Suicide in youth appears to be increasing according to many sources. For example, in 2004, suicide was the third-leading cause of death among youths and young adults aged 10-24 years in the US, accounting for 4599 deaths.
Suicide is one of the leading cause of death in adolescents and young adults.
The SASH (South African Stress and Health Study) conducted between January 2002 and June 2004 including 4185 South African adults indicated the lifetime prevalence rates of suicidal ideation, suicide plans and suicide attempts to be 9%, 3% and 2% respectively.
Relatively little is known about the aetiology and predictors of suicidal ideation and attempts in the South African setting. In all age groups, mental disorders are strong predictors of suicidal behaviour including suicidal ideation and attempts. The SASH Study referred to above utilised the World Health Organization Composite International Diagnostic Interview (CIDI) to, among others, generate psychiatric diagnoses and suicidal behaviour. Sixty-one percent of the total sample that reported suicidal ideation also reported having a prior lifetime DSM-IV disorder.
History of any mental disorder was even higher among respondents who went on to make a suicide plan (64%) and to make a suicide attempt (70%). Further research found the presence of parental psychopathology significantly increased the odds of suicidal behaviour among their adult offspring. The cumulative exposure to adverse childhood experiences also predicts later suicidality. A study conducted amongst 1337 South African university students and published in 2016 indicated that 24% (n=327) of the sample reported some form of suicidal ideation in the two weeks preceding data collection.
Identifying suicidal ideation is essential in the management of suicidal behaviour.
It is known that suicidal ideation is associated with increased risk of fatal and non-fatal suicidal behaviour.
Furthermore suicidal ideation has also been shown to predict impaired psycho-social functioning (e.g. dropping out), poor future psychological health (e.g. depression), and other forms of injury-risk behaviours (e.g. physical fights, sexual behaviour, substance and alcohol abuse) among university students.
Two types of suicidal youth
Suicide attempts in youth may be viewed in two ways: Impulsive suicide or planned suicide.
Impulsive suicide usually occurs in those children and adolescents whom may have been diagnosed with ADHD, a Conduct Disorder or Oppositional Defiant Disorder. Substance use disorder often plays a role as those with a history of impulsive aggression towards others. These children may or may not be depressed.
Planned suicide often occurs with a co-morbid psychiatric disorder like depression or anorexia nervosa. In these cases the suicidal behavior are usually carefully planned and thought out.
Attempts and completion
Generally, it has been shown that although girls make more attempts at suicide, boys use more lethal methods and have more completed suicides. There are about 23 suicide attempts for every completed suicide and one in 10 attempters go on to a completed suicide later.
The South African Depression and Anxiety Group (www.sadag.org) provides a list of possible warning signs of possible teenage suicide.
- Suicidal talk and a previous suicide attempt
- Current talk of suicide or making a plan
- Strong wish to die or a preoccupation with death and dying
- Giving away prized possessions
- Signs of depression, such as moodiness, hopelessness, withdrawal, difficulty with appetite and sleep, and loss of interest in usual activities
- Increased alcohol and/or other drug use
- Hinting about not being around in the future or saying good-bye
- Behavioural changes and taking excessive risks
- Making arrangements to take care of unfinished business.
To contact SADAG, please call 0800 567 567. www.sadag.org
Depression and suicide
According to the American Academy of Child and Adolescent Psychiatry (Fact Sheet No 4, July 2013: The Depressed Child) clinical research is clear that not only do adults become depressed but children and teenagers also may have depression. In modern day medicine depression is a treatable illness in children as in adults. It is estimated that about 5% of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct, or anxiety disorders are at a higher risk for depression. Depression can also be genetic and tends to run in families.
The symptoms of a depressed child or teenager may differ from that of depressed adults. The signs and symptoms of depression in youth may include:
- Frequent sadness, tearfulness, crying
- Decreased interest in activities; or inability to enjoy previously favourite activities
- Persistent boredom; low energy
- Social isolation; poor communication
- Low self-esteem and guilt
- Extreme sensitivity to rejection or failure
- Increased irritability, anger, or hostility
- Difficulty with relationships
- Frequent complaints of physical illnesses such as headaches and stomach aches
- Frequent absences from school or poor performance in school
- Poor concentration
- A major change in eating and/or sleeping patterns
- Talk of or efforts to run away from home
- Thoughts or expressions of suicide or self-destructive behaviour. Depressed children and adolescents are at increased risk for committing suicide.
Assessment and intervention
Several teen-suicide scales exist e.g. the Columbia-Suicide Severity Rating Scale and the Tool for Assessment of Suicide Risk: Adolescent Version Modified (TASR-Am). These are useful tools but can also be cumbersome to use at times. The National Suicide Prevention Lifeline USA (www.sprc.org) devised an easy to use guideline they term SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) for mental health professionals and general practitioners (See Table 2).
Prevention and education
Education and prevention remains the key to the management of Teen-suicide. Vulnerable teenagers should be identified early and social factors associated with suicide managed.
The role of peers and schools are also important. Teens need to be aware of the warning signs of depression and suicidal thoughts. To this effect running Teen-Suicide Prevention Programmes at schools (refer South African Depression and Anxiety Group – SADAG) are highly effective. Worst of all is that adolescents may try to deal with suicidal friends by themselves and if there is a suicide they are left with overwhelming guilt. Not knowing what to do may also delay effective treatment. All schools needs to have some protocol in place on how to deal with the suicidal learner or student. After a suicide a professional crisis team should be called to the school and above all sensationalisation should be controlled to reduce chance of rumour and contagion. Staff and teachers should also have adequate knowledge to identify vulnerable students.
Suicide Assessment – Five-step Evaluation and Triage for Mental Health Professionals
1. IDENTIFY RISK FACTORS
Note those that can be modified to reduce risk
2. IDENTIFY PROTECTIVE FACTORS
Note those that can be enhanced
3. CONDUCT SUICIDE INQUIRY
Suicidal thoughts, plans behaviour and intent
4. DETERMINE RISK LEVEL/INTERVENTION
Determine risk. Choose appropriate intervention to address and reduce risk
Assessment of risk, rationale, intervention and follow-up.
Author: Dr Frans Korb