SUICIDE

Suicide is defined as the deliberate killing of oneself. Tragically, suicide is a problem that affects people of all ages, but most dramatically, adolescents and young adults. In fact, suicide is the most rapidly growing cause of death among youth between the ages of fifteen and twenty-four. In the mid-1990s, the National Center for Health Statistics ranked suicide as the third-leading cause of adolescent death, as it claimed the lives of approximately 5,000 American teenagers and young adults. In addition, the number of recorded deaths by suicide is apparently an underestimate of reality since a large number of completed suicides go unreported or are labeled as accidents.

Suicide attempts are defined as intentional, self-inflicted, and life-threatening acts that do not result in death. During adolescence, the documented prevalence rates of suicide attempts are higher than at any other time in the human lifespan. According to the Centers for Disease Control and Prevention (CDC), about one-half million adolescents and young adults attempt suicide each year with as many as 6 percent of high school males and 11 percent of high school females reporting at least one suicide attempt.

Suicidal ideation is broadly defined as a range of thoughts an individual may have related to the act of committing suicide. Suicidal ideation can range from thoughts that others might be better off if the person were dead to very specific, detailed planning for completing suicide. Signs of suicidal ideation may be expressed behaviorally, in written form, or through speech. Several surveys conducted in the mid-1990s suggest that 10 percent to 15 percent of adolescents have meaningful suicidal thoughts within a one-week or one-month time span. The CDC reported that in 1991 about 27 percent of high school students reported having thought seriously about attempting suicide and 16 percent reported having made a detailed suicide plan.

These facts and statistics become more meaningful when one considers what these findings suggest for a typical high school with an enrollment of 2,000 students. It is quite likely that in such a setting, approximately 500 students will have thoughts of suicide during the school year, 50 students will actually make a suicide attempt during the year, and 1 student will complete suicide once every four years.

Adolescent suicide is a reality that, although difficult and frightening for most of society to think about and discuss, can often be prevented. The key is for people to be informed about the potential reasons individuals might engage in suicidal behavior, the types of individuals who are at risk of engaging in suicidal behavior, the common myths about suicide, the warning signs of suicide, and the actions to take if one suspects a suicide might be attempted. An introductory examination of this vital information follows.

Reasons for Suicidal Behavior

Why do people kill themselves? This is an extremely difficult question to answer. Although there are many ideas or theories about why people commit suicide, there is no single comprehensive theory that describes and explains all life-threatening behaviors. The major theories of suicide can be categorized into sociological theories, psychological theories, and biological theories. In general, sociological theories are based on the idea that suicide results from the level and amount of control society has over an individual and the effects of social conditions and social changes on the person. Psychological theories of suicide typically focus on conflicts within the individual; the role of one's thought processes, emotions, and personality characteristics; the person's developmental stage; and the ways in which the person's family functions. Finally, biological theories are based on the examination of biological aspects of suicide such as the influence of genetics, hormone levels, and neuro-transmitter levels in the brain.

Suicidal acts take on very different meanings based upon the lenses one uses to examine each individual case of suicide. It is tempting to make sense of suicidal behavior by applying one of the many theories that have been developed by researchers to explain suicidal behavior. It appears, however, that the most complete understanding requires one to look beyond theories and ideas to the concrete evidence. Rather than asking why someone would commit suicide, the question can be rephrased as follows: What problem or problems was the person trying to solve?

Based upon the ways in which adolescents attempt to kill themselves, those who work with suicidal teens have found that most do not really want to die. When adolescents attempt suicide, most do it in their own homes, which is the place they are most likely to be found, and between the hours of 4 P.M. and midnight, which is the time of the day when someone in the family is most likely to be around. Thus, the chance of rescue is high, and those who hope for rescue do not really want to die. It appears then, that suicidal teens are simply attempting to solve one or more problems occurring in their life, but they, unfortunately, choose a permanent solution to their temporary problems. These teens are looking for a way to escape the emotional and physical pain that results from the problems they perceive or experience in their lives, and suicide appears to be a sure way to make the pain stop.

Those Who Are at Risk

People at risk of suicide come from a wide variety of backgrounds. There is not a special set of characteristics or personality traits that are common to all suicides. Unfortunately, suicide knows no boundaries. This is obvious since all kinds of youth end their own lives regardless of age, gender, ethnicity, economic background, and mental or physical state. Nevertheless, there are some general risk factors that apply to a large number of suicidal teens that may make suicide more likely for a given individual.

In general, adolescents are at higher risk for engaging in suicidal behaviors following a significant loss such as the death of a friend or family member, parental divorce or separation, or a breakup with a boyfriend or girlfriend. Teens who are depressed, involved with alcohol or other drugs, or are victims of physical, emotional, or sexual abuse have a higher potential for suicide. There is also heightened risk for those who have attempted suicide in the past or who come from a home where someone has committed suicide.

Research shows that adolescent females attempt suicide more often than adolescent males, but that males complete suicide at a higher rate. The most likely reason for this is that males tend to choose methods that are more lethal (e.g., gunshot, hanging, automobile crash), whereas females often use methods that are considered less lethal (e.g., drug overdose, slashing of wrists, carbon monoxide poisoning).

The rates of attempted suicide among gay and lesbian populations are two to six times greater than suicide rates for the general population. These statistics suggest that gay youth are at a greater risk for suicide than their straight counterparts. Finally, suicide risk is higher for teens who are gifted, have learning disabilities, or are pregnant or responsible for a pregnancy.

Warning Signs of Suicide

Most people who are suicidal put out warning signs to the public as a cry for help. They either directly or indirectly tell or show others about their suicide plan. Direct verbal threats such as "I am going to kill myself," "I am going to swallow a bottle of aspirin," or "By the weekend I will be dead" leave nothing to the imagination. These statements should be taken seriously, no matter how overdramatic they may sound, because very few people make such serious statements for the sake of just being funny. Indirect verbal threats are much more subtle and, therefore, more difficult to pick up on. Indirect threats tend to slide right into regular conversations and may easily be overlooked if one is not aware of these subtle cues. Statements such as "I hate my life," "Sometimes I wish I were dead," or "I just can't go on any longer" are all potential clues that someone may be thinking about suicide and that should lead anyone hearing the statement to act to prevent it.

In addition to direct and indirect verbal threats, suicidal people often exhibit a number of behaviors that serve as warning signs. Such signs include sudden changes in behavior related to eating and sleeping patterns, performance at school, physical appearance and hygiene, participation in activities and hobbies, and interactions with friends and family. When people suddenly stop acting like themselves for days or weeks, it is usually a signal that something has gone wrong in their lives and that this behavior should be examined further.

Teens who are making plans to die often try to tie up loose ends before they attempt to take their own life. They do this in a number of ways, including giving away the things that matter most to them, getting their rooms organized and their lockers or work spaces cleaned out, returning borrowed materials, and paying loans. These behaviors are not suspicious in and of themselves, but in combination with other suicide warning signs, these acts may serve as signals that the adolescent does not plan to be alive much longer.

Finally, teens who suddenly become aggressive, rebellious, or disobedient or who engage in risky or self-destructive behavior are also exhibiting signs that could be related to suicidal intent. These behaviors should not be ignored.

Actions to Take to Prevent Suicide

Adolescents who are suicidal need someone who will talk with them openly and honestly, who will listen attentively, and who will find them the help that they need. In order to help prevent a suicide from occurring, one must be informed of the questions to ask when suicide is suspected, the dos and don'ts of interacting with a person contemplating suicide, and who to contact for further assistance.

When signs of suicide have been observed, it is important to reach out to the person to find out what is going on. A good way to do this is by asking questions and listening attentively without making judgments. The goal is to get the person who may be considering suicide to talk about his or her problems out in the open. Specifically, there are four important questions that need to be asked directly: (1) Are you thinking about killing yourself? (2) How do you plan to do it? (3) When do you plan to do it? and (4) Where do you plan to do it? Contrary to popular belief, such candor will not give a person dangerous ideas or encourage a suicidal act. In fact, these questions not only allow the helper to assess the danger so she knows who to contact for further assistance, but also give the helpee permission to talk about suicide and the thoughts and problems that may be occurring. Such action can be a relief to individuals who are suicidal because it shows that someone is taking them seriously.

Some important information to remember when helping a person through a suicidal crisis is to remain calm even if what is said is shocking, to remain positive and never give up hope, and to know one's own limits and when it is time to seek outside help. One should never make promises to keep a person's suicide plans a secret. Instead, the helper should suggest that the suicidal person turn to help from trusted adults (e.g., parents, teachers, coaches), crisis hotlines, or trained professionals (e.g., counselors, therapists, doctors). Most importantly, one should never leave an individual in crisis alone, and one must act quickly if the person appears to be in danger.

Bibliography

Berman, Alan, and David Jobes. Adolescent Suicide: Assessment and Intervention. Washington, DC: American Psychological Association, 1991.

Kirk, William. Adolescent Suicide. Champaign, IL: Research Press, 1993.

Maris, Ronald, Morton Silverman, and Silvia Canetto. Review of Suicidology, 1997. New York: Guilford Press, 1997.

Nelson, Richard, and Judith Galas. The Power to Prevent Suicide. Minneapolis: Free Spirit Publishing, 1994.

Page, Randy. "Youth Suicidal Behavior: Completions, Attempts, and Ideations." High School Journal 80, no. 1 (1996):60-65.

Popenhagen, Mark, and Roxanne Qualley. "Adolescent Suicide:Detection, Intervention, and Prevention." Professional School Counseling 1, no. 4 (1998):30-36.

Robbins, Paul R. Adolescent Suicide. Jefferson, NC: McFarland, 1998.

Jeana L. Magyar-Moe