Teen Suicide-Related Behavior: Risk and Protective Factors

May has been designated as Mental Health Awareness Month. Given the prevalence of suicide related behaviors (suicidal thoughts or suicide attempts) among adolescents, I feel it is important for us to become aware of this issue. It is particularly important for parents to be knowledgeable about what signs to look for and when it is appropriate to seek treatment.

According to the National Institute of Mental Health (NIMH), suicide remains the third leading cause of deaths among adolescents. Spirito and Esposito-Smythers (2006) reported that within a twelve-month period, 16.9% of adolescents seriously considered attempting suicide, 16.5% developed a suicide plan, 8.5% attempted suicide (female, 11.5%; male, 5.4%), and 2.9% of adolescents required emergency treatment as a result of a suicide attempt. In my recent Psychology Today blog post, I discussed the rates of suicide among lesbian, gay, and bisexual (LGB) youth. LGB youth also are at high risk of suicidal behavior due to bullying and lack of acceptance by peers and family. While depressive symptoms are a risk factor, even among those who exhibit depression or depressive symptoms, clinician face difficulties predicting self-harm or suicide attempt (Hetrick, et al., 2011). Therefore, it is important for parents to pay attention if they notice differences in their child’s behavior.

Risk Factors of Suicide

Risk factors for suicide are characteristics or conditions that increase the chance that a person may try to take her or his life. Suicide risk tends to be highest when someone has several risk factors at the same time. The most frequently cited risk factors for suicide are: 

• Mental disorders, in particular:
• Depression or bipolar (manic-depressive) disorder
• Alcohol or substance abuse or dependence
• Schizophrenia
• Borderline or antisocial personality disorder
• Conduct disorder (in youth)
• Psychotic disorders; psychotic symptoms in the context of any disorder
• Anxiety disorders
• Impulsivity and aggression, especially in the context of the above mental disorders
• Previous suicide attempt
• Family history of attempted or completed suicide
• Serious medical condition and/or pain

It is important to bear in mind that the large majority of people with mental disorders or other suicide risk factors do not engage in suicidal behavior. 

Warning Signs of Suicide 

• Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself
• Looking for ways to kill oneself by seeking access to firearms, available pills, or other means
• Talking or writing about death, dying, or suicide when these actions are out of the ordinary for the person
• Feeling hopeless
• Feeling rage or uncontrolled anger or seeking revenge
• Acting reckless or engaging in risky activities - seemingly without thinking
• Feeling trapped - like there's no way out
• Increasing alcohol or drug use
• Withdrawing from friends, family, and society
• Feeling anxious, agitated, or unable to sleep or sleeping all the time
• Experiencing dramatic mood changes
• Seeing no reason for living or having no sense of purpose in life  

Protective Factors for Suicide

Protective factors for suicide are characteristics or conditions that may help to decrease a person’s suicide risk. While these factors do not eliminate the possibility of suicide, especially in someone with risk factors, they may help to reduce that risk. Protective factors for suicide have not been studied as thoroughly as risk factors, so less is known about them. Protective factors for suicide include: 

• Receiving effective mental health care
• Positive connections to family, peers, community, and social institutions such as marriage and religion that foster resilience
• The skills and ability to solve problems

Protective factors may reduce suicide risk by helping people cope with negative life events, even when those events continue over a period of time. The ability to cope or solve problems reduces the chance that a person will become overwhelmed, depressed, or anxious. Protective factors do not entirely remove risk, however, especially when there is a personal or family history of depression or other mental disorders. 

What To Do When You Suspect Someone May Be at Risk for Suicide

1. Take it Seriously

• 50% to 75% of all people who attempt suicide tell someone about their intention.
• If someone you know shows the warning signs above, the time to act is now.

2. Ask Questions

• Begin by telling the suicidal person you are concerned about them.
• Tell them specifically what they have said or done that makes you feel concerned about suicide.
• Don't be afraid to ask whether the person is considering suicide, and whether they have a particular plan or method in mind. These questions will not push them toward suicide if they were not considering it.
• Ask if they are seeing a clinician or are taking medication so the treating person can be contacted.

3. Do not try to argue someone out of suicide. Instead, let them know that you care, that they are not alone and that they can get help. Avoid pleading and preaching to them with statements such as, “You have so much to live for,” or “Your suicide will hurt your family.”

4. Encourage Professional Help

• Actively encourage the person to see a physician or mental health professional immediately.
• People considering suicide often believe they cannot be helped. If you can, assist them to identify a professional and schedule an appointment. If they will let you, go to the appointment with them.

5. Take Action

• If the person is threatening, talking about, or making specific plans for suicide, this is a crisis requiring immediate attention. Do not leave the person alone.
• Remove any firearms, drugs, or sharp objects that could be used for suicide from the area.
• Take the person to a walk-in clinic at a psychiatric hospital or a hospital emergency room.
• If these options are not available, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for assistance.

6. Follow-Up on Treatment

• Still skeptical that they can be helped, the suicidal person may need your support to continue with treatment after the first session.
• If medication is prescribed, support the person to take it exactly as prescribed. Be aware of possible side effects, and notify the person who prescribed the medicine if the suicidal person seems to be getting worse, or resists taking the medicine. The doctor can often adjust the medications or dosage to work better for them.
• Help the person understand that it may take time and persistence to find the right medication and the right therapist. Offer your encouragement and support throughout the process, until the suicidal crisis has passed.

References

American Foundation for Suicide Prevention https://www.afsp.org/

National Suicide Prevention http://www.suicidepreventionlifeline.org/

National Institute of Mental Health http://www.nimh.nih.gov/health/topics/suicide-prevention/suicide-prevention-studies/warning-signs-of-suicide.shtml

Copyright 2013 Erlanger A. Turner, Ph.D.