Suicide is the eighth leading cause of death for all persons regardless of age, sex or race; the third leading cause of death for young people aged 15 to 24; and the fourth leading cause of death for persons between the ages of 10 and 14. The rates of youth suicide had been declining since 1994, but the numbers are rising dramatically. Are the good intentions of the FDA to blame?
Each year, there are approximately 12 suicides for every 100,000 adolescents. A recent CDC study reported that 27% of high school students said they had thought seriously about killing themselves during the past year. 8% said they had actually tried to kill themselves.
Although suicide is considered the most preventable cause of death, not all suicides are preventable. It is inevitable that all law enforcement officers will be called to the scene of a completed suicide. Welfare check calls related to a subject's suicide risk are routine. After working as a psychiatric nurse for well over two decades, I have learned there are two types of therapists: those who have lost a client to suicide and those who will. It just feels different when it is a kid.
What to Look For
Nine out of ten adolescents who commit suicide give clues before the suicide attempt. Most teenagers will display one or more of the following risk factors and/or warning signs:
- A mental health disorder such as depression; alcohol or substance abuse; or behavior/conduct disorders (chronic runaways, incarcerations). A combination of any of these increases the risk.
- Communication of thoughts of suicide, death, dying, reunion with the dead
- Expression of sadness, boredom, negativity
- Impulsivity, aggression, frequent rage
- Exposure to someone else's completed or attempted suicide
- Giving away prized possessions; making a will
- A recent severe stressor (pregnancy, sexual orientation issues, loss of a relationship, a significant failure)
- Family instability/conflict
- An effort to punish oneself or others --the ultimate revenge
- Undue shame or guilt
- A victim or perpetrator of sexual, physical or emotional abuse
- Accessibility to lethal methods, especially guns
For a teen, suicide is viewed as a way to escape from an uncomfortable situation, emotional pain or unacceptable feelings. Most adolescent suicide attempts are precipitated by interpersonal conflicts; the intent is often not to kill themselves, but to change the behaviors or attitudes of others. It gives a teen a sense of control, when they feel out of control with the rest of their world. Most adolescent suicides occur in the teen's home, after school hours.
Compared to adults, adolescent suicides are often more impulsive, related to anger or irritation, romantically or idealistically driven, and motivated by revenge. Attempts may indeed be manipulative, but only a professional psychiatrist or clinician should make that determination.
Treatment: Therapy, Medication (and the Black Box)
Thoughts of suicide span a lifetime; they are very common. These thoughts may be in relation to a situational crisis, or they may be the hallmark of a mental illness. Anytime anyone verbalizes suicidal intent, they should be referred to a mental health professional. Treatment typically includes psychotropic medications and therapy. When a child or teen has a mild depression, the first line of treatment is therapy: individual, behavioral, cognitive, group and/or family. When the depression is moderate to severe, a psychiatrist may prescribe an antidepressant. Currently only Prozac, a SSRI (selective serotonin reuptake inhibitor) antidepressant, is FDA approved to treat depression in children and adolescents. Additionally, Prozac and three other antidepressants have been FDA approved for pediatric obsession compulsive disorder: Zoloft, Anafranil, and Luvox.