Suicide in youth
22 September 2021 | Health
There is also an increasing awareness in the general population about the tremendous negative consequences of youth suicidality, not only because of the direct loss of many young lives but also in the disruptive psychosocial and adverse socio-economic effects on a large societal scale. From the perspective of public mental health, suicide among young people is one of the main issues to address through effective preventive measures.
Risk Factors for Suicide in Youth
The definition of youth in terms of strict age ranges is rather arbitrary and varies by country and over time. Suicide under the age of 5 is hard to find. Most literature (including this mini review) on youth suicide refers to school-age children (7–12 years) and adolescents (13–20 years).
These young people are by nature vulnerable to mental health problems, especially during the years of adolescence. This period in life is characterized by movement, changes and transitions from one state into another, in several domains at the same time.
Young people have to make decisions about important concrete directions in life, for example school, living situation, peer group etc. They must also address new challenges with regard to building their own identity, developing self-esteem, acquiring increasing independence and responsibility, building new intimate relationships, etc.
In the meantime they are subject to ongoing, changing psychological and physical processes themselves. And besides that they are often confronted with high expectations, sometimes too high, from significant relatives and peers.
Such situations inevitably provoke a certain degree of helplessness, insecurity, stress and a sense of losing control.
To address these challenges and successfully cope with these emotions, young people must have access to significant supporting resources such as a stable living situation, intimate friendships, a structural framework and economic resources. Risk factors can be seen as factors that undermine this support or hinder access to these resources, while protective factors strengthen and protect these resources, or serve as a buffer against risk factors.
Most studies agree that suicide is closely linked to mental disorders. About 90% of people who commit suicide have suffered from at least one mental disorder. Mental disorders are found to contribute between 47 and 74% of suicide risk.
Affective disorder is the disorder most frequently found in this context. Criteria for depression were found in 50 – 65% of suicide cases, more often among females than males. Substance abuse, and more specifically alcohol misuse, is also strongly associated with suicide risk, especially in older adolescents and males.
Among 30 – 40% of people who die by suicide had personality disorders, such as borderline or antisocial personality disorder. Suicide is often the cause of death in young people with eating disorders, in particular anorexia nervosa, as well as in people with schizophrenia, although schizophrenia as such accounts for very few of all youth suicides.
Finally, associations have also been found between suicide and anxiety disorders, but it is difficult to assess the influence of mood and substance abuse disorders that are also often present in these cases. In general, the comorbidity of mental disorders substantially increases suicide risk. Especially important here is the high prevalence of comorbidity between affective and substance abuse disorders.
Previous Suicide Attempts
Many studies find a strong link between previous suicide attempts, or a history of self-harm, and suicide. About 25 –33% of all cases of suicide were preceded by an earlier suicide attempt, a phenomenon that was more prevalent among boys than girls.
Research has shown that boys with a previous suicide attempt have a 30-fold increase in suicide risk compared to boys who have not attempted suicide. Girls with previous suicide attempts have a threefold increase in suicide risk. In prospective studies, it was found that 1–6% of people attempting suicide die by suicide in the first year. The risk of suicide is found to be related mainly to the self-inflicting act as such, and less to the degree of suicidal intention of that act.
Suicide is associated with impulsivity. Although we know that a suicidal process can take weeks, months or even years, the fatal transition from suicidal ideation and suicide attempts to an actual completed suicide often occurs suddenly, unexpectedly and impulsively, especially among adolescents.
Difficulties in managing the various, often strong and mixed emotions and mood fluctuations accompanying the confrontation with new and ever-changing challenges in different domains is another risk factor for youth suicide, probably partly influenced by bio-neurological factors.
Young people who committed suicide were also found to have had poorer problem-solving skills than their peers. Their behavior was characterized by a rather passive attitude, waiting for someone else to solve the problem for them, for simple problems as well as for more complex interpersonal problems.
Some researchers indicate defects of memory in this context, with few detailed memories of effective solutions in the past. Others link it to the rigid thinking process often found in these young people. In this way of thinking, also called “dichotomy thinking,” people experience events and express their experiences as totally “black” or “white,” totally good or totally bad, with little space for nuance and gradation. This also accounts for their self-image.
This inability in problem solving and mood regulation often causes insecurity, low self-efficacy and self-esteem, but it can also lead to anger and aggressive behavior, emotional crisis and suicidal crisis, especially in combination with perfectionist personalities.