some day be used for the suicide of their children. Attempts at suicide are a warning sign of future tries – the risk being higher with someone who attempted suicide in a remote site with little chance of discovery. For such instances, family and educators should be especially vigilant and seek counselling for the teen.

Depression is a frequent factor in suicide

Depression is more common during adolescence than hitherto recognized and a frequent reason for suicide attempts. Most specialists believe that childhood depression can be as severe as in adults, but it can be hard to recognize the depth of despondency felt by some young people because their apparent “coolness” or air of invincibility hides the inner despair. Tragically, parents and other adults may overlook it because they expect adolescence to be a time of turmoil.

Depression in adolescents may vary from mood swings to chronic feelings of worthlessness, helplessness and hopelessness. Depressed adolescents often appear angry and rebellious rather than despondent, with “acting-out” behaviors such as rudeness, risk-taking, running away. Alerting signs include withdrawal from the family, non-communication, loss of interest in usual activities, changes in sleep and eating patterns. While depressed adolescents who “act out” with misconduct are greeted with disapproval and annoyance, by contrast many depressed adults receive sympathy ! Factors involved in adolescent depression:

* Decreased self-worth – real or perceived achievements falling short of aspirations;

* significant loss – death of a loved relative or boyfriend/ girlfriend, separation or divorce of parents;

* inability to cope with developmental tasks of adolescence;

* parental substance abuse, family conflicts or poor communication;

* social isolation – real or imaginary rejection by peers.

Signs of adolescent depression:

* a perpetually sad or worried expression;

* loss of interest or pleasure in all activities;

* refusal to go to school, socialize with peers;

* low energy all day, every day;

* declining schoolwork;

* rapid mood swings, irritability, angry outbursts;

* glum view of future and own relationship to it;

* poor self-image, excessive self-criticism;

* lack of stress-coping skills – whereby the slightest challenge may seem overwhelming;

* a wish to be “left alone.”

* Physiological changes (psychosomatic clues):

* insomnia or excessive need for sleep, fatigue;

* anorexia and weight loss (even if not dieting);

* headaches, abdominal pain.

Suicide-proofing: preventive measures

The best preventive strategy is to promote the mental health and self-esteem of adolescents, to try and identify troubled youngsters at home or in school and to make counselling and mental-health care available to them via teen clinics and mental-healthcare providers. There’s a crying need for more suicide-proofing. “Rather than taking a blunderbuss approach to all schoolchildren,” says one educationalist, “we must make efforts to screen for and identify vulnerable adolescents.” This means training parents and educators to recognize mentally ill youth at particular risk – such as those who are depressed or suffering from schizophrenia, anxiety and other disorders.

It’s also vital to curb publicity about teen suicides. In order to forestall a copy-cat rash of suicides, the press might be persuaded to act responsibly and restrict themselves to single, rather than multiple, sensationalized, statements about suicide, preferably not putting them on the front page or siring them at prime viewing time – and not casting suicides in a heroic or flattering light.

Schools and communities might have a preventive contingency plan in case of a suicide cluster, rather than taking a “wait-and-see” approach. Families can help by showing concern, interest and empathy. There’s often a tendency by parents and teachers to brush aside the possible danger of suicide, a reluctance to intervene or say anything in case of worsening the problem. But if an adolescent talks or even hints of suicide or has other warning signs, it’s imperative to seek professional help so that the risks can be assessed and real “intent” separated from fleeting thoughts. Anyone who is worried about a youngster’s suicidal intent should guide the adolescent to expert assistance.

A thorough examination by a child psychiatrist, psychologist or mental health team can determine if an adolescent is truly suicidal. Handling suicidal people deftly depends on familiarity with the person, a good psychiatric assessment and supportive therapy. People who admit that they have definite plans to commit suicide should not be left alone and in many cases are best admitted to hospital. Follow-up of suicide attempts is essential – with counselling and attention to improving school and family relationships. Help for despondent teens is available via pediatricians, psychiatrists, school counsellors and telephone hotlines. Make sure the numbers are posted and accessible.

Indigenous or aboriginal native populations are in special need of suicide-prevention strategies. Because of poverty, poor education and unemployment, many have a low sense of self-worth and try to escape via alcohol use and/or suicide tries. They need native-run crisis centers, special training schemes, education in traditional practices that can promote self-esteem and help to redefine an individual’s “purpose in life.” Communities must also provide recreational facilities and gathering places where young people can meet, enjoy and define themselves freely, without adults present. Many teenagers complain of a lack of privacy, “no place to be on their own,” away from the ever-watchful gaze of adults. Teenagers typically say they feel as though they’re constantly under scrutiny and not trusted or allowed to develop autonomy. Suicide|prevention strategies might also include efforts to make lethal methods – such as firearms, poisonous exhaust gases and medications less available – by stricter gun laws, detoxifying car exhaust, restricting access to medications and subway lines.

Boosting adolescent self-esteem crucial

Every decision made by young people is influenced by the way they feel about themselves. To prevent suicide, we must promote self-confidence among adolescents so they can better avail themselves of openings and opportunities. Instead of the common tendency to dismiss youth as “callow,” “superficial” or “self-indulgent,” we should value their abundant energy and creative potential, explore their thought styles and try to understand the current teen culture. We should tap young people’s amazing energy, originality and enthusiasm to run their own peer counselling and support groups. Every positive action or contribution by adolescents should be recognized and praised by relatives, teachers, employers and health professionals. We must do all we can to make youth feel respected, listen to their opinions and treat them as valued members of society encouraging them to participate in the decision-making at home, in school, at work and in the community.

(For more on depression see Health News February 1987 issue.)

Possible hints of suicidal intent:

* suicidal letters, quotes, poems, diary-entries – any references to death or suicide, even in jest;

* understated or vague allusions to “being better off dead” or “being a burden”- which may remain unvoiced unless someone inquires;

* sense of hopelessness and a bleak view of the future;

* irritability, angry outbursts, hostility at self or others;

* “acting out”- anti-social attitude, conduct disorders, rebellion, truancy, running away;

* pervasive fatigue, low energy, insomnia;

* boredom, loss of interest in usual activities;

* excessive guilt and expressions of unworthiness;

* expressed fears of “becoming insane,” “losing control,” “hurting others;”

* giving away cherished possessions, for no apparent reason;

* inappropriate preoccupation with making a will;

* a sudden tranquillity or cheery mood in the formerly depressed indicating that death has been accepted.

Factors that may trigger suicide.

* loss or death of a “significant” person;

* break-up of an intimate relationship with a friend, relative, girlfriend or boyfriend;

* divorce or separation of parents;

* too few rules, boundaries or guidelines in the family;

* overly high parental expectations;

* disciplinary incidents at school or at home;

* family turmoil, quarrels or disputes;

* obsessive perfectionism and anxiety about falling short of expectations (their own or those of parents);

* reduced school performance – an inability to achieve or maintain a valued position or to get good grades;

* low self-esteem, feelings of failure;

* truancy, running away, theft, substance abuse;

* inability to cope with stress;

* physical or sexual abuse/assault;

* publicity about suicide in others -“cluster” effect;

* mental illness (e.g., anxiety disorders, schizophrenia, depression).

COPYRIGHT 1993 Strategic Inc. Communications Ltd.

COPYRIGHT 2004 Gale Group

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