What Parents and Teachers should Know about Suicide in Adolescents (Part 1)

By Dr. Shahul Ameen, M.D.

INTRODUCTION

Suicide is one of the commonest causes of death among young people. The latest mean worldwide annual rates of suicide per 100,000 are 0.5 for females and 0.9 for males among 5-14-year-olds, and 12.0 for females and 14.2 for males among 15-24-year-olds. Suicide is the sixth leading cause of death among children aged 5-14 years, and the third leading cause of death among all those 15-24 years old. In most countries, males outnumber females in youth suicide statistics. There are far more suicidal attempts and gestures than actual completed suicides. One epidemiological study estimated that there were 23 suicidal gestures and attempts for every completed suicide. Though female teens are much more likely to attempt suicide than males, male teens are more likely to actually kill themselves.

The suicide rate among young teens and young adults has increased by more than 300% in the last three decades. Social changes that might be related to the rise in adolescent suicide include an increased incidence of childhood depression and decreased family stability. Some researchers argue that economic and political institutions have penetrated the family unit, reducing it to a consumer unit no longer able to function as a support system, and no longer able to supply family members with a sense of stability and rootedness. Awareness of the existing state of the world, now threatened by sophisticated methods of destruction, can cause depression which contributes to the adolescent's sense of frustration, helplessness, and hopelessness. Faced with these feelings and lacking coping mechanisms, adolescents can become overwhelmed and turn to escapist measures such as drugs, withdrawal, and ultimately suicide.

The rising rate has also been explained as a reaction to the stress inherent in adolescence compounded by increasing stress in the environment. Adolescence is a time when ordinary levels of stress are heightened by physical, psychological, emotional, and social changes. Adolescents suffer a feeling of loss for the childhood they must leave behind, and undergo an arduous period of adjustment to their new adult identity. Yet society alienates adolescents from their new identity by not allowing them the rights and responsibilities of adulthood. They are no longer children, but they are not accorded the adult privileges of expressing their sexuality or holding a place in the work force. Our achievement-oriented, highly competitive society puts pressure on the teens to succeed, often forcing them to set unrealistically high personal expectations. There is increased pressure to stay in school, where success is narrowly defined and difficult to achieve. In an affluent society which emphasizes immediate rewards, adolescents are not taught to be tolerant of frustration.

RISK FACTORS FOR SUICIDE

Contrary to popular belief, suicide is not an impulsive act but the result of a three-step process: a previous history of problems is compounded by problems associated with adolescence; finally, a precipitating event, often a death or the end of a meaningful relationship, triggers the suicide. The major, empirically proven risk actors for suicide among adolescents are detailed below.

PERSONAL CHARACTERISTICS

Psychopathology: More than 90% of youth suicides and around 60% of younger adolescent suicide victims have had at least one major psychiatric disorder. The most prevalent disorder in adolescent suicide victims is depressive disorders. Depression that seems to quickly disappear for no apparent reason is a cause for concern, and the early stages of recovery from depression can be a high risk period. Substance abuse, conduct disorder, posttraumatic stress disorder and panic attacks are the other disorders found to be common in this population.

Previous suicide attempts: A history of prior suicide attempts is one of the strongest predictors of completed suicide, especially in boys. One quarter to one third of teen suicide victims have made a previous suicide attempt.

Cognitive and personality factors: Hopelessness, poor interpersonal problem solving ability and aggressive impulsive behaviour have been linked with suicidality.

Biological factors: Some teens are at greater risk for suicide because of their biochemical makeup. Abnormalities in the function of serotonin, a neurotransmitter, have been associated with suicidal behaviour.

FAMILY CHARACTERISTICS

Family history of suicidal behaviour: Teens who kill themselves have often had a close family member who attempted or committed suicide.

Parental psychopathology: High rates of parental psychopathology, particularly depression and substance abuse, have been found to be associated with completed suicide and suicidal ideation and attempts in adolescents. Moreover, family cohesion has been reported to be a protective factor for suicidal behaviour among adolescents.

ADVERSE LIFE CIRCUMSTANCES

Stressful life events: Life stressors such as interpersonal losses and legal or disciplinary problems are associated with completed suicide and suicide attempts in adolescents. The anniversary of a loss can also evoke a powerful desire to commit suicide.

Common problems preceding suicide attempts:

* School or work problems
* Difficulties with boyfriends or girlfriends
* Physical ill health
* Difficulties or disputes with parents, siblings or peers
* Depression
* Bullying
* Low self esteem
* Sexual problems

Physical abuse: Childhood physical abuse has been found to be associated with increased risk of suicide attempts in late adolescence and early adulthood.

SOCIOECONOMIC AND CONTEXTUAL FACTORS

School and work problems: Difficulties in school, neither working nor being in school, dropping out of high school and not attending college pose significant risks for completed suicide.

Contagion/Imitation: Teens are more likely to kill themselves if they have recently read, seen, or heard about other suicide attempts. Evidence continues to amass from studies of suicide clusters and the impact of the media, supporting the existence of suicide contagion. The impact of suicide stories on subsequent competed suicides appears to be greatest for teenagers.

PREVENTION STRATEGIES

Youth suicide prevention strategies have primarily been implemented within three domains - school, community, and health are systems. This article reviews the school-based programs in detail and briefly describes the community based interventions.

SCHOOL-BASED SUICIDE PREVENTION PROGRAMS

School based suicide prevention programs include both curricula components to teach students about these warning signs and what to do, as well as non-curricula components such as peer groups, hot lines, intervention services and parent training. Prevention includes education efforts to alert students and the community to the problem of teen suicidal behavior. Intervention with a suicidal student is aimed at protecting and helping the student who is currently in distress. Postvention occurs after there has been a suicide in the school community. It attempts to help those affected by the recent suicide. In all cases it is a good idea to have a clear plan in place in advance. It should involve staff members and administration. There should be clear protocols and clear lines of communication. Careful planning can make interventions more organized, and effective.

The goals of school based suicide prevention programs are to:

* Increase awareness
* Promote identification of students at high risk of suicide and suicide attempts
* Provide knowledge about the behavioral characteristics ("warning signs") of teens at risk for suicide.
* Provide information to students, teachers and parents on the availability of mental health resources
* Enhance the coping abilities of teenagers

Education: Education may be done in a health class, by the school counselor or outside speakers. Education should address the factors that make individuals more vulnerable to suicidal thoughts. Education regarding the ill effects of drug and alcohol abuse would be useful. PTA meetings can be used to educate parents about depression and suicidal behavior. Parents should be educated about the risk of unsecured firearms in the home. Outside mental health professionals can discuss their programs so that students can see that these individuals are approachable. Education on the following topics will be useful:

Warning signs of suicide:

* Preoccupation with death and dying
* Signs of depression
* Taking excessive risks
* Increased drug use
* The verbalizing of suicide threats
* The giving away of prized personal possessions
* The collection and discussion of information on suicide methods
* The expression of hopelessness, helplessness, and anger at oneself or the world
* Themes of death or depression evident in conversation, written expressions, reading selections, or artwork
* The scratching or marking of the body, or other self-destructive acts
* Acute personality changes, unusual withdrawal, aggressiveness, or moodiness
* Sudden dramatic decline or improvement in academic performance, chronic truancy or tardiness, or running away
* Physical symptoms such as eating disturbances, sleeplessness or excessive sleeping, chronic headaches or stomachaches, menstrual irregularities, apathetic appearance

Sudden changes in behavior that are significant, last for a long time, and are apparent in all or most areas of his or her life (pervasive) are more specific than presence of isolated signs. However, it should be noted that many completed suicides had only a few of the conditions listed above, and that all indications of suicidality need to be taken seriously in a one person to another person situation.

Signs of depression in teens:

* Sad, anxious or "empty" mood
* Declining school performance
* Loss of pleasure/interest in social and sports activities
* Sleeping too much or too little
* Changes in weight or appetite

Features of self harm that suggest high suicidal intent:

* Conducted in isolation
* Timed so that intervention is unlikely (for example, after parents have gone to work)
* Precautions to avoid discovery
* Preparations made in anticipation of death (for example, leaving indication of how belongings to be distributed)
* Adolescent told other people beforehand about thoughts of suicide
* The act had been considered for hours or days beforehand
* Suicide note or message
* Adolescent did not alert others during or after the act

(Article continued in Part II)

About the Author

Dr. Shahul Ameen, M.D., is a psychiatrist based in Ranchi, India. He edits http://www.psyplexus.com/ (a portal for mental health professionals) and http://www.mind.in/ (a portal on mental health for the consumers).

Is Your Kid Disorganized? What can you do?

Children with disabilities like ADD, ADHD, Mood Disorders, and Autism have lots of difficulty with organization.  This is because these disorders affect the Executive Functioning part of the brain.  It’s very frustrating for parents and teachers to try to help these kids learn organizational skills.  It’s just as frustrating for kids to always feel like they’re not prepared and not ready for what they need to do.  But there are things that can be done. Children with these types of disabilities can learn strategies and techniques for independent organization.

Think about the last time you were in the grocery store and you realize you left the list of groceries on the kitchen table.  You feel unprepared as you go through the store trying to remember what was on the list, hoping you don’t forget something you really need and pretty much just trying to get it done, but knowing you’re not doing a really good job. You feel stressed and anxious because you’re wandering up and down the aisles randomly choosing things from the shelves.  Going back down aisles numerous times because something in another aisle reminds you of something you’ve forgotten.  It takes you twice as long and you spend too much.  Then you get home and look at the list and learn that you did indeed forget things and will have to go back.

This is how our kids feel every day.  They get to school and they’ve forgotten their homework, or their book.  They can’t find their assignment book.  They know they were supposed to have something for their math notebook signed by mom, but can’t remember what.  They start to get stressed knowing they’re going to get in trouble or even worse that they will get to class and not be able to participate because they don’t have their book.  Their brain is thinking that they don’t want to tell the teacher they forgot it again and that causes them to miss out on what the teacher is saying to the class and now they don’t even know what is going on.  It’s a vicious cycle.  How can we help?

We can help by helping our kids to have good habits at home.  After school, unpack the backpack and look at everything that needs to be done.  Review the assignment book. Assignments should be in folders or binders, preferably colored for each subject.  My son used an accordion file with different colored tabs for each subject.  Then he only had to keep track of one item that went everywhere with him.  He would put all papers in it in the proper section.  Find what works for your child and stick with it.  Help your child make a plan for the evening based on what needs to be done.  When finished have him put everything back in the appropriate folder, etc., and then back into the backpack.  Place the backpack in the same spot all the time.  I recommend a hook right near the door.  Do this at night before bed, so everything is away and you’re not scrambling in the morning.

If your child is involved in any activities, have a bag for every activity to keep all of the needed supplies together.  I suggest a soccer bag for soccer stuff, a baseball bag for baseball stuff, etc.  You don’t want to get to the big game and not have cleats.  (This has happened to me. Two hours away from home and we are hunting for a sports store to buy a pair.)  Plus you don’t want to hound your child throughout the day to make sure they have everything.  As I like to remind parents, we won’t be there forever to remind them, let’s help them be independent.  We can’t follow them to college, I’ve tried but for some reason my kids object.

I used to have to remind my son every morning about 30 times to brush his teeth, comb his hair, get his shoes, and get his homework.  I’d send him upstairs to do 3 things and it never failed, he would come down only having done 1 or 2.  So, to help him be more independent, I purchased a write on wipe off board and placed it on his bedroom door.  He wrote on it the things he needed to do in the mornings.  He wrote, ‘Brush Teeth, Comb Hair, Get Shoes, Get Gym Bag, and Feed Fish’. He would then check them off as he had done them.  Erasing the checkmarks at night.  I never had to remind him of what he had to do again.  He is independent.  Our mornings are much nicer and there is much less stress for him when he gets to school.  He can even add things that don’t relate to school that he wants to do, like call his friend to go to a movie or rent a video game.  Of course, he still occasionally forgets something, (the disability never goes away), but it only happens once in a great while and let’s face it we all forget things sometimes.

Not all things work for every child, but keep trying things and you’ll figure out what works for your child.  Give each thing you try at least two weeks before giving up and trying something new, don’t forget, we’re trying to help our child learn a routine which takes time.  I now put my list in my bag as soon as I’ve finished writing it.  I rarely forget it on the table.  And my grocery shopping is much less stressful.  Good luck.

About the Author

Lynne Castino has been advocating for children for over 15 years.  She is a public speaker, trainer, author, and advocate working with families throughout the Southcoast of Massachusetts.  Visit her website at http://www.beyondadvocacy.com or email her at lmccmw@gmail.com