PREVENTING ADOLESCENT SUICIDES
Suicide is the third leading cause of death in 15- to 19-year-olds, after accidents and homicide. Suicide is much less common in early adolescence and rare in prepubertal children. However, suicide rates increase with age from childhood through adolescence and continue to increase through early adulthood. Boys are about five times more likely to commit suicide than girls, although girls are considerably more likely to make nonlethal suicide attempts. Teenage boys tend to use more lethal methods, such as weapons and hanging, as compared to the less dangerous methods often used by girls, such as poisoning or wrist cutting. The difference reflects the nature of suicidal intent.
Suicidal thinking and suicide attempts are fairly common in late adolescence. Although completed attempts at life are rare in prepubertal children, self- destructive thoughts and behavior are frequent. Those children who express suicidal ideation are more likely to have symptoms of psychiatric illness and have suicidal behaviour later in adolescence. Similar to rates for completed suicide, rates for suicide attempts increase through adolescence.
One point of concern is that about one-third of suicidal youth think they should be able to handle problems on their own and avoid seeking help, and one-quarter think they should keep their suicidality a secret. The awareness of help being required for the same is less amongst the population. In addition, the fear of being stigmatised by society lingers in the minds, thereby hampering the help seeking process.
The key to effective intervention is a careful assessment of suicidal risk. Asking about suicidal ideation and a history of attempts at self-harm, depressive feelings and symptoms, family problems, and recent stressors should be a routine part of the initial evaluation of any depressed adolescent or depressed child. A history of a previous attempt is the strongest predictor of completed suicide, an effect that is considerably stronger for boys. Boys with a previous attempt are at 30 times the risk of non- attempters, whereas girls with a previous attempt are at 3 times the risk for non-attempters.
Clinically, suicidal ideation or recent attempt, especially when coupled with a plan involving lethal means, is most often the trigger to a judgment of imminent danger requiring hospitalization. Multiple past attempts increase the risk. Individuals who attempt suicide make further attempts at a rate of 6%–15% per year. The time of greatest risk for another suicide attempt is within the first 3 months to 2 years after an initial attempt. Suicidal intent needs to be differentiated from non-suicidal self-harm, such as repetitive cutting.
Four factors that are useful to consider in assessing intent in a recent attempt: belief about intent, preparation, prevention of discovery, and communication. As adolescents often minimize their intent after an attempt, it is important to obtain corroborative data about what occurred.
Family cohesion functions as a crucial protective factor. Once a family is alerted to a child’s or adolescent’s difficulties, they can be of great assistance in supervising and supporting the suicidal youth by making the home safe, monitoring medication, and ensuring treatment compliance. The role of family does not end with identification of the suicide attempt but also in providing a suitable environment to prevent the attempt.
Most, but by no means all, suicides and suicide attempts have a clearly identified precipitant. However, a stressor alone, in the absence of pre- existing vulnerability, does not lead to suicide. It appears that many adolescent suicides are impulsive responses to stressors, which leaves a very brief window between the time when an adolescent develops suicidal ideation and the time when he or she carries out a suicidal act. Separation and loss issues are the most common stressors Management
Protection of the patient
Protection of the patient is the first consideration. The youth who expresses suicidal ideation must be protected and if the intentionality is high then it warrants supervision. The adolescent must be removed from the stressful environment as soon as possible. The various strategies required to overcome the stressor can be discussed.
Continue to Assess Risk
It is important to emphasize that assessment of suicidality is a process that continues throughout treatment. Suicidality changes over time, both in response to the severity of underlying pathology and in the patient’s response to external events. Any treatment modality employed with suicidal youth should include ongoing, repeated, and documented assessments of suicide risk.
Ameliorate Risk Factors
Treatment should include addressing and diminishing dynamic risk factors. Central in this, is the treatment of underlying cause.
Enhance Protective Factors
To increase family support is an important component of enhancing protective factors. Family’s role in monitoring the youth’s condition is very important. Many helpline centres are available these days wherein the youth can call and address his/her thought and help in overcoming the stressor. Many of these centres maintain confidentiality and thus the person can remain anonymous.
I hope, with better awareness and social help, we will be able to prevent loss of innocent lives in the future.