Suicide is a major public health problem in the United States, and
suicide
and attempted suicide are important causes of morbidity and mortality
in
adolescents. It is important for clinicians to recognize risk factors
for
suicide and to screen all adolescents for suicidal thoughts and
feelings.
Outlined here are the important facts about adolescents and suicide.
Epidemiology
More people die from suicide than from
homicide: In 1998, there were 1.7 times as many suicides as homicides.
Overall, suicide is the 8th
leading cause of death for all Americans in the United States
Approximately 500,000 people need
emergency room treatment as a result of attempted suicide
For young people, 15-24 years of age,
suicide is the 3rd leading cause of death.
Suicide has increased in prevalence in
younger children as well- it is the 4th leading cause of
death in the 10 to 14 year old age group.
Adolescent females are more likely to
attempt suicide.
Adolescent males are more likely to
complete suicide, actually they are 4 times more likely to complete
suicide than females.
White and Native American populations
have significantly higher rates of suicide than African American,
Latino or Asian populations.
Gay youth may be 2 to 3 times more
likely to attempt suicide as compared to their peers. This is more
prevalent in homosexual/bisexual males, who in some studies have been
found to be 7 time more likely to have suicide attempts.
Risk and
Protective
Factors
Risk factors:
Personal
Mood Disorder
Alcohol and/or substance abuse
Conduct disorder
Personality disorders
Impulsive behavior
Violent behavior
Chronic physical illness
Being isolated
Real or imagined loss (relationships,
school or financial losses)
Gay, lesbian, bisexual, transgender or
questioning youth, especially males
Previous suicide attempt
Family
Physical or sexual abuse of children
in the family
Family history of mental health issues
or substance abuse
Family history of suicidal behavior
Familial conflict and stress (death,
divorce)
Environmental
Access to lethal methods (especially
firearms)
Local suicide epidemics
Barriers to access mental health
treatment
Protective Factors:
Personal
Problem solving skills
Religious beliefs
Academic achievement
Familial
Family support and connectedness
Environmental
Support from medical and mental health
providers
No access to lethal methods
Community and school
support/connectedness
Prevention
and
intervention strategies
Questions to assess risk of
suicide: mnemonic “is path warm”
Ideation — Talking about
or threatening to kill or hurt oneself; looking for ways to kill
oneself; talking or writing about death, dying or suicide
abuse
— Increased substance use
Purposelessness
Anxiety — Anxiety,
agitation, or changes in sleep pattern
Trapped — Feeling like
there is no way out
Hopelessness
Withdrawal — Withdrawing
from friends, family, and society
Anger
Recklessness
Mood changes
There is no evidence that asking about
suicide will bring about suicidal behavior.
Suicidal comments MUST be discussed
with any teen.
Common symptoms: frequent crying,
isolation, weight loss or gain, fatigue, insomnia.
Some symptoms are more common in
adolescents: irritability, behavior problems, violence issues, vague
systemic complaints like headache, abdominal pain, syncope
Always ask about grades, drug abuse,
sexual promiscuity and truancy. These may be clues to possible suicidal
behavior
If a teen admits to suicidal thoughts,
ask if he or she has plans, a means to commit suicide, and if there are
prior attempts.
Adolescents must be made aware that
this is one of the rare occasions in which strict confidentiality may
not be kept. This will have to be assessed on an individual case basis
assessment of risk.
For adolescents at low risk-those
feeling sad, but who have no plans of history of attempts, should have
an appointment set up with a mental health professional.
For those who are at moderate or high
risk, an emergent evaluation by a mental health professional is in
order.
An actively suicidal adolescent needs
a complete medical and psychiatric evaluation as well as initiation in
a controlled setting. Interventions are going to depend on the needs
and resources of specific patients. Is the family supportive? Is there
a history of prior attempts? Does the patient have co-morbid drug or
alcohol abuse?
It is vital that clinicians address the issue of
suicide or
depression with their adolescent patients. There must be questions
addressed at
the risk factors outlined previously in order to help in assessing
teens at
risk. Clinicians must integrate questions regarding family functioning,
psychiatric illness, sexual orientation and access to firearms in
routine care.
Antidepressants
on
Suicide Risk in Adolescents
Studies have shown that
there is a slightly increased risk of suicidal thoughts and behaviors
among a small group of children and adolescents treated with
antidepressant medications compared to placebo. Currently, the evidence
is inadequate to conclusively establish this association
The risks of
antidepressant-associated suicidality must be weighed against the
benefits of treatment and the long-term risk of suicide in untreated
depression. Current consensus among most mental health specialists is
that the benefits of treatment with antidepressants outweigh the risks.
Treatment with
antidepressants requires close monitoring.