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Suicide In Youth

(10-4-13)

A continuum of suicidal behavior

  • Thoughts about suicide
    • passive, intermittent, infrequent, easily dismissed
    • active, constant, frequent, intrusive
    • Intent
  • Preparation for suicide: precursor behavior
    • saying goodbye, writing notes, giving away possession
    • procuring materials for attempt
  • Attempts at suicide
    • lethality
    • “suicidal gestures”
  • Death from suicide

Lineham has suggested that the population who die from suicide are different in many ways from the population who show suicidal ideation, preparation, or (nonlethal) attempts. She suggested (consistent with usage in Great Britain) reserving the term “suicide” to refer to self inflicted deaths, and using the term “parasuicide” to refer to all nonlethal behavior (thoughts, preparations, attempts which are survived).

Suicidal behavior needs to be distinguished from “self-injurious behavior” (SIB)–deliberately hurting oneself (without the intention to die). SIB, also referred to as Deliberate Self-Harm and/or Self-Mutilating Behavior, occurs in some neurological conditions, is often seen in Borderline Personality Disorder cases, and sometimes occurs during adolescence (possibly in association with depression and/or “rebellious behavior.”

Lethality

The lethality of a suicide attempt can be considered in terms of three characteristics.

  • the dangerousness of the method–how likely it is to end your life (some authors refer to this as “lethality” also, sorry for confusion).
  • the latency of the method–how quickly the method works (or how much opportunity to change your mind you have.
  • the willingness of a person to trigger the method–the cultural/personal acceptability of this method of death.

Prevalence/Age/Sex/Method

Below a certain age (usually 4 or 5 years) we don’t speak of “suicide”, although children may certainly cause their own deaths. Self-inflected deaths below a certain age will usually be viewed as “accidental” deaths–with some justification: our everyday understanding of suicide is of “intentional” self-inflicted death. For this to be the case, two elements seem necessary:

  1. The individual understands the likely consequences of their actions
  2. The individual understands the idea of “death” as an irreversible state

Beyond the age at which we are willing to consider suicide as a possibility, the association with age is positive: rates are very low in childhood, increase significantly during adolescence, and continue increasing across the life span.

Male and female children both attempt and die from suicide at approximately equal numbers; beginning in adolescents a “sex pattern” difference emerges: females attempt more often; males die more often. This is strongly associated with the emergence of differences in choice of method: young males and females both tend to use high lethality methods (firearms and hanging), during early adolescence females tend to switch in greater numbers to lower lethality methods (overdoses, poisons, slashing wounds)–leading to greater survival numbers (and more reattempts). This trend may be weakening, but is still evident in data from the final decades of the 20th century.

Risk factors for suicide

Demographic — in children there are relatively few demographic risk factors other than age (in constast to adults where sex, race, SES, ethnic background, nationality, employment, marital status, and religion or childhood history are significant predictors

  • Personal history
    • history of mood disorder
    • history of substance use disorder
    • problems in school
    • poor health
    • suicide attempt by friend
    • childhood adversity
    • social disadvantage
  • Personal status
    • psychiatric disorder
      • Mood Disorder (depression)/Schizophrenia/Substance Abuse
    • Prior attempts
  • Proximal predictors
    • Blood Alcohol Level/intoxication/substance use
    • Disruption of human relationships
    • Loss of communication opportunities

Suicide Prevention

  • “Rational suicides”
  • “Romantic infatuation with suicide”
  • typical suicide attempts and completions: conflict, acute crisis, despair–permanent solutions to short term problems
    • Establish communication
    • Delay impulsive decision making
    • Instill realistic hope
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