Tittle: suicide among youth

SUICIDE AMONG YOUTH

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. This mini review gives a short overview of the most important risk factors for late school-
age children and adolescents, as established by scientific research in this domain. Key risk factors
found were: mental disorders, previous suicide attempts, specific personality characteristics,
genetic loading and family processes in combination with triggering psychosocial stressors,
exposure to inspiring models and availability of means of committing suicide. Further unraveling
and knowledge of the complex interplay of these factors is highly relevant with regard to the
development of effective prevention strategy plans for youth suicide.

Introduction:
Youth suicide is when a young person, generally categorized as someone below the legal age
of majority, deliberately ends their own life. Rates of attempted and completed youth suicide in
Western societies and other countries are high. Youth suicide attempts are more common
among girls, but adolescent males are the ones who usually carry out suicide. Suicide rates in
youths have nearly tripled between the 1960s and 1980s. For example, in Australia suicide is
second only to motor vehicle accidents as its leading cause of death for people aged 15–25,
according to the National Institute for Mental Health, suicide is the third leading cause of death
among teens
The majority of children and adolescents who attempt suicide have a significant mental health
disorder, usually depression.Among younger children, suicide attempts are often impulsive.
They may be associated with feelings of sadness, confusion, anger, or problems with attention
and hyperactivity.Among teenagers, suicide attempts may be associated with feelings of stress,
self-doubt, pressure to succeed, financial uncertainty, disappointment, and loss. For some teens,
suicide may appear to be a solution to their problems.Depression and suicidal feelings are
treatable mental disorders. The child or adolescent needs to have his or her illness recognized
and diagnosed, and appropriately treated with a comprehensive treatment plan.
Suicide is defined as a fatal self-injurious act with some evidence of intent to die Worldwide,
more than 800,000 people die due to suicide each year. It is estimated that about 1.5 million
people will die due to suicide by the year 2020. The suicide mortality rate in 2015 was 10.7 per
100,000, which means about one death every 20 s. Suicide accounts for 1.4% of all deaths, and is
the 15th leading cause of death globally many more men than women die by suicide. The male-to-
female ratio varies between 4 to 1 (Europe and Americas) and 1.5 to 1 (Eastern Meditarranean
and Western Pacific region), and is highest in richer countries.
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.
Suicide attempts, i.e. non-fatal suicidal behavior, are much more frequent, and are estimated to be
about 10–20 times more freq uent than actual suicide. The estimated global annual prevalence of
self-reported suicide attempts is approximately 3 per 1,000 adults. About 2.5% of the population
makes at least one suicide attempt during their lifetime.

Factors:
In some cases, it may be impossible to ascertain whether some deaths, caused for example by car
crashes, drowning, falls and overdoses of illegal drugs, were unintentional or intentional.
Adolescent suicidal behaviour is widely deemed to be underreported, because many deaths of this
type are inaccurately classified as unintentional or accidental.
Postmortem studies of adolescents who died from violent causes indicate that they do not
constitute a homogeneous group. They show subtle manifestations of self-destructive and risk-
taking tendencies and, while some of their deaths may be caused by unintentional acts, others are
intentional acts resulting from the pain of living.
In addition, the definitions of attempted suicide used by students differ from those used by
psychiatrists. Self-reported results show almost twice the number of suicide attempts revealed by
psychiatric interviews. The most likely explanation is that the young people who responded to
anonymous inquiries were using a broader definition of attempted suicide than that used by
professionals. Moreover, only 50% of adolescents reporting that they had tried to kill themselves
had sought hospital care after their suicide attempts. Thus, the number of suicide attempters
treated in hospital is no real indication of the dimension of the problem in the community.
Generally speaking, adolescent boys commit suicide more often than girls do. Nevertheless, the
rate of attempted suicide is two to three times higher among girls. Girls develop depression more
often than boys do, but they also find it easier to talk about their problems and to seek assistance,
and this probably helps to prevent fatal suicidal acts. Boys are often more aggressive and
impulsive, and not infrequently act under the influence of alcohol and illicit drugs, which
probably contributes to the fatal outcome of their suicidal acts.

Protective Factors:
Major factors that afford protection against suicidal behaviour are:
 Family patterns
 good relationships with family members;
 support from family.

 Cognitive style and personality

 good social skills;
 confidence in oneself and one’s own situation and achievements;
 seeking help when difficulties arise, e.g. in school work:
 seeking advice when important choices must be made;
 openness to other people’s experiences and solutions;
 openness to new knowledge.
Cultural and sociodemographic factors
• social integration, e.g. through participation in sport, church associations, clubs and other
• activities;
• good relationships with schoolmates;
• good relationships with teachers and other adults;
• support from relevant people.
Risk Factors:
 Thoughts about suicide and suicide attempts are often associated with depression. In addition to
depression, Risk factors include:
 family history of suicide attempts
 exposure to violence
 impulsivity
 aggressive or disruptive behavior
 access to firearms
 bullying
 feelings of hopelessness or helplessness

 Children and adolescents thinking about suicide may make openly suicidal statements or
comments such as, "I wish I was dead," or "I won't be a problem for you much longer." Other
warning signs associated with suicide can include:
 changes in eating or sleeping habits
 frequent or pervasive sadness
 withdrawal from friends, family, and regular activities
 Frequent complaints about physical symptoms often related to emotions, such as
stomachaches, headaches, fatigue, etc.
 preoccupation with death and dying
 decline in the quality of schoolwork
Young people who are thinking about suicide may also stop planning for or talking about the
future. They may begin to give away important possessions.
Methodology:
Suicidal ideation is rare before the age of 10 and its prevalence rapidly increases between 12 and
17 years of age (Nock, Borges, & Ono, 2012; Nock et al., 2013). Many adolescents continue to
experience suicidal ideation even after hospitalization (Czyz & King, 2015; Wolff et al., 2018).
Adolescents who experience suicidal ideation (vs. nonsuicidal adolescents) are approximately 12
times more likely to have attempted suicide by the age of 30 (Reinherz, Tanner, Berger,
Beardslee, & Fitzmaurice, 2006), and over one‐third of adolescents who experience suicidal
ideation go on to attempt suicide (Nock et al., 2013). Suicidal ideation that is especially frequent,
serious, and chronic is associated with suicide attempt (Miranda et al., 2014; Czyz & King, 2015;
Wolff et al., 2018). Of those adolescents who do transition to attempt, the majority do so within
1–2 years of ideation onset (Glenn et al., 2017), and are typically characterized by specific clinical
presentations (e.g. depression/dysthymia, eating disorder, attention‐deficit hyperactivity disorder,
conduct disorder, intermittent explosive disorder; Nock et al., 2013). As expected, suicide attempt
has a slightly later age of onset than suicidal ideation. Suicide attempt is rare before the age of 12,
and its prevalence increases during early to mid/late adolescence (Glenn et al., 2017; Nock et al.,
2013) and stabilizes in the early 20s (Goldston et al., 2015). Among clinical populations, most
suicide attempts after late adolescence have been found to be reattempts, with the amount of time
between reattempts decreasing with greater frequency (Goldston et al., 2015). Even though
suicide death is less frequent among children, suicides at ages as young as 5‐8 years have been
documented (e.g. Bridge et al., 2015; Grøholt, Ekeberg, Wichstrøm, & Haldorsen, 1998). Suicide
 death becomes increasingly common by 15–19 years (Kolves & de Leo, 2017).

Demographic patterns:
There are distinct demographic patterns in the presentation, prevalence, and course of
suicidal thoughts and behaviors. Some of the most distinguishing demographic characteristics
include sex, age, race/ethnicity, as well as sexual orientation and gender identity.

Sex:
Sex presents a now well‐established paradox in which adolescent girls are more likely to have
experienced suicidal ideation and suicide attempt than boys, but adolescent boys are more likely
to die by suicide (Brent, Baugher, Bridge, Chen, & Chiappetta, 1999; Fergusson, Woodward, &
Horwood, 2000; Kokkevi et al., 2012; Lewinsohn, Rohde, Seeley, & Baldwin, 2001). There is
no pronounced sex difference in prevalence or severity until approximately 11 years of age
(Nock & Kazdin, 2002). Recent findings suggest slight differences in ages of onset (e.g. earlier
age of onset for suicidal ideation among females, earlier age of onset for suicide attempt among
males), though these patterns may vary across different levels of clinical severity (Glenn et al.,
2017). There are mixed findings pertaining to the transition from adolescence into young
adulthood, with some studies reporting more tempered sex differences (Lewinsohn et al., 2001),
whereas others report persistent group differences (Fergusson et al., 2000). The sex difference
in suicide death rates among youth tend to mimic those found among adults, such that boys and
young men die by suicide at a rate of more than two times—and sometimes more than three
times—that of girls and young women (Figure 1).
Youth suicide deaths by sex in selected countries (ages 5–29). Note. Data were obtained from the
World Health Organization for the most recent year available (2012–2015). Countries selected by
availability of vital registration data by sex and age groups 5–14 and 15–29. The following
countries were excluded due to missing data for any sex or age group: Saint Vincent and the
Grenadines, Iceland, Grenada, Brunei Darussalam, Bahamas, Latvia, Estonia, Slovenia, Slovakia,
and Luxembourg

Age:
 Older adolescents are more likely to die by suicide than children and younger adolescents
(Brent et al., 1999; Grøholt et al., 1998). Typically across countries, suicide death rates for older
adolescents and young adults (15–29 years) are at least 10 times greater than children and young
adolescents (5–14 years; Table 1). This trend among older adolescents is at least somewhat
attributed to greater prevalence of psychopathology such as substance abuse and suicidal intent
(Brent et al., 1999).2 Notable age patterns also exist in the use of methods. For instance,
hanging/suffocation is more common among children compared with adolescents (Kolves & de
Leo, 2017; Olfson, Gameroff, Marcus, Greenberg, & Shaffer, 2005; Sheftall et al., 2016), and
the use of a sharp object is more common among adolescents compared with adults (Parellada et
al., 2008). Adolescents and children who die by suicide, compared with adults, are less likely to
have been intoxicated or to have made a previous suicide attempt (Grøholt et al., 1998).

Race/Ethnicity:
The most consistent cross‐national finding is the higher risk of suicide death among
indigenous youth. This pattern has been observed throughout distinct parts of the world ranging
from American Indian, Alaska Native, and Aboriginal youth in the United States and Canada
(CDC, 2017; Mullany et al., 2009), to indigenous youth in Australia and New Zealand
(Beautrais, 2001; Cantor & Neulinger, 2000), to Guaraní Kaiowá and Ñandeva communities in
Brazil (Coloma, Hoffman, & Crosby, 2006). Substance use, poverty/unemployment, high
accessibility to lethal means, intergenerational trauma, and loss of culture/identity have been
cited as potential risk factors, and community/family connectedness and communication have
been cited as potential protective factors (Borowsky, Resnick, Ireland, & Blum, 1999; Coloma
et al., 2006; Wexler & Gone, 2012). Findings regarding other racial/ethnic minorities are
nuanced and often specific to region, type of suicide‐related outcome, and time. For instance, in
the United States, Black Non‐Hispanic adolescents are less likely to experience suicidal ideation
compared with other adolescents (CDC, 2017; Nock et al., 2013); however, there is a consistent
trend of increasing suicide attempt and death rates over time among Black youth relative to
same‐aged White peers (Bridge et al., 2015; Joe & Kaplan, 2001; Shaffer, Gould, & Hicks,
1994), and higher death rates among Black children compared with Black adolescents (Sheftall
et al., 2016). An additional and critical consideration is the local environment and whether this
interacts with minority status. As an example, Swedish children were found to be at greater risk
of suicide death if they had foreign‐born parents and lived in an area deeming them to be a
relative minority; in contrast, living in areas of Sweden where larger proportions of the
population had foreign‐born parents protected against suicide risk (Zammit et al., 2014). Similar
interactions between individual demographic characteristics and environment have been found
in other countries such as England (Neeleman & Wessely, 1999), and the United States as
described below (Hatzenbuehler, 2011), and may help resolve inconsistent findings among
other minority groups (e.g. Hispanic adolescents in the United States; South Asian adolescents
in the United Kingdom; Bhui, McKenzie, & Rasul, 2007; CDC, 2017).
Sexual orientation and gender identity:
Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth show elevated
prevalence of suicidal ideation and suicide attempt than heterosexual youth (Fergusson,
Horwood, & Beautrais, 1999; Haas et al., 2010; Wichstrøm & Hegna, 2003). Related to the
aforementioned point on race, the impact of sexual minority status may vary across social
environments depending on degree of local LGB support. In a compelling example,
Hatzenbuehler (2011) examined LGB youth across distinct counties within Oregon, USA, and
found that LGB youth were at 20% greater risk of attempting suicide if they lived in an
‘unsupportive county’ (e.g. low proportion of registered Democrats; low presence of gay‐straight
alliances at school; low proportion of schools with antibullying and antidiscrimination policies
specifically protecting LGB students) compared to supportive counties. Similarly, Raifman et al.
(2017) recently demonstrated that same‐sex marriage legislation at the state‐level related to
decreased rates of suicide among LGBQ youth in that respective state. The higher risk status of
both sexual and gender minority youth (LGBT) may also be attributed to the consistently higher
rates of victimization they experience both at home and school, relative to sexual nonminority
youth (D'Augelli, Grossman, & Starks, 2006; Friedman et al., 2011; McGuire, Anderson,
Toomey, & Russell, 2010). Increased attention on these higher risk populations is strongly
encouraged.
 Suicides among youth in India:
Data on suicide incidence, age, sex, residence (urban or rural), season, previous attempts,
presence or absence of mental disease history, and methods of suicides were collected
retrospectively from the Forensic Medicine & Toxicology Department, King George’s Medical
University in the Lucknow province from January 2008 to October 2012. The reports include
full autopsy and toxicological analysis for the cause of death to differentiate between cases of
homicidal, suicidal, or accidental cause of death. As reported in the Census of India 2011, the
population of Lucknow was 4,588,455 which is roughly equal to the nation of Georgia,13 of
which male and female were 2,407,897 and 2,180,558 respectively. The total area of the
Lucknow district is about 2,528 km2.14 A high percentage of the total population (36.37%)
resides in rural areas which mean that around 63.3 percent are urban in nature.15 Suicide
methods were classified into seven groups according to the cause of death: poisoning by drugs,
poisoning by other means, hanging, drowning, firearm, falling from a height, and burns.

• Stastical Analysis:
The causes of death among males differed from those of females, as shown in In males, the
main cause of death was due to poison (31%), followed by hanging (26%), firearm (16%),
burns (11%), drowning (10%), and falling from a height (6%), while, in females, the
distribution of causes of death was as follows: poison (48%), followed by hanging (24%),
burns (12%), drowning (7%), falling from a height (6%), and firearm injuries (3%). This can
be explained by the differences in the personality characteristics between males and females, as
males mostly choose more violent methods of suicide. These results matched those of Hawton
(2000), who stated that the suicide rates in most countries are higher among males than in
females, except for China, which has very high rates of suicide in females, especially in rural
areas. This is explained by the fact that females seek help for psychological problems more
than males. These results differ from those of the WHO data, which classify the methods of
suicide in different countries according to the WHO mortality database, finding that, in most of
the studied countries, hanging was the most frequent cause of suicide among males, followed
by firearm injuries and poisoning.
Suggestions:
 Media should avoid repeated or sensationalistic coverage
 Programmes and workshop for parenting
 The schools should have plans to deal with stress among children
 Nationwide suicide intervention program
 Providing support to those bereaved by suicide and discriminalizing attempted suicide
 Complimentary therapies to combat stress
 Chill out zones in schools to relax
 Including various curricular activities to inhibit new talents in the students
 Creating bullying free environment
 Parents shouldn’t pressure their childen for career or their love or any other choices.
People often feel uncomfortable talking about suicide. However, asking your child or adolescent
whether he or she is depressed or thinking about suicide can be helpful. Specific examples of such
questions include:
• Are you feeling sad or depressed?
• Are you thinking about hurting or killing yourself?
• Have you ever thought about hurting or killing yourself?
Rather than putting thoughts in your child's head, these questions can provide assurance that
somebody cares and will give your child the chance to talk about problems.

Parents, teachers, and friends should always err on the side of caution and safety. Any child or
adolescent with suicidal thoughts or plans should be evaluated immediately by a trained and
qualified mental health professional.

Concusions:
 Mental health has been recognized as an important priority in several global agendas, including Goal 3
of the Sustainable Development Goals and the WHO Comprehensive Mental Health Action Plan 2013–
2020. Understanding the distribution and determinants of mental health-related conditions in the leaders of
tomorrow – adolescents – is a critical step towards these goals. Programs should focus on improving social
relationships throughout adolescence by sex, with specific themed interventions for younger and older
adolescents. Our work should be used to continue and expand on the mental health dialogue and action
worldwide.
Suicide is a very grave problem that may be caused and aggravated by many factors that occur in the
society, such as unemployment, dowry dispute, love affairs, illegitimate pregnancy, extra-marital affairs,
bankruptcy and spinsterhood. The increasing evidence of suicidal menace is creating a greater challenge
for psychiatrists, social workers, public health personnel, sociologists and psychologists to identify the
underlying factors in the social system which promotes suicidal tendencies and improvement in the mental
health of the community which in turn surely prevents such incidences further. Suicide affects mainly
youth who are capable of work, which causes a big loss to the community. Research helps determine
which factors can be modified to help prevent suicide and what interventions are taken which are
appropriate for a specific group of people. Before being put into practice prevention programs should be
tested through research to determine their safety and effectiveness. A three-pronged attack to combat
suicide suggested in a 2003 monograph was (1) reducing social isolation, (2) preventing social
disintegration, and (3) treating mental disorders. Therefore, all efforts should be directed to solving youths’
problems to decrease the rate of suicide in the society. The present study exposes a wide range of causative
factors of suicide among different age groups and gender which is due to a series of socioeconomic,
psychological and cultural practices. It raises awareness and stirs up interest with regard to the serious
public health and community burden represented by suicide.
Refrences:
 https://en.wikipedia.org/wiki/Youth_suicide
 https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teen-
Suicide-010.aspx
 file:///C:/Users/Prakash/Downloa+ds/Suicide_and_Youth_Risk_Factors.pdf
 https://www.who.int/mental_health/media/en/62.pdf
 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09209-z#Sec12
 https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.12831#:~:text=studies%20are
%20featured.-,Prevalence,et%20al.%2C%202008
 https://www.sciencedirect.com/science/article/pii/S2090536X13000245