Suicide in Teens and Young Adults

Suicide in Teens

Summary

Suicide among teens and young adults is a complex and distressing problem. Lives are lost just as they seem to be getting started. The death of a young person is always a tragedy. In addition, because young people often turn to suicide as an impulsive solution to problems, suicide is often preventable.

Suicide is the third-leading cause of death among 15 to 24 year olds (after accidents and homicides), and the fourth-leading cause of death among 10 to 14 year olds, according to the National Institute of Mental Health(NIMH).

Suicidal thoughts or behaviors may be symptoms of different mental health disorders. Many young people who commit suicide have at least one major mental health disorder. For teens and young adults, suicide may be associated with depression, substance abuse, eating disorders and conduct disorders.

Young people appear to be especially susceptible to suicide contagion (exposure to the suicide of others that leads to an increase in suicidal behavior). This can include certain types of media reports of the suicide of strangers.

There appears to be an association between self-directed violence (e.g., suicide) and violence directed at others, especially among young people. A sizable proportion of fatal school-associated violence (e.g., school shootings) involves suicidal behavior. More research is needed to better understand this connection between suicide and interpersonal violence.

Males commit suicide more often than females among these age groups. American Indians and Alaskan Natives have the highest suicide rate in the 15 to 24 year old age group, according to the U.S. Centers for Disease Control and Prevention (CDC). More whites commit suicide than blacks or Hispanics, although the suicide rate of African American youth has climbed dramatically since the 1980s. Homosexual and bisexual teens apparently report suicidal ideation and attempts more often than heterosexual teens (although the accuracy of this data is questionable, due to a lack of reliable statistics for both sexual orientation and suicide attempts among youth).

There are warning signs of suicide that are specific to young people. These include declining grades, skipping school, disciplinary problems and running away from home. When approaching a teen or young adult about suicide, parents and others should focus on maintaining open lines of communication.

About suicide in teens & young adults

Young people can be especially vulnerable to self-destructive emotions. They often experience strong feelings of stress, confusion, self-doubt, fear and uncertainty. Divorce or family turbulence, social isolation, academic stress or moving to a new home or school can intensify these feelings. For many young people, suicide may appear to be a solution to their problems.

Suicidal behavior among teens and young adults is often a complex and impulsive reaction to specific circumstances rather than an actual wish to die. Many young people have not yet developed effective coping skills for the personal, social and academic pressures they face. Or, they may have no available model of healthy coping techniques from which to learn. This can lead to difficulty dealing with the problems of life (e.g., breakup of a romantic relationship, failure in school, witnessing family turmoil).

Withdrawing or being socially isolated from others, especially during times of stress, can enhance destructive or hopeless feelings in young people and lead to suicidal thoughts or behavior. People who talk about suicide often commit suicide. Therefore, all discussions regarding suicide should be taken seriously.

In addition, many teens and young adults who commit suicide have at least one major mental health disorder. Mood disorders (e.g., depression) and substance abuse are among the most common, and can include symptoms of suicidal thoughts and behavior. A combination of depression, substance abuse, and lowered impulse control can result in a suicide attempt. This is often a fatal combination.

The number of suicides among teens and young adults nearly tripled from 1965 to 1987, according to the National Alliance on Mental Illness (NAMI). Since then, youth suicide rates have been declining. However, suicide in teens and young adults remains an especially tragic problem because lives are lost as they have just begun. In addition, research shows that teens who contemplate suicide have an increased risk of developing both emotional and behavioral problems that last throughout their young adulthood.

Thousands of young people commit suicide every year. According to the National Institute of Mental Health, suicide is the third-leading cause of death among 15 to 24 year olds (after accidents and homicides), and the fourthleading cause of death for 10 to 14 year olds.

Preteen children who commit suicide tend to be of above-average intelligence. High intelligence may expose younger children to stress levels – and thoughts of suicide – not ordinarily encountered until adolescence. Although there is little research in the area, suicide among gifted children may be linked to emotional and social problems. Gifted children often have difficulty fitting in with other children their own age, which may lead to strong feelings of isolation. Also, children learn socialization skills by interacting with peers of the same developmental level – gifted children who do not have such peers may not learn how to appropriately socialize with others. Early academic achievement can put added stress on a child who may not be able to emotionally cope with that stress. In addition, teachers or adults may not notice symptoms of depression (which includes the risk of suicide) in gifted children.

College students may face a difficult transition period between childhood and adulthood. Going to college can include living away from home for the first time and balancing newfound independence with responsible behavior. According to the National Mental Health Association, suicide is the second-leading cause of death among college students.

Certain methods of suicide used by teens and young adults have changed over the years. By the late 1990s, suffocation (e.g., hanging) replaced firearms as the most common method of suicide among youth aged 10 to 14 years. Firearms remain the more common method for older teens and young adults. Changes in suicide methods may be due to the availability of those means (e.g., rope may be more readily available to young people than a gun). A gun in the house may make it easy for a troubled teen to commit suicide.

Research has indicated an association between violence directed at others and self-directed violence (i.e., suicide). According to a study conducted by the U.S. Centers for Disease Control and Prevention (CDC), the majority of high school students who reported attempting suicide also reported physical fighting in the year preceding the suicide attempt. Also, certain students who engaged in extremely violent behavior at school (e.g., school shootings) exhibited suicidal ideation or behavior before or during the attack.

Variables that may be common to both forms of violence (self-directed and interpersonal) include aggressiveness, impulsiveness, substance abuse and feelings of hopelessness. According to the CDC, a sizable proportion of deadly school-associated violence involves suicidal behavior. Further research is needed to better understand the association between suicide and violent behavior among youth. The extent to which youth are involved in victim-precipitated homicide (VPH) is unknown. VPH occurs when a person instigates activity by others (e.g., law enforcement officers) with the intent of being killed. Sometimes referred to as “suicide by cop,” VPH may also involve positioning oneself in the line of fire during gang warfare. However, because another person ultimately causes the death in a VPH, these deaths are not classified as suicides. There is little known about the number of teens or young adults who may engage in VPH, and what other factors may be involved.

Risk factors for suicide in teens & young adults

A number of factors can increase a person’s risk of suicide. These include easy access to lethal means (e.g., having a gun in the house), a history of suicidal ideation or previous suicide attempts. For young people, a history of family violence, impaired family relationships, stress and social isolation can also increase the risk of suicide. In addition, many teens and young adults who commit suicide have at least one major mental health disorder and/or substance abuse, which may increase their suicide risk.

The following may also increase the risk of suicide in teens and young adults:

  • Gender. According to the National Institute of Mental Health (NIMH), males commit suicide three times as often as females among children age 10 to 14, five times as often as females among teens age 15 to 19 years, and seven times as often as females among young adults age 20 to 24 years. However, there are more suicide attempts made by females than males, probably due to the lethality of the means selected (i.e., girls more often choose overdose, whereas boys tend to choose more deadly means, such as firearms and hanging).
  • Race. American Indians and Alaskan Natives have the highest suicide rate in the 15 to 24 age group, according to the U.S. Centers for Disease Control and Prevention (CDC).  White teens and young adults in the United States commit suicide more often than blacks and Hispanics. The suicide rate for African American youth continues to be lower than that of whites, although it has risen dramatically since the 1980s, according to NIMH.
  • Exposure to suicide. Suicide contagion isexposure to the suicide of others that causes an increase in or outbreak of suicidal behavior. Teens and young adults appear to be especially susceptible to contagion. The exposure may be direct (e.g., knowledge or witness of suicide in one’s family) or indirect (e.g., the suicide of strangers that are reported in the media) and may increase the risk of suicide among young people.
  • Physical or sexual abuse. Teens or young adults who have been physically or sexually abused face an increased risk of depression and suicide.

According to NIMH, some studies indicate higher rates of suicidal ideation and suicide attempts among high school students who report to be homosexually or bisexually active. However, the accuracy of this data is questionable, due to a lack of national standards for measuring reports of suicide attempts and sexual orientation among youth. In addition, there is no reliable data that associates sexual orientation and completed suicides.

Suicidal thoughts or behavior can also occur as a symptom of various mental health disorders. The degree of suicide risk depends on the severity of the disorder. For teens and young adults, the risk of suicide is most often associated with:

  • Mood disorders. Characterized by severe fluctuations in mood that affect an individual’s ability to function (e.g., depression, bipolar disorder). Depressive disorders are the most common mental health problem among young people who attempt or commit suicide. Teens may be especially susceptible to mood disorders because hormones and sleep cycles, which affect mood, both change dramatically during adolescence.
    The U.S. Food and Drug Administration (FDA) has advised that antidepressants (sometimes used to treat mood disorders) may increase the risk of suicidal thinking in some patients. Thus, all people being treated with these drugs, including teens and young adults, should be monitored closely for any unusual changes in behavior.
  • Substance abuse. Ingestion of substances (e.g., alcohol, drugs) that affect mood or behavior and cause distress in a person’s life. These substances decrease impulse control and can lead to harmful behaviors, including suicide. Half of all deaths (from accidents, homicides and suicides) among young people age 15-24 involve alcohol or drug abuse, according to the American Academy of Child & Adolescent Psychiatry.
  • Anxiety disorders. These disorders involve chronic, debilitating worry and fear. An example of an anxiety disorder is post-traumatic stress disorder(PTSD), in which symptoms occur following exposure to a traumatic event.
  • Eating disorders. Related to the abnormal intake of food as the result of distorted thinking, which can result in bodily harm. Examples are anorexia nervosa and bulimia nervosa, both of which occur primarily in adolescent and young adult women.
  • Conduct disorders. Chronic antisocial behavior by children or teens that violates the rights of others. These disorders are exclusive to young people and involve increased aggression or impulsive behaviors, which can increase the risk of suicidal thoughts or behavior among youth.
  • Personality disorders. Characterized by patterns of behavior that cause problems with personal relationships and affects a person’s ability to deal with the stress of daily life. An example is antisocial personality disorder, which may include extreme impulsivity and violence.

Warning signs of suicide in teens & young adults

Not all suicide attempts are preceded with a warning. However, many occur with at least some type of outward signal to friends or family members. Being able to identify and respond to warning signs can help prevent suicide among teens and young adults. See Suicide Prevention & Awareness for a comprehensive list of warning signs.

Signs primarily seen in teens and young adults may include some behaviors (e.g., rebellion) that are common to most teenagers. It is important to note behaviors that are unusual for a particular youth, the severity of the behavior, and its relationship to other signs indicating that a young person may be contemplating suicide. These signs include:

  • Decline in quality of schoolwork (sudden poor grades from previously well-performing students)
  • Lack of involvement in school or work
  • Skipping school (truancy)
  • Drug and alcohol use
  • Engaging in risk-taking behavior (e.g., unsafe sex, reckless driving)
  • Impulsive or aggressive tendencies
  • Violent or rebellious behavior
  • Disciplinary problems
  • Frequently running away from home
  • Incarceration
  • Neglect of personal appearance, hygiene
  • Frequent physical complaints (e.g., stomachache, headache, fatigue), which may be related to emotional distress
  • Not tolerating praise or rewards
  • Obsession with death (e.g., poems, drawings or essays that refer to death)
  • Hopelessness, as evidenced by statements such as:
    • Nothing matters
    • I won’t be a problem for you anymore
    • What’s the point of living?
    • I wish I hadn’t been born
    • I wish I were dead

Teens and young adults who talk about suicide often attempt or commit suicide. Therefore, all discussions regarding suicide should be taken seriously.

Approaching a loved one about suicide

Friends and family can help teens and young adults with suicidal thoughts or behavior. It is important to maintain open communication. Any existing conflicts within a family may make it difficult to talk openly or to constructively resolve issues. It may help to involve someone a teen or young adult feels comfortable talking to including a trusted adult, such a teacher, nurse, counselor or mental health professional. Friends and family members should continue to express their love and support, and take the young person’s concerns seriously (making sure not to minimize or discount feelings).

Contrary to the common belief, it is a recommended approach to ask a depressed teen or a young adult if they are thinking about suicide. Asking this question provides assurance that somebody cares and might give the young person the opportunity to discuss their problems.

In addition, a growing number of schools across the nation are screening youngsters for signs of mental illness and suicidal tendencies. However, there is great controversy surrounding such screening measures, which opponents claim are unreliable and an invasion of privacy.

Questions for your doctor regarding suicide

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following suicide-related questions:

  1. Do alcohol and/or drugs induce suicidal thoughts and behavior?
  2. Do I (or my loved one) have an underlying disorder that is related to my (or their) suicidal thoughts or behavior?
  3. What do you think is causing my/my loved one’s suicidal thoughts or behavior?
  4. Are there medications that may be appropriate for me/my loved one? What are their side effects?
  5. What type of psychological therapy would be most effective for me/my loved one?
  6. Can you recommend a therapist, mental health professional, group or other setting that may benefit me?
  7. Would you recommend hospitalization? What are the benefits and/or risks associated with inpatient psychiatric care?
  8. Are there other treatment methods I/my loved one might benefit from?
  9. Does anything in my/my loved one’s personal history increase the risk for suicidal thoughts or behavior?
  10. What can I do to lessen my risk of my/my loved one’s suicidal thoughts or behavior? Are there changes I/my loved one can make to the environment that would help?
  11. Should I monitor my teenage children for suicidal behavior? What should I look for?
  12. If a teenager or young adult has attempted suicide once, how likely are they to try it again?
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