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Understanding Adolescent Suicidal Behavior: Rates, Risk Factors, and Insights

Explore completed suicide rates in adolescence, gender and ethnicity variations, international comparisons, and factors influencing suicidal behavior. Discover risk zones and precipitating stressors, alongside symptoms, methods, and family dynamics.

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Understanding Adolescent Suicidal Behavior: Rates, Risk Factors, and Insights

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  1. Suicidal Behavior in Adolescence

  2. Completed Suicide: Rates/100,000 (N) by Gender & Ethnicity, Ages 15-19, 2003

  3. U.S. Suicide Rates per 100,0001990-2003, ages 15-24

  4. Suicide rates by age group and sexUnited States, 1997 Source: Natl. Center for Health Statistics

  5. International Comparisons • Age 14 & under, US rate > 2x higher than other industrialized nations • Age 15-24, compared with 47 other nations, US rate at ~66th %ile. • Some nations, suicide rate is flat across age groups– Australia, Canada, Ireland, Costa Rica (i.e., does not increase with age).

  6. International Rates, C’t’d • Males with highest rates • in Russia 53.7/100,000, Lithuania (48.6), New Zealand (44.1) • Females with highest rates • Cuba 17.9, New Zealand 12.3, Singapore 11.6, Finland 8.4 • Greatest increases in suicide rates: • Males: 154% in Ireland, 95% New Zealand, 87% Northern Ireland, • Females: N. Ireland 213%, Israel 175%, , Norway 91% • Greatest Decreases: • Males: 45% Japan, 38% Czechoslovakia & Israel • Females: Denmark 87%, Costa Rica 65%, Japan 40%.

  7. Variation in US States (ages 10-19) • Alaska 20.74/100,000 • Wyoming, S. Dakota, Idaho, New Mexico, Montana, ranged from 9-12/100,000 • New Jersey, California, New York, Mass, 2-3/100,000 • Why?? • Population density/ social isolation • Rural states more poor • Lower access to mental health services

  8. Can We Predict Suicide? • No. • Why Not? • Low base rates (e.g., ages 15-19 in US, approx. 1,700 suicides, of pop. = 20 million). • Too many ‘false positives’ and ‘false negatives’ • But, we have identified risk factors which help to place youth into ‘risk zones’ • What we can do is assess risk in a reasonable, reliable, consistent manner, and document thoroughly

  9. Risk Factors, Predisposing Factors (Percentages) • Ethnic / racial differences: Females, 2003

  10. Risk Factors: Predisposing Factors • Ethnic / racial differences: Males, 2003

  11. Rates by Grade: Females, 2003

  12. Rates by Grade: Males, 2003

  13. Overlap of Suicide Attempts and Completed Suicide • Gender breakdown differs • Methods used differ • Most common method for completers: firearms, second most common = strangulation • For attempters, most common = self-poisoning • Considerable overlap for psychopathology, family history of psychopathology, precipitating events • Roughly one-third to one-half of completed suicides have made a previous attempt

  14. Presenting Symptoms • Psychiatric disorder present in 80-90% of youth suicides

  15. Symptoms, continued… • Depression • Depressed mood, plus other symptoms on “Student Interview Worksheet” • Irritable/grouchy mood • Hopelessness • Mania (Unusually happy/excited, energetic, sure of self for week or more) • Panic Attacks • Anger / agitation / impulsivity • Self report: of urgent emotion and need for relief; feeling out of control? If yes, how did you cope deal with that? • Objective: arguments, physical fights, risky behavior

  16. Risk Factors: Predisposing Factors 2 • Parental Psychopathology • Youth history of suicidal behavior • History of physical/sexual abuse, family violence, harsh discipline

  17. Risk Factors: Precipitant Stress • Recent significant loss • Major academic failure • Significant relationship conflict with family, friends, romantic partner • Unsolvable impasse

  18. Interpersonal Functions of Emotions in Suicidal Behavior • Poor family communication: • Avoid direct communication, including communication of emotions (Richman, Orbach, Pfeffer) • Use more indirect , avoidant actions (looks, gestures, walking out, ignoring). • Unexpressed hostility (Pfeffer 81). • Suicidal act is a desperate attempt to communicate

  19. Interpersonal Factors, Ctd. • Scapegoating: The “Expendable Child” (Sabbath,’69). • Parents perceive child as threat to their well-being, and wish (perhaps unconsciously) to be rid of child or for him/her to die. Child thus feels rejected and expendable. • Scapegoating: Parental Rejection: (e,g, Richman, Orbach, others) • One child (or other family member) must die, or fail, to ensure the success of other(s). • Parental rejection internalized by child, becomes self hatred. Child feels burdensome, or that s/he has no right to live.

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