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Preventing the Spread of Suicide in Teens

» Mental Health Library » Disorders & Conditions » Suicide » Featured Article

By: Lynn Margolies, Ph.D.

Teen suicide awakens us to the pain and suffering of teens, and the risk of contagion.

Suicide is the 3rd leading cause of death among adolescents and young adults, second to accidents and homicides. Most youth suicides donít come on suddenly but, rather, after a long period of inner torment.

Many suicidal teens are preoccupied with death and suicide and talk or write about feeling hopeless and wanting to die. 90% of teens who commit suicide have expressed suicidal feelings and intent either directly or indirectly. Yet, the majority of suicidal youth are not receiving mental health services (National Institute of Mental Health, 2012).

Parents with an emotion avoidant, or conflict avoidant, style may have difficulty noticing or responding to painful affect in their children. Also, families with overwhelming problems and/or chronically troubled kids can become exhausted and desensitized, making it difficult to respond with needed urgency in each situation. However, any expressions of hopelessness, feeling like a burden, feeling trapped, and/or threat or attempt to hurt oneself should always be taken seriously and never dismissed as teen "drama,Ē a ploy to "get attention,Ē or shut down with reassurance that things are not that bad.

Warning signs:

Warning signs of suicide include changes in personality and behavior such as: withdrawing from people and activities that once brought pleasure, hopelessness, deterioration in academic functioning, sudden, unexplained energy/relief from depression, giving things away, physical/medical complaints (a manifestation of depression) irritability, sleep problems, revenge fantasies, increased alcohol, recklessness, and substance abuse (Suicide Prevention Resource Center, 2011)

Risk factors:

Risk factors for suicide include: depression or other psychological conditions, prior suicide attempt, suicidal thoughts, non-suicidal self-injury, exposure to a suicide, access to lethal means, impulsivity, aggression, family history of psychiatric disorder or suicide, family conflict, academic stress, history of physical and/or sexual abuse, peer victimization, alcohol/substance abuse. Use of substances or alcohol play a role in more than half of all suicides - exacerbating depression, impulsivity, disinhibition, and impaired judgment (Juhnke, Granello, & Haag-Granello, 2011; "Teen Suicide," n.d.).

Triggers:

Suicide attempts vin teens are often triggered by common stressors such as family conflict, relationship break-ups, loss, major disappointments, and/or recent disciplinary action. Although such events are often precipitants, they are never the "causeĒ of suicide, but may activate a teen already at risk.

Though the risk factors and warning signs give us a map, teens can be at risk without meeting the risk profile. Understanding teens cannot be formulaic. If it is, teens will not open up and it will be easy to miss signs that are not on our list.

Teens concealing from adults

Teens donít feel safe talking to adults about suicide. Some suicidal teens may be good actors - showing us what we want to see. They may be afraid to open up because they feel ashamed, fear disappointing parents, or donít believe anyone should or can help them. 93% of teens surveyed said they would consult a friend before telling an adult. Only 25% would tell an adult if they or a friend were suicidal (Centers for Disease Control and Prevention, 2010). However, most teens who attempt or commit suicide express their feelings and intent and do so through text, Twitter, Facebook, Instagram, and other social media (Dunlop, More, & Romer, 2011).

These finding remind us that it makes sense to "friendĒ our kids on Facebook, explaining to them that - just as we want to know their friends and activities off line to protect them - we also want to be aware of their online friends and activities.

Helping teens talk to adults

We must help teens understand why they should tell an adult if they or a friend want to hurt themselves. They need to know that people who are considering suicide are in a very dangerous and complicated situation.

Telling an adult a friend is in trouble is an act of courage and friendship - not betrayal. Even if it seems otherwise, suicidal teens are reaching out for help. No one really wants to die. People kill themselves in desperation - intending to escape, give themselves the illusion of control, and/or communicate through desperate actions when they are unable to effectively communicate in words (Juhnke, Granello, & Haag-Granello, 2011).

Teens should be told that failing to ask an adult for help may leave them with a terrible burden of guilt if a friend commits suicide. Teens connected with the recent victims need help with these and other feelings, including: helplessness, guilt, grief, anger, confusion, unsafety.

Suicide contagion:

Although we donít think of suicide as contagious, one of the strongest predictors of suicide attempts in youth is learning that a friend or family member attempted or committed suicide. Teens exposed to suicide - even of someone they donít know, are at significantly higher risk of suicide for 2 years (Mayer, 2013). Additional exposure to suicide online through YouTube videos about suicide, and online forums with pro-suicide content (Dunlop, More, & Romer, 2011), increase self-destructive fantasy and risk.

Research offers guidelines for parents, teachers, mentors and the media to reduce the risk of contagion. Guidelines include refraining from giving details or images of the method or place where the victim was found (Centers for Disease Control and Prevention, 1994; Sudak & Sudak, 2005).

Care should be taken not to focus on the immediate external precipitant as the cause of the suicide, for example, a break-up, or other things with which teens can easily identify (Mayer, 2013). Doing so can inadvertently increase teens identification with the victim and convey that suicide could also be a solution to their problems. A related risk is allowing memorializing to go too far, feeding into idealization of death and suicide or reinforcing suicide as a solution to problems (Centers for Disease Control and Prevention, 1994; Sudak & Sudak, 2005).

Vulnerable teens, feeling unpopular or alone in their pain, may envy the compassion others feel for the victim, seeing suicide as an effective means of becoming popular and getting others to finally say good things about them, care about them, recognize their pain and/or take them seriously. To protect against this, it is important not to portray the victim and what happened in a simplified or one-dimensional way (Mayer, 2013; Sudak & Sudak, 2005).

Adults can help teens recognize that people who resort to suicide have complicated psychological conditions. Such conditions temporarily cause overwhelming feelings and desperation. They affect our ability to think clearly and flexibly, find solutions to problems, have hope and perspective. We should alert teens that when people are going through this, they donít recognize that they are caught in a distorted way of thinking and painful emotional state which will not last, and from which they can recover.

Teens should be warned that that this frame of mind can trick them into believing they are seeing life clearly, which is why itís important to tell an adult they trust at the first sign that they or a friend want to hurt themselves or die.

Parental support:

Above and beyond the content of what we say, we communicate whether itís safe to talk to us through our own feelings, reactions and behavior. Behaviors that discourage teens from talking include: lecturing, talking too much, being preoccupied, giving unsolicited advice, using emotional force or guilt, taking teenís feelings personally, pulling away, and reacting to our own anxiety.

Behaviors that encourage teens to trust us: being grounded and calm, admitting when we are wrong, having presence of mind, being emotionally available instead of reactive even when they pull away, listening with respectful curiosity, asking questions that show interest in how they think and feel, and being accepting and refraining from judgment.

Teens feel safe to talk when parents are interested and open, without unconsciously rigging teenís responses with our own anxiety, need for control and/or need for reassurance. If we are open to hearing the truth, weíll be able break secrecy and open the door for teens to get help. Our relationship with teens is our most valuable resource.

References

Centers for Disease Control and Prevention. (1994, April). Suicide contagion on the reporting of suicide: recommendations from a national workshop. MMWR, 43(RR-6), 9-18. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/00031539.htm

Centers for Disease Control and Prevention. (2010, June). Youth risk behavior surveillance Ė United States, 2009. MMWR, 59(SS05). Retrieved from http://www.cdc.gov/MMWR/preview/mmwrhtml/ss5905a1.htm

Dunlop, S. M., More, E., & Romer, D. (2011, October). Where do youth learn about suicides on the internet, and what influence does this have on suicidal ideation? Journal of Child Psychology and Psychiatry, 52(10), 1073-80.

Friedman, M. (n.d.). Preventing tragedy: bringing an end to youth suicide. Retrieved from www.tapartnership.org/docs/preventingTragedy.pdf

Juhnke, G. A., Granello, P. F., & Haag-Granello, D. (2011). Suicide, self-injury and violence in the schools: assessment, prevention, and intervention strategies. Hoboken, NJ: John Wiley & Sons, Inc.

Mayer, A. (2013, May). Needed: new approaches to defuse Ďsuicide contagioní among teens. Retrieved from http://www.cbc.ca

Sudak, H. S. & Sudak, D. M. (2005). The media and suicide. Academic Psychiatry, 29, 495-499.

Youth Suicide Prevention School-Based Guide. (2012). Risk factors: how can a school identify a student at-risk for suicide? Retrieved from http://theguide.fmhi.usf.edu/pdf/2012PDFs/IB-3b

About the Author...

Dr. Lynn Margolies is a psychologist and former Harvard Medical School faculty and fellow. She has helped people from all walks of life with relationship, family, and life problems. Dr. Margolies has worked in inpatient, outpatient, residential and private practice settings. She has supervised other practitioners, and consulted to clinics, hospitals, universities, newspapers. Dr. Margolies has appeared in mediaóon news and talk shows, and written columns for various publications. Dr. Margolies is currently in private practice in Newton Centre, MA.

Click here to contact or learn more about Dr. Lynn Margolies

Last Update: 11/8/2013



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