REVIEW OF RELATED LITERATURE

Suicide is a global public health concern, accounting for approximately 1.5% of all deaths
worldwide. Its prevalence is high among the adolescent and young adult populations. In the
Philippines, the prevalence of suicide is not clear since there is no country-wide suicide registry
in place. However, the most recent Global School-based Student Health Survey (GSHS)
reported that 11.6% of Filipino adolescents aged 13 to 17 years old considered attempting
suicide while 16.8% attempted suicide at least once in the past year.
According to the data of World Health Organization (2016) on suicide, close to 800 000 people
die due to suicide every year, which is one person every 40 seconds. Suicide is a global
phenomenon and occurs throughout the lifespan. Effective and evidence-based interventions
can be implemented at population, sub-population and individual levels to prevent suicide and
suicide attempts. There are indications that for each adult who died by suicide there may have
been more than 20 others attempting suicide. Suicide is a global phenomenon; in fact, 79% of
suicides occurred in low- and middle-income countries in 2016. Suicide accounted for 1.4% of
all deaths worldwide, making it the 18th leading cause of death in 2016. Suicide occurs
throughout the lifespan and is the second leading cause of death among 15-29 year old
globally. These suicide figures are probably still an underestimation of the real cases.
Registering a suicide is a complicated process, often involving judicial authorities. Suicide
deaths may not be recognized or may be misclassified as an accident or another cause of
death. Sometimes suicide is not acknowledged or reported, due to its sensitive nature and the
taboo that still surrounds it (Leo, 2015).

RISK FACTORS FOR SUICIDAL THOUGHTS AND BEHAVIORS

Table 1
Lists of Suicide Risk Factors and Warning Signs from Several Health- and Suicide-Focused
Organizations (Franklin, J. C., et. al., 2017)
Organization Risk factors Warning signs
American Association of Suicidology (Adults) (AAS, 2015) More than one warning sign;
anticipated or actual losses or life stresses (e.g., romantic break-ups, legal problems, academic
failures); prior suicide attempts Increased substance use; no reason or purpose for living;
anxiety, agitation, or sleep problems; feeling trapped; hopelessness; social withdrawal; rage and
anger; reckless or risky behaviors; dramatic mood changes
American Association of Suicidology (Youths) (AAS, 2015) More than one warning sign; new or
increased warning signs; actual or anticipated losses or life stresses Talking about or
planning suicide; hopelessness; severe or overwhelming emotional pain/distress; worrisome
behaviors or marked changes in behaviors (e.g., social withdrawal; changes in sleep; anger or
hostility; increased agitation or irritability)
American Foundation for Suicide Prevention (AFSP, 2015) Depression; bipolar disorder;
schizophrenia; borderline or antisocial personality disorders; conduct disorder; psychotic
disorders or symptoms; substance abuse disorders; serious or chronic physical health
problems; exposure to others’ suicide; access to lethal means; stressful life events; family
history of suicide or mental health problems; childhood abuse; prior suicide attempt Talking
about suicide, having no reason to live, being a burden, feeling trapped, or unbearable pain;
increased substance use; planning suicide; acting recklessly; social withdrawal; sleep problems;
saying goodbye to people; giving away prized possessions; aggression; depression; loss of
interest; rage and irritability; anxiety; humiliation
Centers for Disease Control (CDC, 2015) Family history of suicide or childhood maltreatment;
prior suicide attempt; mental disorders (especially depression); substance abuse; hopelessness;
impulsive or aggressive tendencies; cultural or religious beliefs that suicide is noble; local
suicide epidemics; social isolation; barriers to mental health treatment; loss; physical illness;
access to lethal means; unwillingness to seek help due to stigma concerns Talking about
hurting oneself; increased substance use; changes in mood, diet, or sleeping patterns
National Institute of Mental Health (NIMH, 2015) Mental disorders (especially depression and
substance abuse); prior suicide attempt; family history of mental disorder, substance abuse,
suicide, violence, or physical/sexual abuse; guns or firearms in the home; incarceration; being
exposed to others’ suicidal behaviors Threatening or talking about killing oneself;
planning suicide; hopelessness; rage or anger; reckless behaviors; feeling trapped; increased
substance abuse; social withdrawal; anxiety, agitation, or sleep problems; dramatic mood
changes; lack of purpose in life
World Health Organization (WHO, 2015) Mental disorders (especially depression and
substance abuse); moments of crisis; chronic pain and illness; conflict, disaster, violence,
abuse, and loss; being a refugee, migrant, indigenous person, prisoner, or non-heterosexual
person; prior suicide attempt None noted

REVIEW OF RELATED STUDIES

According to (Akhtar & Alam, 2015) studies on stress and suicidal ideation have a great
importance in the present era and have become an important topic in academic circles. Such
researches have drawn the attention of behavioral scientists to explore the latent factors, which
cause increasing tendency of suicidal ideation. Students feel the effects of stress in a harsh and
probably negative ways. Some effects include a sudden drop in grades, depression, general
fatigue, and aggression. Studies show that stress and anxiety during adolescence may even
have a negative effect on health, too. Stress affects the human body physically, it can also harm
a person's emotional well-being as well. Stress level affects the students academically and
changes the way the person thinks and acts during school or while studying.
Suicide ideation is a robust predictor of suicide completion. Research into the extent of and the
factors related to suicide ideation is thus important (Sta. Maria, et. al., 2015). Despite the
increasing suicide cases among the youth in the Philippines, substantive local studies on
suicide ideation are sparse. Suicide is a major public health problem due to its enormous social
and economic costs to individuals, families, communities, and the larger society.
According to (Bilsen, 2018) suicide occurs more often in older than in younger people, but is still
one of the leading causes of death in late childhood and adolescence worldwide. This not only
results in a direct loss of many young lives, but also has disruptive psychosocial and adverse
socio-economic effects. From the perspective of public mental health, suicide among young
people is a main issue to address. Therefore we need good insight in the risk factors
contributing to suicidal behavior in youth.
These facts, together with the finding that overall these figures have not tended to decline
clearly and steadily over recent decades, have caused growing concern among scientists and
policy makers. There is also an increasing awareness in the general population about the
tremendous negative consequences of youth suicidality, not only because of the direct loss of
many young lives but also in the disruptive psychosocial and adverse socio-economic effects on
a large societal scale. From the perspective of public mental health, suicide among young
people is one of the main issues to address through effective preventive measures. Therefore, it
is important to gain as much insight as possible in the risk factors contributing to suicidal
behavior in youth (Bilsen, 2018).
Although it is common to find that people do not admit to having suicidal thoughts, some of them
have the potential to die by committing suicide. In fact, there is a common public misperception
that only those who are diagnosed with depression are at risk of committing suicide. However,
almost 40% of the people who commit complete suicide are not clinically depressed, which
indicates that various psychological conditions could potentially increase the risk of suicide.
These include post-traumatic stress disorder, eating disorders and bipolar disorder (Smith,
2014).
Suicidal ideation is the consideration of or desire to end one's own life. Suicidal ideation typically
ranges from relatively passive ideation (e.g. wanting to be dead) to active ideation (e.g. wanting
to kill oneself or thinking of a specific method on how to do it). Studies using self-report
measures and real-time monitoring techniques have demonstrated that community-based
adolescents who experience suicidal ideation typically do so at a moderate frequency (e.g. 1
thought per week), with thoughts often ranging between mild to moderate in severity (Miranda
et. al., 2014).
Environmental risk factors and correlates
Childhood maltreatment
There is strong evidence indicating that various forms of childhood maltreatment such as
sexual, physical, and emotional abuse predict future suicidal ideation and suicide attempt
among youth. Prospective cohort studies and twin studies have demonstrated the unique impact
of sexual abuse on suicide attempt and death among adolescents and young adults,
independent of contextual factors such as parent and child characteristics and quality of family
environment (Castellví et al., 2017). Although less frequently studied, emotional abuse also has
been shown to increase likelihood of suicidal ideation in older children and adolescents
controlling for covariates such as history of suicidal ideation, depressive symptoms, and in some
cases controlling for sexual and physical abuse (Miller et al., 2016).
Bullying
Strong evidence highlights bullying (i.e. peer victimization) as a risk factor for suicidal thoughts
and behaviors among youth. Bullying consists of intentionally harmful or disturbing behavior that
is repeated and invokes a power differential. Longitudinal studies have demonstrated the impact
of social exclusion, verbal/physical abuse, and coercion by peers during childhood and early
adolescence on later suicidal ideation, suicide attempt, and suicide death (Geoffroy et al.,
2016).
Peer and media influence
Reference
Book

Research Journal
Akhtar, Z., & Alam, M. (2015). Stress and Suicidal Ideation among School Students. Journal of
the Indian Academy of Applied Psychology Volume: 41. Issue: 2, 236. Retrieved from
https://www.questia.com/read/1P3-4017249501/stress-and-suicidal-ideation-among-school-stud
ents
Bilsen, J. (2018). Suicide and Youth: Risk Factors. Front Psychiatry, 9. doi:
10.3389/fpsyt.2018.00540
Geoffroy, M. C., Boivin, M., Arseneault, L., Turecki, G., Vitaro, F., Brendgen, M., ... &
Côté, S. M. (2016). Associations between peer victimization and suicidal ideation and suicide
attempt during adolescence: results from a prospective population-based birth cohort. Journal of
the American Academy of Child & Adolescent Psychiatry, 55(2), 99-105.
https://doi.org/10.1016/j.jaac.2015.11.010

Leo, D. D. (2015 ). Can We Rely on Suicide Mortality Data? Crisis , 36(1):1-3.

https://doi.org/10.1027/0227-5910/a000315

Miller, A. B., Jenness, J. L., Oppenheimer, C. W., Gottleib, A. L. B., Young, J. F., & Hankin,
B. L. (2017). Childhood emotional maltreatment as a robust predictor of suicidal ideation: A
3-year multi-wave, prospective investigation. Journal of abnormal child psychology, 45(1),
105-116. https://link.springer.com/article/10.1007/s10802-016-0150-z

Miranda, R., Ortin, A., Scott, M., & Shaffer, D. (2014). Characteristics of suicidal ideation
that predict the transition to future suicide attempts in adolescents. Journal of
Child Psychology and Psychiatry, 55(11),
12881296. https://doi.org/10.1111/jcpp.12245

Smith, B. L. (2014). Psychologists need more training in suicide risk assessment. Monitor on
Psychology, 45(4), 42.
Sta. Maria, M., Lee, R. B., Estanislao, S., Rodriguez, C. A., Wang, J., & Liu, Y. (2015). A
Multivariate Analysis of Suicide Ideation Among University Students in the Philippines.
Asia-Pacific Social Science Review, 15(1). Retrieved from
https://ejournals.ph/article.php?id=6015
Thesis
Castellví, P., Miranda-Mendizábal, A., Parés-Badell, O., Almenara, J., Alonso, I., Blasco,
M. J., ... & Piqueras, J. A. (2017). Exposure to violence, a risk for suicide in youths
and young adults. A meta-analysis of longitudinal studies. Acta psychiatrica
scandinavica, 135(3), 195-211. https://doi.org/10.1111/acps.12679
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., ... &
Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: a meta-
analysis of 50 years of research. Psychological Bulletin, 143(2), 187.
https://psycnet.apa.org/doiLanding?doi=10.1037%2Fbul0000084
Article
Depression and Other Common Mental Disorders: Global Health Estimates. (2017). Retrieved
from World Health Organization:
https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf
Global School-based Health Survey Philippines. (2015). Retrieved from World Health
Organization: https://www.who.int/ncds/surveillance/gshs/PIH2015_fact_sheet.pdf
Mental Health: Suicide Data. (2016). Retrieved from World Health Organization:
https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/