| INTRODUCTIONSuicide is one of the commonest | | | | The suicidal person is ambivalent - part of him wants |
| causes of death among young people. The latest | | | | to live and part of him wants not so much death as he |
| mean worldwide annual rates of suicide per 100,000 | | | | wants the pain to end. It is the part that wants to live |
| are 0.5 for females and 0.9 for males among | | | | that tells another "I feel suicidal." If a suicidal person |
| 5-14-year-olds, and 12.0 for females and 14.2 for males | | | | turns to you it is likely that he believes that you are |
| among 15-24-year-olds. Suicide is the sixth leading | | | | more caring, more informed about coping with |
| cause of death among children aged 5-14 years, and | | | | misfortune, and more willing to protect his confidentiality. |
| the third leading cause of death among all those 15-24 | | | | No matter how negative the manner and content of |
| years old. In most countries, males outnumber females | | | | his talk, he is doing a positive thing and has a positive |
| in youth suicide statistics. There are far more suicidal | | | | view of you.3. Be willing to give and get help sooner |
| attempts and gestures than actual completed suicides. | | | | rather than later. |
| One epidemiological study estimated that there were | | | | Suicide prevention is not a last minute activity. |
| 23 suicidal gestures and attempts for every completed | | | | Unfortunately, suicidal people are afraid that trying to |
| suicide. Though female teens are much more likely to | | | | get help may bring them more pain: being told they are |
| attempt suicide than males, male teens are more likely | | | | stupid, foolish, sinful, or manipulative; rejection; |
| to actually kill themselves. The suicide rate among | | | | punishment; suspension from school; written records of |
| young teens and young adults has increased by more | | | | their condition; or involuntary commitment. You need to |
| than 300% in the last three decades.RISK FACTORS | | | | do everything you can to reduce pain, rather than |
| FOR SUICIDEContrary to popular belief, suicide is not | | | | increase or prolong it. Constructively involving yourself |
| an impulsive act but the result of a three-step process: | | | | on the side of life as early as possible will reduce the |
| a previous history of problems is compounded by | | | | risk of suicide.4. Listen. |
| problems associated with adolescence; finally, a | | | | Give the person every opportunity to unburden his |
| precipitating event, often a death or the end of a | | | | troubles and ventilate his feelings. You don't need to |
| meaningful relationship, triggers the suicide. The major, | | | | say much and there are no magic words. If you are |
| empirically proven risk actors for suicide among | | | | concerned, your voice and manner will show it. Give |
| adolescents are detailed below.PERSONAL | | | | him relief from being alone with his pain; let him know |
| CHARACTERISTICSPsychopathology: | | | | you are glad he turned to you. At times everyone |
| More than 90% of youth suicides and around 60% of | | | | feels sad, hurt, or hopeless. You know what that's like; |
| younger adolescent suicide victims have had at least | | | | share your feelings. Let the child know he or she is not |
| one major psychiatric disorder. The most prevalent | | | | alone. Avoid arguments and advice giving. If the child's |
| disorder in adolescent suicide victims is depressive | | | | words or actions scare you, tell him or her. If you're |
| disorders. Depression that seems to quickly disappear | | | | worried or don't know what to do, say so.5. ASK: "Are |
| for no apparent reason is a cause for concern, and | | | | you having thoughts of suicide?" |
| the early stages of recovery from depression can be | | | | Myth: "Talking about it may give someone the idea." |
| a high risk period. Substance abuse, conduct disorder, | | | | People already have the idea; suicide is constantly in |
| posttraumatic stress disorder and panic attacks are | | | | the media. If you ask a despairing person this question |
| the other disorders found to be common in this | | | | you are doing a good thing for them: you are showing |
| population.Previous suicide attempts: | | | | him that you care about him, that you take him |
| A history of prior suicide attempts is one of the | | | | seriously, and that you are willing to let him share his |
| strongest predictors of completed suicide, especially in | | | | pain with you. You are giving him further opportunity to |
| boys. One quarter to one third of teen suicide victims | | | | discharge pent up and painful feelings. If the person is |
| have made a previous suicide attempt.Cognitive and | | | | having thoughts of suicide, find out how far along his |
| personality factors: | | | | ideation has progressed.6. If the person is acutely |
| Hopelessness, poor interpersonal problem solving | | | | suicidal, do not leave him alone. |
| ability and aggressive impulsive behaviour have been | | | | If the means are present, try to get rid of them. |
| linked with suicidality.Biological factors: | | | | Detoxify the school or home.7. Urge professional help. |
| Some teens are at greater risk for suicide because | | | | Persistence and patience may be needed to seek, |
| of their biochemical makeup. Abnormalities in the | | | | engage and continue with as many options as possible. |
| function of serotonin, a neurotransmitter, have been | | | | In any referral situation, let the person know you care |
| associated with suicidal behaviour.FAMILY | | | | and want to maintain contact.8. No secrets. |
| CHARACTERISTICSFamily history of suicidal | | | | It is the part of the person that is afraid of more pain |
| behaviour: | | | | that says "Don't tell anyone." It is the part that wants to |
| Teens who kill themselves have often had a close | | | | stay alive that tells you about it. Respond to that part |
| family member who attempted or committed | | | | of the person and persistently seek out a mature and |
| suicide.Parental psychopathology: | | | | compassionate person with whom you can review the |
| High rates of parental psychopathology, particularly | | | | situation. Distributing the anxieties and responsibilities of |
| depression and substance abuse, have been found to | | | | suicide prevention makes it easier and much more |
| be associated with completed suicide and suicidal | | | | effective.Interventions with a suicidal student:Schools |
| ideation and attempts in adolescents. Moreover, family | | | | should have a written protocol for dealing with a |
| cohesion has been reported to be a protective factor | | | | student who shows signs of suicidal or other |
| for suicidal behaviour among adolescents.ADVERSE | | | | dangerous behavior. The following steps may be |
| LIFE CIRCUMSTANCESStressful life events: | | | | effective in dealing with a student who expresses |
| Life stressors such as interpersonal losses and legal | | | | active suicidal intent.1. Calm the immediate crisis |
| or disciplinary problems are associated with completed | | | | situation. Do not leave the suicidal student alone even |
| suicide and suicide attempts in adolescents. The | | | | for a minute. Ask whether he or she is in possession |
| anniversary of a loss can also evoke a powerful | | | | of any potentially dangerous objects or medications. If |
| desire to commit suicide.Physical abuse: | | | | the student has dangerous items on his person, be |
| Childhood physical abuse has been found to be | | | | calm and try to verbally persuade the student to give |
| associated with increased risk of suicide attempts in | | | | them to you. Do not engage in a physical struggle to |
| late adolescence and early | | | | get the items. Call administration or the designated |
| adulthood.SOCIOECONOMIC AND CONTEXTUAL | | | | crisis team. Escort the student away from other |
| FACTORSSchool and work problems: | | | | students to a safe place where the crisis team |
| Difficulties in school, neither working nor being in school, | | | | members can talk to him. Be sure that there is access |
| dropping out of high school and not attending college | | | | to a telephone.2. The crisis individuals then interview the |
| pose significant risks for completed suicide.Contagion | | | | student and determine the potential risk for suicide. |
| Imitation: | | | | a. If the student is holding on to dangerous items, it is |
| Teens are more likely to kill themselves if they have | | | | the highest risk situation. Staff should call an |
| recently read, seen, or heard about other suicide | | | | ambulance, the police and the student's parents. Staff |
| attempts. Evidence continues to amass from studies | | | | should try to calm the student and ask for the |
| of suicide clusters and the impact of the media, | | | | dangerous items. |
| supporting the existence of suicide contagion. The | | | | b. If the student has no dangerous objects, but |
| impact of suicide stories on subsequent competed | | | | appears to be an immediate suicide risk, it would be |
| suicides appears to be greatest for | | | | considered a high-risk situation. If the student is upset |
| teenagers.PREVENTION STRATEGIESYouth suicide | | | | because of physical or sexual abuse, staff should |
| prevention strategies have primarily been implemented | | | | notify the appropriate school personnel and contact |
| within three domains - school, community, and health | | | | the police. If there is no evidence of abuse or neglect, |
| are systems. This article reviews the school-based | | | | staff should contact parents and ask them to come in |
| programs.SCHOOL-BASED SUICIDE PREVENTION | | | | to pick up their child. Staff should inform them fully |
| PROGRAMSSchool based suicide prevention | | | | about the situation and strongly encourage them to |
| programs include both curricula components to teach | | | | take their child to a mental health professional for an |
| students about these warning signs and what to do, as | | | | evaluation. The team should give the parents a list of |
| well as non-curricula components such as peer groups, | | | | telephone numbers of crisis clinics. If the school is |
| hot lines, intervention services and parent training. | | | | unable to contact parents, and if the police cannot |
| Prevention includes education efforts to alert students | | | | intervene, designated staff should take the student to |
| and the community to the problem of teen suicidal | | | | a nearby emergency room. |
| behavior. Intervention with a suicidal student is aimed at | | | | c. If the student has had suicidal thoughts but does not |
| protecting and helping the student who is currently in | | | | seem likely to hurt himself in the near future, the risk is |
| distress. Postvention occurs after there has been a | | | | more moderate. If abuse or neglect is involved, staff |
| suicide in the school community. It attempts to help | | | | should proceed as in the high-risk process. If there is |
| those affected by the recent suicide. In all cases it is a | | | | no evidence of abuse, the parents should still be called |
| good idea to have a clear plan in place in advance. It | | | | to come in. They should be encouraged to take their |
| should involve staff members and administration. There | | | | child for an immediate evaluation. |
| should be clear protocols and clear lines of | | | | d. Follow-Up: It is important to document all actions |
| communication. Careful planning can make | | | | taken. The crisis team may meet after the incident to |
| interventions more organized, and effective.The goals | | | | go over the situation. Friends of the student should be |
| of school based suicide prevention programs are to:* | | | | given some limited information about what has |
| Increase awareness | | | | transpired. Designated staff should follow up with the |
| * Promote identification of students at high risk of | | | | student and parents to determine whether the student |
| suicide and suicide attempts | | | | is receiving appropriate mental health services. |
| * Provide knowledge about the behavioral | | | | Follow-up is crucial, because most suicides occur within |
| characteristics ("warning signs") of teens at risk for | | | | three months of the beginning of improvement in |
| suicide. | | | | depressive symptoms, when the youth has the energy |
| * Provide information to students, teachers and | | | | to carry out plans conceived earlier. Regularly |
| parents on the availability of mental health resources | | | | scheduled supportive counseling should be provided to |
| * Enhance the coping abilities of teenagersEducation: | | | | teach the youth coping mechanisms for managing |
| Education may be done in a health class, by the | | | | stress accompanying a life crisis, as well as |
| school counselor or outside speakers. Education should | | | | day-to-day stress.Role of the teachers:Teachers play |
| address the factors that make individuals more | | | | an especially important part in prevention, because |
| vulnerable to suicidal thoughts. Education regarding the | | | | they spend so much time with their students. Along |
| ill effects of drug and alcohol abuse would be useful. | | | | with holding parent-teacher meetings to discuss |
| PTA meetings can be used to educate parents about | | | | teenage suicide prevention, teachers can form referral |
| depression and suicidal behavior. Parents should be | | | | networks with mental health professionals. They can |
| educated about the risk of unsecured firearms in the | | | | increase student awareness by introducing the topic in |
| home. Outside mental health professionals can discuss | | | | health classes.Some schools have automatic expulsion |
| their programs so that students can see that these | | | | policies for students who engage in illegal or violent |
| individuals are approachable. Education on the following | | | | behavior. It is important to remember that teens who |
| topics will be useful:Warning signs of suicide:* | | | | are violent or abuse drugs may be at increased risk |
| Preoccupation with death and dying | | | | for suicide. If someone is expelled, the school should |
| * Signs of depression | | | | attempt to help the parents arrange immediate and |
| * Taking excessive risks | | | | possibly intensive psychiatric and behavioral |
| * Increased drug use | | | | interventions.Role of the peers:Peers are crucial to |
| * The verbalizing of suicide threats | | | | suicide prevention. According to one survey, 93% of |
| * The giving away of prized personal possessions | | | | the students reported that they would turn to a friend |
| * The collection and discussion of information on | | | | before a teacher, parent or spiritual guide in a time of |
| suicide methods | | | | crisis. Peers can form student support groups and, |
| * The expression of hopelessness, helplessness, and | | | | once educated themselves, can train others to be |
| anger at oneself or the world | | | | peer counselors.Adolescents often will try to support a |
| * Themes of death or depression evident in | | | | suicidal friend by themselves. They may feel bound to |
| conversation, written expressions, reading selections, or | | | | secrecy, or feel that adults are not to be trusted, and |
| artwork | | | | this may delay needed treatment. Ideally, a teenage |
| * The scratching or marking of the body, or other | | | | friend should listen to the suicidal youth in an empathic |
| self-destructive acts | | | | way, but then insist on getting the youth immediate |
| * Acute personality changes, unusual withdrawal, | | | | adult and professional help.Role of the parents:Parents |
| aggressiveness, or moodiness | | | | need to be as open and as attentive as possible to |
| * Sudden dramatic decline or improvement in | | | | their adolescent children's difficulties. The most |
| academic performance, chronic truancy or tardiness, | | | | effective suicide prevention technique parents can |
| or running away | | | | exercise is to maintain open lines of communication |
| * Physical symptoms such as eating disturbances, | | | | with their children. Sometimes teens hide their |
| sleeplessness or excessive sleeping, chronic | | | | problems, not wanting to burden the people they love. It |
| headaches or stomachaches, menstrual irregularities, | | | | is extremely important to assure teens that they can |
| apathetic appearanceSudden changes in behavior that | | | | share their troubles, and gain support in the process. |
| are significant, last for a long time, and are apparent in | | | | Parents are encouraged to talk about suicide with their |
| all or most areas of his or her life (pervasive) are more | | | | children, and to educate themselves by attending |
| specific than presence of isolated signs. However, it | | | | parent-teacher or parent-counselor education sessions |
| should be noted that many completed suicides had | | | | and from nearby libraries or the internet. Once trained, |
| only a few of the conditions listed above, and that all | | | | parents can help to staff a crisis hotline in their |
| indications of suicidality need to be taken seriously in a | | | | community. Parents also need to be involved in the |
| one person to another person situation.Signs of | | | | counseling process if a teen has suicidal tendencies. |
| depression in teens:* Sad, anxious or "empty" mood | | | | These activities may both alleviate parents' fears of |
| * Declining school performance | | | | the unknown and assure teenagers that their parents |
| * Loss of pleasure/interest in social and sports | | | | care.Postvention/crisis intervention:The rationale for |
| activities | | | | school-based postvention/crisis intervention is that a |
| * Sleeping too much or too little | | | | timely response to a suicide is likely to reduce |
| * Changes in weight or appetiteFactors associated | | | | subsequent morbidity and mortality in fellow students, |
| with repeated self harm:* Previous self harm | | | | including suicidality, the onset and exacerbation of |
| * Personality disturbance | | | | psychiatric disorders, and other symptoms related to |
| * Depression | | | | pathological bereavement.The school should have |
| * Alcohol or drug misuse | | | | plans in place to deal with a suicide or other major |
| * Chronic psychosocial problems and behaviour | | | | crisis in the school community. The administration or the |
| disturbance | | | | designated individual should try to get as much |
| * Disturbed family relationships | | | | information as soon as possible. He or she should |
| * Alcohol dependence in the family | | | | meet with teachers and staff to inform them of the |
| * Social isolation | | | | suicide. The teachers or other staff should inform each |
| * Poor school recordHow to support a student with | | | | class of students. It is important that all of the students |
| suicidal thoughts and a low self-esteem?* Listen | | | | hear the same thing. After they have been informed, |
| actively. Teach problem-solving skills | | | | they should have the opportunity to talk about it. Those |
| * Encourage positive thinking. Instead of saying that he | | | | who wish should be excused to talk to crisis |
| cannot do something, he should say that he will try. | | | | counselors. The school should have extra counselors |
| * Help the student write a list of his or her good | | | | available for students and staff who need to talk. |
| qualities. | | | | Students who appear to be the most severely |
| * Give the student opportunities for success. Give as | | | | affected may need parental notification and outside |
| much praise as possible | | | | mental health referrals. Rumor control is important. |
| * Help the student set up a step-by-step plan to | | | | There should be a designated person to deal with the |
| achieve his goals. | | | | media. Refusing to talk to the media takes away the |
| * Talk to the family so that they can understand how | | | | chance to influence what information will be in the |
| the student is feeling. | | | | news. One should remind the media reporters that |
| * He or she might benefit from assertiveness training | | | | sensational reporting has the potential for increasing a |
| * Helping others may raise one's self-esteem. | | | | contagion effect. They should ask the media to be |
| * Get the student involved in positive activities in | | | | careful in how they report the incident. Media should |
| school or in the community. | | | | avoid repeated or sensationalistic coverage. They |
| * If appropriate, involve the student's religious | | | | should not provide enough details of the suicide |
| community. | | | | method to create a "how to" description. They should |
| * Make up a contract with rewards for positive and | | | | try not to glorify the individual or present the suicidal |
| new behaviors.What can be done to help someone | | | | behavior as a legitimate strategy for coping with |
| who may be suicidal?:1. Take it seriously. | | | | difficult situations.It is imperative for crisis interventions |
| Myth: "The people who talk about it don't do it." | | | | to be well planned and evaluated; otherwise, not only |
| Studies have found that more than 75% of all | | | | may they not help survivors, but they may potentially |
| completed suicides did things in the few weeks or | | | | exacerbate problems through the induction of |
| months prior to their deaths to indicate to others that | | | | imitation.CONCLUSIONSuicide attempts and completed |
| they were in deep despair. Anyone expressing suicidal | | | | suicides among adolescents are problems of |
| feelings needs immediate attention. | | | | increasing significance. School staff, parents, and health |
| Myth: "Anyone who tries to kill himself has got to be | | | | professionals should be sensitized about the risk |
| crazy." Perhaps 10% of all suicidal people are | | | | factors and warning signs of suicide, and about the |
| psychotic or have delusional beliefs about reality. Most | | | | ways to deal with suicidal adolescents.FURTHER |
| suicidal people suffer from the recognized mental | | | | READING* Gould, M.S., Greenberg, T., Velting, D.M. & |
| illness of depression; but many depressed people | | | | Shaffer, D. (2003) Youth suicide risk and preventive |
| adequately manage their daily affairs. The absence of | | | | interventions: a review of the past 10 years. Journal of |
| "craziness" does not mean the absence of suicide risk. | | | | the American Academy of Child and Adolescent |
| "Those problems weren't enough to commit suicide | | | | Psychiatry, 42, 4, 386-405. |
| over," is often said by people who knew a completed | | | | * Hawton, K. & James, A. (2005) Suicide and |
| suicide. You cannot assume that because you feel | | | | deliberate self harm in young people. British Medical |
| something is not worth being suicidal about, that the | | | | Journal, 330, 891-894. |
| person you are with feels the same way. It is not how | | | | * |
| bad the problem is, but how badly it's hurting the | | | | * |
| person who has it.2. Remember: suicidal behavior is a | | | | * Shahul Ameen, M.D., is a psychiatrist based in |
| cry for help. | | | | Ranchi, India. |
| Myth: "If someone is going to kill himself, nothing can | | | | He edits (a portal for mental health professionals) and |
| stop him." The fact that a person is still alive is | | | | (a portal on mental health for the consumers). |
| sufficient proof that part of him wants to remain alive. | | | | |