Suicide Defined
According to the United States Centers for Disease Control suicide is a death caused by self-directed injurious behavior with an intended outcome of death. This is different from self-harm non-suicidal self-injury which does not have the intent of resulting in death. In addition, suicide, although related, is the result of a suicide attempt, which is a non-fatal self-directed and potentially injurious behavior with any intent to die as a result of the behavior. Both suicide and suicide attempt have the intent of wanting to escape an unbearable psychological pain. Both are associated with an inability to problem solve. Furthermore, a suicide attempt may or may not result in injury.
Statistics
It is estimated that 1 million deaths occur annually due to suicide, and that for every death there are 25 attempts. National suicide rates increased by 24% from 1999 to 2014. During 2020, the proportion of mental health–related emergency department (ED) visits among adolescents aged 12–17 years increased 31% compared to 2019. In 2020 ED visits for suspected suicide attempts began to increase among adolescents aged 12–17 years, especially girls. During February 21–March 20, 2021, suspected suicide attempt ED visits were 50.6% higher among girls aged 12–17 years than during the same period in 2019. Among boys aged 12–17 years, suspected suicide attempt ED visits increased 3.7%. The most common psychiatric disorder associated with suicidality is major depressive disorder.
Risk and Protective Factor Associated with Suicide
While suicide can occur in the absence of a psychiatric disorder, it is commonly associated with and highly correlated with a number of psychiatric disorders. Risk factors associated with increased suicidal behavior can be classified as internal/intrapersonal and/or external/intrapersonal:
|
Intrapersonal Factors |
| Current/Past Psychiatric Disorder: Mood Disorders, Psychotic Disorders, ADHD, Conduct Disorders |
| Substance Abuse |
| Health Problems: Traumatic Brain Injury, HIV/AIDS, Sleep Disorders |
| Violence Victimization/Perpetration |
| Self-injurious behaviors |
|
Interpersonal Factors |
| High conflict or violent relationships |
| Sense of isolation/lack of social support |
| Family or loved one’s history of suicide |
| Financial or work stress |
In addition, parents of children with higher probability of engaging in suicide communicated the following interactions with their children:
- Invalidation and minimization
- High Levels of Criticism
- High Levels of Punishment
- Distress
These parents also reported that conflict with their teens to be “highly aversive” and tended to de-escalate much less than would be considered normal. In addition, to Risk Factors, some warning signs to be aware of:
- Giving away possessions
- Securing weapons.
There is also evidence that youth that identify as Lesbian, Gay, Bi-sexual, or Transgender that are from families that are unaccepting are approximately 9% more likely to attempt suicide. In addition, youth that are bullied are 2.5 times more likely to attempt suicide. Other risk factors include history of child abuse and the death of relative by suicide. There is also evidence that disruption in a primary relationship and/or substance use/abuse are strongly correlated with attempts when coupled with a precipitating event. A major emotional factor in suicidality is a sense of “being a burden”; the belief that the person is a major burden to others.
Protective Factors Associated with Decrease likelihood of suicide attempts include:
| Internal |
External |
| Ability to cope with extra stress | Responsibility of loved ones or beloved pet |
| Religious beliefs | Positive Therapeutic Relationship |
| Able to tolerate frustration | Social Support |
The need for social support cannot be understated especially during the pandemic where social isolation has increased and, in an era, where so much social interactions have moved to virtual settings.
What Can Parents Do?
As parents we need to be aware of these risk factors and not be afraid to inquiry when suspect something is awry. The tone in which you inquire should be that of respectful curiosity. A tone that makes it clear that it is acceptable to talk openly and honestly about suicidal thoughts and behaviors. Use the LUV Method: – Listen, Understand, and Validate.
Parental inquiry should ask about:
- Ideation (thoughts of wanting to die or killing oneself),
- with specifics about frequency (how often are these thoughts),
- Intensity (how strongly does child want to die),
- Duration (i.e., how long do the thoughts last – last 48 hours, past month, worst ever).
- Plan or thought about a plan for ending one’s life
- Timing – when
- Location – where
- Lethality – what means
- Availability – access to means
- Preparing Acts – Have step been put in place to get timing, location, and means taken place.
Even after the assessment is conducted and severity is assessed. Parents need to immediately seek help from mental health professionals. They can seek help from their primary care physician, counselors at school, local department of health, their insurance provider portal, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
