For many youngsters adolescence is a time of limited responsibilities and excessive fun where the biggest problem is deciding what to wear to Saturday night’s party. But not all teens find adolescence as trouble-free and easy as many perceive it to be. The tumultuous emotions that accompany puberty and all its changes, the deep need for acceptance by one’s peers, the hard task of forming a separate identity from one’s family and the increasing pressures society exerts on teens of today are contributing to more and more South African teens attempting suicide in what should, theoretically be, the happiest days of their lives.
For some adolescents, returning to school is a prospect filled with potential anxiety and additional stress. The uncertainty of a new year, in a new class, with different classmates, is fraught with feelings of loneliness and the pressure to “fit in” and re-establish relationships. The transition from primary to secondary school is often a change that many already vulnerable teenagers find difficult to cope with. Academic and social pressure escalate dramatically, often beyond the scope of an adolescent’s established coping mechanisms. With the new school term looming, issues of teen pressure and a possible devastating means of escape are highlighted once again.
Sonja is one such troubled teen who felt the academic and social pressures of her teen years too strongly and attempted suicide a number of times before eventually getting help. Pretty, intelligent and popular to the outsider, Sonja appeared to have it all. However, behind her mask she was hiding extreme emotional pain stemming from sexual abuse she had experienced as a child. Upon reaching high school, Sonja developed bulimia and finally, unable to handle the mounting pressure of her environment, made several suicide attempts. Her turning point came when she started to attend therapy and develop a trusting relationship with an understanding therapist. In this secure environment she was able to work through her self-destructive emotions that she was fostering because of the abuse. She had internalised all guilt and blame from the incident and was suffering from severe clinical depression. After a long process of intensive therapy, Sonja was finally able to let go of the demons of her past. She is now more stable and is completing an Honours degree in Sociology.
Sonja’s story is a successful one but there are many other teens that are not as lucky as she was. Sonja had to make several suicide attempts before someone finally understood her plea. Troubled teenagers are often calling out for our help in many different ways but we are blind to their warning signals. One of the most important ways in which we can help troubled teens is by watching out for suicidal warning signals and intervening with appropriate help.
Contrary to the popular notion, suicide is very seldom an impulsive act. The vast majority of people who try to commit suicide go through a four-stage process of attempts at less drastic adaptive behavioural strategies before attempting suicide. The four stages are rebelling, withdrawal into oneself, running away from home and finally attempting suicide. In only rare cases does a person attempting suicide not employ a variety of coping strategies prior to the suicidal act.
There are a number of behavioural changes to look out for in troubled teens. Declining grades, extreme behaviour and mood change (persistent depression), loss of previous interests, risk-taking behaviour, drug or alcohol use, social withdrawal and a break in a key relationship could be signs that a teen is moving towards suicidal behaviour. Interestingly enough, behavioural risk factors for suicide can differ significantly between teen boys and girls. A recent American study found that demonstration of aggressive behaviour, school misconduct and experiencing or perpetrating forcible sex were behaviours most strongly associated with suicidality among boys, whilst, on the other hand, over-the-counter drugs use and cigarette smoking were the behaviours most predictive of suicidality among girls. Similarly, boys are far more likely to make use of violent means to commit suicide (e.g.: hanging, shooting) whilst girls tend to use less violent methods (e.g.: pill overdose).
South African research into risk-taking behaviour in this age group established that almost 20% of a high-school sample had thought about harming themselves in a way that could have led to death, in the 12 months preceding the study. In another study, data from South African youths in the 15-19 age group found that approximately 10% of all deaths are attributable to suicide*. In Tembisa 17 seemingly normal youngsters have committed suicide during this year alone and the community has formed a committee to try and understand why this is happening.
The Gauteng-based Depression and Anxiety Support Group has recently launched a successful school programme to combat the increasingly high numbers of teen suicides which have been reported. The programme involves professionals visiting both black and white schools and educating teachers and pupils on suicide, the warning signs and the effective help that is available. The Support Group hopes to increase awareness of teen suicide as well as sending out the message that there is help available.
* Reference: Fisher AJ, Ziervogel FG, Chalton DO, Leger PH, Robertson BA, SAMJ 1993; 83: 474-476