Suicide is a serious public health concern in the United States across all ages, particularly for youth, and for those aged 15 to 24 suicide is the third leading cause of death. The Centers for Disease Control and Prevention (CDC) reports that annually approximately 4,600 youth die as a result of suicide, and another 156,000 youth aged 10 to 24 are treated for self-inflicted injuries at emergency rooms. A January 2013 study published in JAMA Psychiatry assessed almost 6,500 teens and found that one in eight contemplated suicide and one in 25 had attempted suicide. A little over one-half of those individuals were receiving mental health treatment.
Suicide in youth is related to many complex risk factors. Research shows that the overwhelming majority of individuals, including teens, who attempt suicide have one or more psychiatric or mental health conditions. Substance abuse disorders may also increase suicide risk. Most youth who live with mental health conditions do not attempt suicide, which means additional stressors and factors often play a role in those who attempt suicide.
Common stressors include an important interpersonal loss, relationship break-ups, victimization and/or humiliation by peers and legal trouble. Some individuals that have an increased risk also have had a history of childhood trauma. The presence of impulsivity, hopelessness, isolation, exposure to someone who has committed suicide, a family history of suicide and prior suicide attempts can also increase risk. Teens that identify as gay, lesbian, bisexual or transgender (GLBT) may have increased risk of suicidal thinking due in part to isolation or criticism from peers.
Access to guns is also an important risk factor. Males aged 15 to 19 have a rate of dying by suicide five times higher than females due in large part to their use of guns during attempts. The CDC reports that firearms account for 46 percent of all youth suicides. Talking with families about gun safety in the home is a growing area of interest in medical and psychiatric settings.
Protective factors can help to reduce the risk of suicide. These include connected and supportive relationships with family, adults and peers. They also include feeling safe at school and having access to good medical and mental health supports. Religion and faith communities can also offer protection. Teens who have good coping skills, are willing to seek help and can trust even one other person have key protective factors. Healthy strategies to deal with distressing feelings can be taught in psychotherapy. Psychotherapy can also help youth understand what triggers feelings of desperation. Effectively treating an underlying psychiatric condition can also promote resiliency and reduce suicide risk. Getting help for substance abuse also reduces suicide risk because abuse increases poor decision making. In most instances, teens can learn how best to create ways to promote their health and mental health.
Suicidal thoughts and actions should always be taken seriously, and a professional assessment should be sought. Research shows that suicidal thoughts are more common than many adults might imagine. Talking about one’s distress is usually helpful, and doing so with loved ones compliments professional support.
A comprehensive approach to treatment planning that engages the youth is essential. There are several effective treatments that have shown promise in promoting coping strategies and therefore, the potential to reducing suicide. Cognitive behavioral therapy (CBT), a form of psychotherapy, helps to reduce automatic and intense negative thinking which can lead to suicidal thoughts. For youth who live with borderline personality disorder, a psychotherapy called dialectical behavior therapy (DBT) has been shown to reduce the outcome of suicide. Connection with a mental health professional that the teen can trust makes all the difference.
Medications may also prove effective in reducing the symptoms of mental illness and thereby in reducing suicide risk. For young adults with bipolar disorder, lithium has shown some promise in reducing suicide. Medications are generally only one piece of a successful treatment plan. Some medicines require a careful risk and benefit assessment. Antidepressants can help to reduce symptoms of depression in youth, but do present some risk. The Food and Drug Administration (FDA) developed a “black box” warning for all antidepressant medications for the increased risk of suicidal thinking in a small percentage of children, youth and young adults. The risk typically exists in the first few months of treatment. In weighing this risk, it is important to remember that untreated depression is a major contributor to suicide. Active monitoring for suicidal thinking is essential in the early stages of treatment for any youth at risk for suicide.
Proactive crisis planning is also important in suicide prevention. For youth at risk of suicide, understanding how to access help during times of risk is essential. For individuals in need of immediate help, one resource is to contact the National Suicide Prevention Lifeline at (800) 273-TALK (8255), available 24 hours a day, seven days a week.
It is important that youth and families know that they are not alone. Resources in high schools, colleges and communities can take many forms. One national resource is NAMI, which has a community of support for youth and families. Youth and young adults seeking support and connection with peers are invited to visit www.strengthofus.org, an online community developed by NAMI and young adults. NAMI Basics is a family educational and support program for parents and caregivers of children and youth who live with mental illness which has been studied and shown to be effective. NAMI Family-to-Family is a 12-week peer led education program which provides support and education to family members of people living with mental illness. Family-to-Family has demonstrated effectiveness in a randomized controlled trial to improve coping strategies for families
Prevention and reducing the risk of youth suicide are important public health concerns. The U.S. Preventive Services Task Force (USPSTF), a federally sponsored organization that works to assess the benefits and risks of preventive screenings, recommends screening for depressive disorders in youth aged 12 to 18. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening children aged 7 to 11 for depressive disorders at this time. The research based on screening for a number of mental health conditions continues to evolve and should help to drive policy decisions in identifying youth at risk of suicide and emerging mental illness.
There are also media guidelines for reporting on suicide. These guidelines help inform media on how best to provide information in a non-sensationalized way. For media guidelines, please visit www.reportingsuicide.org.
Reviewed by Ken Duckworth, M.D., June 2013