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Suicidal Behavior in Adolescents

Human Resource Management

Research done by :
Abhishek Mishra
Roll no. 39
Class. 11th Science A
Suicide is both a public and mental health problem, and is a leading cause of deaths, especially
among adolescents. Two factors that contribute to the decision of adolescents to commit
suicide are having a primary mood disorder and/or substance use. In the Indian culture, the
family unit has both a positive and negative impact on suicide. The family serves as a protective
factor that provides a strong support for the individual, but alternately creates an inseparable
individual when seeking mental health care, which often complicates the situation. Due to the
stigma, Indians typically perceive having a mental illness as shameful. Religion is integral to the
Indian culture so much so that individuals often use herbal remedies, seek help from religious
leaders, and attend religious establishments prior to obtaining a mental health evaluation in
those that are subsequently deemed as mentally ill. Despite the fact that suicides are
underreported and misdiagnosed in India, it is known that the highest rates are among those
<30 years old. The methods most commonly used to commit suicide in India include the
ingestion of poison (often pesticides), hanging, burning, and drowning. When immigrating,
Indians tend to switch the methods they use to commit suicide from ingestion of poison to
hanging, which may reflect a lack of available poisonous substances or the influence of the host
culture. Considering the high suicide rates in adolescents, the importance of providing
psychoeducation, restricting access to lethal means, and promoting social integration in
immigrants are various ways by which suicides in Indian adolescents can be avoided.
In children and adolescents, risk of suicidal behavior is influenced by the presence of other
mental disorders and other disorders that affect the brain, family history, psychosocial
factors, and environmental factors.
Other contributing factors may include
 A lack of structure and boundaries, leading to an overwhelming feeling of lack of

 Intense parental pressure to succeed accompanied by the feeling of falling short of


A frequent motive for a suicide attempt is an effort to manipulate or punish others with the
fantasy “You will be sorry after I am dead.”

Protective factors include

 Effective clinical care for mental, physical, and substance use disorders

 Easy access to clinical interventions

 Family and community support (connectedness)

 Skills in conflict resolution

 Cultural and religious beliefs that discourage suicide


 Crisis intervention, possibly including hospitalization

 Psychotherapy

 Possibly drugs to treat underlying disorders, usually combined with psychotherapy

 Psychiatric referral
Every suicide attempt is a serious matter that requires thoughtful and appropriate
intervention. Once the immediate threat to life is removed, a decision regarding the need for
hospitalization must be made. The decision involves balancing the degree of risk with the
family’s capacity to provide support. Hospitalization (even in an open medical or pediatric
ward with special-duty nursing) is the surest form of short-term protection and is usually
indicated if depression, psychosis, or both are suspected.

Lethality of suicidal intent can be assessed based on the following:

 Degree of forethought evidenced (eg, by writing a suicide note)

 Steps taken to prevent discovery

 Method used (eg, firearms are more lethal than pills)

 Degree of self-injury sustained

 Circumstances or immediate precipitating factors surrounding the attempt

 Mental state at the time of the episode (acute agitation is especially concerning)

 Recent discharge from inpatient care

 Recent discontinuation of psychoactive drugs

Drugs may be indicated for any underlying disorder (eg, depression, bipolar or conduct disorder,
psychosis) but cannot prevent suicide. Antidepressant use may increase risk of suicide in some
adolescents. Use of drugs should be carefully monitored, and only sublethal amounts should be

Psychiatric referral is usually needed to provide appropriate drug treatment and

psychotherapy. Cognitive-behavioral therapy for suicide prevention and dialectical behavioral
therapy may be preferred. Treatment is most successful if the primary care practitioner
continues to be involved.
Rebuilding morale and restoring emotional equilibrium within the family are essential. A
negative or unsupportive parental response is a serious concern and may suggest a need for
a more intensive intervention such as out-of-home placement. A positive outcome is most
likely if the family shows love and concern.

Response to suicide

Family members of children and adolescents who committed suicide have complicated
reactions to the suicide, including grief, guilt, and depression. Counseling can help them
understand the psychiatric context of the suicide and reflect on and acknowledge the child’s
difficulties before the suicide.

After a suicide, the risk of suicide may increase in other people in the community, especially
friends and classmates of the person who committed suicide. Resources (eg, a toolkit for
schools) are available to help schools and communities after a suicide. School and community
officials can arrange for mental health care practitioners to be available to provide
information and consultation.


Suicidal incidents are often preceded by behavioral changes (eg, despondent mood, low self-
esteem, sleep and appetite disturbances, inability to concentrate, truancy from school,
somatic complaints, and suicidal preoccupation), which often bring the child or adolescent to
the physician’s office. Statements such as “I wish I had never been born” or “I would like to
go to sleep and never wake up” should be taken seriously as possible indications of suicidal
intent. A suicidal threat or attempt represents an important communication about the
intensity of experienced despair.

Early recognition of the risk factors mentioned above may help prevent a suicide attempt. In
response to these early cues, to threatened or attempted suicide, or to severe risk-taking
behavior, vigorous intervention is appropriate. Adolescents should be directly questioned
about their unhappy or self-destructive feelings; such direct questioning may diminish suicide
risk. A physician should not provide unfounded reassurance, which can undermine the
physician’s credibility and further lower the adolescent’s self-esteem.

Physicians should help patients do the following, which may help reduce the risk of suicide:

 Get effective care for mental, physical, and substance use disorders

 Access mental health services

 Get support from the family and community

 Learn ways to peacefully resolve conflict

Suicide prevention programs can help. The most effective programs are those that strive to
ensure that the child has the following:

 A supportive nurturing environment

 Ready access to mental health services

 A social setting that is characterized by respect for individual, racial, and cultural