In this article, and on World Suicide Prevention Day, Dr Anastacia Kudinova – Assistant Professor at Brown Medical School and Clinical Psychologist at Bradley Hospital, specializing in risk factors underlying suicidal thoughts and behavior in youth, and Professor Frances Maratos – a Professor of Psychology and Affective Science at University of Derby, UK, specializing in emotional wellbeing and mental health – discuss this sensitive but important topic.
Suicide in youth
Suicide is the third leading cause of death among 15-29-year-old youth world-wide. And, sadly, the incidence of youth suicide has continued to rise in many countries over the past decade. For instance, in the U.S., the largest increases are among 12-17-year-old children and adolescents, with hospitalization rates in youth for suicidality nearly tripling between 2008 and 2015. They coincide with increases in mood disorders and social media use, but the underlying reasons for the increases are likely to be multifaceted and are still being debated.
Why is this?
Developmentally, adolescence is a time of important hormonal, socio-psychological, and brain changes. Puberty initiates important social, self-referential, and neurodevelopmental processes. It is when teens form a sense of identity, including how they relate to others outside of their family and the world around them. For example, relationships with peers are typically paramount for teens, and feeling included and accepted by their peers is among their highest priorities at this time. At the same time, their brain is still developing critical connections essential for regulating emotions and effective decision-making. Additionally, youth today face challenges and consequences of increased social media use through widespread access to smartphones and the internet. Consequently, navigating daily challenges and stressors can be harder for youth, leading some teens to develop mental health conditions, including depression and suicidal thoughts during this life period.
As such, scientists are researching what factors may make it more likely that a teen will attempt suicide and what factors may buffer this risk. Ultimately to prevent suicide in youth.
It is important to note that most adolescents presenting with risk factors for mental health conditions do not attempt suicide. However, it is important to recognize suicide attempt risks, especially when multiple factors are present.
So, what are the current known risk factors for suicide attempts?
Awareness of the more commonly known risk factors is important for all, not just on World Suicide Prevention Day, but every day of the year. Things to consider include:
Prior suicide attempts
Attempting suicide carries a long-term risk of repeated attempts. Having a family member who attempted suicide also carries an increased risk.
Health conditions
Having mental health conditions, including depression, anxiety, bipolar disorder, and substance use, increases the likelihood of suicide attempts in youth.
Thoughts about suicide
Having thoughts about suicide does not necessarily lead to future suicide attempts, but thoughts about suicide are a strong predictor of future attempts.
Non-suicidal self-harm
Engaging in non-suicidal self-harm –this is hurting the self with no intent or desire to die – is one of the strongest predictors of future suicide attempts in youth.
Bullying and cyberbullying
Experiencing bullying victimization in person or online is an environmental stressor that is linked to increased suicidality in youth.
Childhood abuse
Various forms of childhood abuse, including emotional, physical, and sexual, are risk factors for future suicide attempts in adolescents.
Life stressors (e.g., interpersonal conflict)
Experiencing interpersonal stress, including a fight with a peer or a parent, increases the likelihood of an attempt.
Access to lethal means
Living at home with a firearm has been shown to increase the risk of suicide.
Sleep problems
Sleep disturbance and short sleep duration are emerging as a risk factor for suicide attempts among adolescents.
Being a sexual or gender minority
Due to stigmatization, discrimination, and other stressors imposed by our cis-normative society, sexual and gender minority (SGM) teens are at a greater risk for suicide compared to their heterosexual and cisgender peers.
When more than one risk factor is present
Importantly, having thoughts about suicide or engaging in non-suicidal self-injury is not a sure indicator in itself that an individual will attempt suicide. Indeed, the majority of adolescents who think about suicide or engage in non-suicidal self-harm will not attempt their lives. However, a study that followed 310 teens who struggled with thoughts about suicide, but never attempted suicide before enrolling in the study, provided some information about factors that increased the risk of suicide attempts. To expand, adolescents who already experienced thoughts about suicide, engaged in non-suicidal self-injury and/or were exposed to a family member or a friend who engaged in self-harm, were more vulnerable to attempting suicide. Other risk factors included using cannabis or further illicit drugs and higher levels of personality traits like openness. Among adolescents who already struggled with non-suicidal self-injury, those who also used cannabis, had problems sleeping, or were less extroverted were more likely to attempt suicide. So, this study revealed teens who experience more than one risk factor are at increased risk for suicide.
Protective factors
However, there are factors that can potentially mitigate against suicide risk. So, what do we know about these?
Parental involvement
Parental involvement, support, attention, and monitoring have all been found to be protective against suicide risk in youth. Strong bonds with family and a safe family environment for communicating issues have been linked to a lower risk of suicide.
Positive relationships with peers and school
Having positive social relationships with peers and school (e.g., feeling secure at school and having positive interactions with school staff) has been linked to a decreased likelihood of suicide attempts in adolescents.
Self-esteem
Higher self-esteem is another protective factor against suicide in youth.
What can I do?
If this article has made you think that something isn’t quite right, some action you can take is:
Talk to your child
Parents, or carers, may be reluctant to ask about whether their child has thoughts about suicide and, if yes, what types of thoughts. This may be out of fear of introducing or exacerbating these thoughts. Prior research, however, suggests that asking about suicide is not iatrogenic (e.g., does not cause more suicidal thoughts) and does not increase suicide risk.
Regularly check in with your child about their feelings and provide validation (e.g., recognize their struggles and feelings) combined with support. Crucially, refraining from immediately jumping into problem-solving mode – and trying to fix everything for your child may be hard – but it is very important. For example, asking what they need for support, at that moment (talking, walking together or alone, reading a book, some space, etc.), can help them know you are a source of support for them.
Seek professional support
Seeing (your) children struggle with mental health can be hard, and you don’t have to be alone. Working with a therapist may help adolescents monitor their mood, identify early signs that a crisis may be approaching, and enable them to learn effective coping strategies. Some therapies you might want to consider include:
Dialectical behavioral therapy (DBT) is an effective treatment adapted to adolescents, as it targets typical risk factors for suicide.
Integrated cognitive behavioral therapy integrates individual and family techniques and includes a parent training component. Adolescents engaging in this therapy modality for six months have shown a promising reduction in suicide attempts.
Cognitive behavioral interventions that focus on safety can be as brief as one session and have been shown to effectively reduce thoughts about suicide and suicide attempts in adults and adolescents.
If you are worried about your mood or safety, ask an adult you trust for help immediately or call/ text a crisis line.
U.S:
https://www.crisistextline.org
Australia:
U.K. and Ireland:
https://www.samaritans.org/how-we-can-help/contact-samaritan
China:
A list of crisis lines around the world can be found here: