In an increasingly competitive world where adolescents are constantly under pressure to achieve and excel – at school, on the sports field, at home, among friends - it comes as no surprise that suicide is one of the leading causes of teen deaths, worldwide as well as in South Africa.
Statistics, trends
“Suicidal thoughts are common amongst the youth, with about 1 in 6 females and 1 in 10 males between ages 12-16 experiencing suicidal thoughts in the past 6 months. The rates of completed suicides are higher in males than females,” Dr Kerryn Armstrong, specialist psychiatrist at Akeso Clinic in Milnerton advises.
The South African Anxiety and Depression Group (SADAG) also points out South Africa’s high teen suicide rate and concerns about the trend: “In South Africa 9.5% of all teen deaths are due to suicide – and this figure is on the increase. In the 15-24 age group, suicide is the second leading – and fastest growing – cause of death. Children as young as 6 years old have committed suicide in South Africa. Every day 23 people (adults and adolescents) take their lives. Suicide is on the increase and the question is why?”4
An infographic on the SADAG website in lieu of Teen Suicide Prevention week (14-21 February 2016) furthermore revealed the following:
- 17.6% of teens had considered attempting suicide;
- 17.8% had one or more suicide attempts;
- 15.6% had made a plan to commit suicide;
- 31.5% of teen suicide attempts required medical treatment;
- 1 in 4 teens had experienced sad or hopeless feelings;
- 21.9% of 18 year olds had one or more suicide attempts; and
- 43.6% had tried to seek help (counselling) after considering suicide.5
Key indicators
According to Dr Armstrong, a range of indicators and tell-tale signs should act as “alarm bells” for adolescent suicide risk. These include:
- Communication of suicidal thoughts, presence of a suicide plan, preparation for suicide/saying goodbye
- Low mood, feelings of hopelessness
- Deterioration in school work, loss of interest in activities
- Social withdrawal
- Increased irritability, aggression, moodiness
- Reckless behaviour
- Abuse of substances
- Prominent symptoms of unstable personality
- History of risk factors discussed above
Risk factors
Suicide results from a complex interaction between individual, psychosocial and mental health factors, Dr Armstrong adds.
Major risk factors for teen suicide include:
- Previous suicide attempt (the most important predictor)
- Mental health problems
o Major depression (very important) and other mood disorders such as substance use disorders
o Dysfunctional/unstable personality characteristics
o Feelings of hopelessness and worthlessness
o Impulsive anger outbursts
o Family history of depression or suicide
o Loss of a parent or close relationship
o Family conflict
- Poor support structures, lack of friends, feelings of isolation
- Unsupportive or negative response from family, friends or community when “coming out” or dealing with gender identification issues
- Bullying or victimisation
- High pressure/unrealistic expectations of achievement
- Lethal means available
- Exposure to suicide through family, friends, internet or media
Intervention
A holistic approach tailored to each individual’s unique personal and contextual needs should be followed, Dr Armstrong advises. “The patient, family and community should all be actively involved in planning and implementation of interventions. Once the individual’s safety has been ensured, steps should be taken to:
- identify and treat underlying psychiatric disorders,
- decrease stress and demands on the individual,
- address contributing psychosocial stressors through family and school interventions, and
- optimise support for the individual going forward.”
Prevention
Open communication with a caring adult who can listen without judgement to the concerns of the teen, is the best form of prevention. It is vital for a teenager to have open communication yet, despite this, sometimes teens are unable to let someone know how much distress they feel.
By limiting their teenager’s access to guns, knives, alcohol, prescription pills and illegal drugs, parents can play a pivotal preventive role. Moreover, they should be very aware of who their child's friends are and network with the other parents on a regular basis so that they can keep track of their child’s whereabouts and communications. Teenagers tend to complain about their right to privacy, but it is the parents’ job to keep them safe.2
It is imperative that suicide prevention measures are taken seriously in order to decrease the occurrence of this devastating outcome,” Dr Armstrong stresses.
“Parents, families, teachers and health care providers need to be aware of the very real risk of adolescent suicide. They should be vigilant for indications of mental health problems and ensure that at-risk individuals receive urgent help. Steps should be taken to minimise stress and pressure placed on adolescents, and foster a climate with close support and open communication. Restriction of means to suicide should be ensured,” she advises.
“Likewise, the media has a responsibility to educate the public about suicide in a way that avoids sensationalising or normalising suicide, but rather encourages help-seeking behaviour,” she concludes.
Facts about Teen Suicide
According to the World Health Organisation (WHO):
1. In South Africa, hanging is the most frequently employed method of suicide, followed by shooting, gassing and burning.
2. Risk factors for suicide among the young include the presence of mental illness, especially depression, conduct disorder, alcohol and drug abuse, previous suicide attempts, and the availability of firearms in the home.
3. In South Africa 60% of people who commit suicide are depressed.
4. Internationally the suicide rate for children aged 10-14 years old has more than doubled over the last fifteen years.
5. In South Africa the average suicide is 17.2 per 100 000 (8% of all deaths). This relates only to deaths reported by academic hospitals. The real figure is higher.
References:
1. Rey, JM (editor). IACAPAP Textbook of Child and Adolescent Psychiatry. Geneva: International Association for Child and Adolescent Psychiatry Allied Professions, 2015
2. AACAP American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with suicidal behaviour. Journal of the American Academy of Child and Adolescent Psychiatry, 40 (sup):24S-51S, 2001
3. Cash S, Bridge J. Epidemiology of youth suicide and suicidal behaviour. Current Opinion in Paediatrics, 21:613-6619, 2009
4. Curbing Teen Suicide in South Africa. Available at: www.sadag.org/index.php?option=com_content&view=article&id=816:curbing-teen-suicide-in-south-africa&catid=94&Itemid=132
5. South African Depression and Anxiety Group - Teen Suicide Infographic 2016. Available at http://www.sadag.org/index.php?option=com_content&view=article&id=2941:teen-suicide-infographic-2016&catid=92&Itemid=154
6. TEEN SUICIDE PREVENTION: Frequently Asked Questions (Sources: Michelina Gautieri, Psy.D., Marin County Community Mental Health; Diane Suiffridge, Ph.D., Family Service Agency; Margaret Perlstein, M.F.T., Teen Mental Health Board; Jessica Potter, L.M.F.T., Bay Area Community Resources; National Institute of Mental Health; Teen Life and Tandem Journey) Available at http://www.marinschools.org/SafeSchools/Documents/Student%20Mental%20Health/SuicidePreventionFAQs.pdf
7. Akeso Clinics at https://www.akeso.co.za/articles/uncategorised/the-facts-about-teen-suicide
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