- Suicide is the process of purposely ending one's own life. How societies view suicide varies by culture, religion, ethnic norms, and the circumstances under which it occurs.
- Nearly 1 million people worldwide commit suicide each year -- about 30,000 each year in the United States.
- Self-mutilation is the act of deliberately hurting oneself without meaning to cause one's own death.
- Physician-assisted suicide is defined as a doctor ending the life of a person who is incurably ill in a way that is either painless or minimally painful for the purpose of ending the suffering of the individual.
- The effects of suicide on the loved ones of the deceased can be devastating, resulting in suicide survivors enduring a variety of conflicting, painful emotions.
- Life circumstances that may immediately precede a suicide include the time period of at least a week after discharge from a psychiatric hospital, a sudden change in how the person appears to feel, or a real or imagined loss.
- Firearms are the most common means by which people take their lives. Other common methods include overdose of medication, asphyxiation, and hanging.
- There are gender, age, ethnic, and geographical risk factors for suicide, as well as those based on family history, life stresses, and medical and mental-health status.
- In children and teens, bullying and being bullied seem to be associated with their committing suicide, and being bullied may put them at risk for committing murder-suicide.
- Warning signs that an individual is imminently planning to kill him- or herself may include the making of a will, getting his/her affairs in order, suddenly visiting or writing letters to loved ones, buying instruments of suicide, experiencing a sudden change in mood, or writing a suicide note.
- Many people who complete suicide do not tell any health professional of their intent in the months before they do so. If they communicate a plan to anyone, it is more likely to be a friend or family member.
- The assessment of suicide risk often involves an evaluation of the presence, severity, and duration of suicidal thoughts as part of a mental-health evaluation.
- Treatment of suicidal thinking or attempt involves adapting immediate treatment to the sufferer's individual needs. Those with a strong social support system, who have a history of being hopeful and have a desire to resolve conflicts may need only a brief crisis-oriented intervention. Those with more severe symptoms or less social support may need hospitalization and long-term outpatient mental-health services.
- Treatment of any underlying emotional problem using a combination of psychotherapy, safety planning, and medication remains the mainstay of suicide prevention.
- People who are contemplating suicide are encouraged to talk to a doctor or other health professional, spiritual advisor, or immediately go to the closest emergency room or mental-health crisis center for help. Those who have experienced suicidal thinking are commonly directed to keep a list of people to call in the event that those thoughts return. Other strategies include having someone hold all medications to prevent overdose, removing any weapons from the home, scheduling frequent stress-relieving activities, getting together with others, writing down feelings, and avoiding the use of alcohol or other drugs.
- Techniques for coping with the suicide of a loved one include nutritious eating, getting extra rest, writing about their emotions, talking to others about the experience, thinking of ways to handle painful memories, understanding their state of mind will vary, resisting pressure to grieve by any one else's time table, and survivors doing what is right for them.
- To help children and adolescents cope with the suicide of a loved one it is important to ensure they receive consistent caretaking, frequent interaction with supportive peers and adults, and understanding of their feelings as they relate to their age.
Tuesday, March 29, 2011
Suicide At A Glance
What are the signs and symptoms for suicide?
Warning signs that an individual is imminently planning to kill themselves may include the person making a will, getting his or her affairs in order, suddenly visiting friends or family members (one last time), buying instruments of suicide like a gun, hose, rope, pills or other forms of medications, a sudden and significant decline or improvement in mood, or writing a suicide note. Contrary to popular belief, many people who complete suicide do not tell their therapist or any other mental-health professional they plan to kill themselves in the months before they do so. If they communicate their plan to anyone, it is more likely to be someone with whom they are personally close, like a friend or family member.
Individuals who take their lives tend to suffer from severe anxiety or depression, symptoms of which may include moderatealcohol abuse, insomnia, severe agitation, loss of interest in activities they used to enjoy (anhedonia), hopelessness, and persistent thoughts about the possibility of something bad happening. Since suicidal behaviors are often quite impulsive, removing guns, medications, knives, and other instruments people often use to kill themselves from the immediate environment can allow the individual time to think more clearly and perhaps choose a more rational way of coping with their pain.
How are suicidal thoughts and behaviors assessed?
The risk assessment for suicidal thoughts and behaviors performed by mental-health professionals often involves an evaluation of the presence, severity, and duration of suicidal feelings in the individuals they treat as part of a comprehensive evaluation of the person's mental health. Therefore, in addition to asking questions about family mental-health history and about the symptoms of a variety of emotional problems (for example, anxiety, depression, mood swings, bizarre thoughts, substance abuse, eating disorders, and any history of being traumatized), practitioners frequently ask the people they evaluate about any past or present suicidal thoughts, dreams, intent, and plans. If the individual has ever attempted suicide, information about the circumstances surrounding the attempt, as well as the level of dangerousness of the method and the outcome of the attempt, may be explored. Any other history of violent behavior might be evaluated. The person's current circumstances, like recent stressors (for example, end of a relationship, family problems), sources of support, and accessibility of weapons are often probed. What treatment the person may be receiving and how he or she has responded to treatment recently and in the past, are other issues mental-health professionals tend to explore during an evaluation.
Sometimes professionals assess suicide risk by using an assessment scale. One such scale is called the SAD PERSONS Scale, which identifies risk factors for suicide as follows:
- Sex (male)
- Age younger than 19 or older than 45 years of age
- Depression (severe enough to be considered clinically significant)
- Previous suicide attempt or received mental-health services of any kind
- Excessive alcohol or other drug use
- Rational thinking lost
- Separated, divorced, or widowed (or other ending of significant relationship)
- Organized suicide plan or serious attempt
- No or little social support
- Sickness or chronic medical illness
What are the risk factors and protective factors for suicide?
Ethnically, the highest suicide rates in the United States occur in non-Hispanic whites and in Native Americans. The lowest rates are in non-Hispanic blacks, Asians, Pacific Islanders, and Hispanics. Former Eastern Bloc countries currently have the highest suicide rates worldwide, while South America has the lowest. Geographical patterns of suicides are such that individuals who live in a rural area versus urban area and the western United States versus the eastern United States are at higher risk for killing themselves. The majority of suicide completions take place during the spring.
In most countries, women continue to attempt suicide more often, but men tend to complete suicide more often. Although the frequency of suicides for young adults has been increasing in recent years, elderly Caucasian males continue to have the highest suicide rate. Other risk factors for taking one's life include single marital status, unemployment, low income, mental illness, a history of being physically or sexually abused, a personal history of suicidal thoughts, threats or behaviors, or a family history of attempting suicide.
Data regarding mental illnesses as risk factors indicate that depression, manic depression, schizophrenia, substance abuse, eating disorders, and severe anxietyincrease the probability of suicide attempts and completions. Nine out of 10 people who commit suicide have a diagnosable mental-health problem and up to three out of four individuals who take their own life had a physical illness when they committed suicide. Behaviors that tend to be linked with suicide attempts and completions include violence against others and self-mutilation, like slitting one's wrists or other body parts, or burning oneself.
Risk factors for adults who commit murder-suicide include male gender, older caregiver, access to firearms, separation or divorce, depression, and substance abuse. In children and adolescents, bullying and being bullied seem to be associated with an increased risk of suicidal behaviors. Specifically regarding male teens who ultimately commit murder-suicide by school shootings, being bullied may play a significant role in putting them at risk for this outcome. Another risk factor which renders children and teens more at risk for suicide compared to adults is that of having someone they know commit suicide, which is called contagion or cluster formation.
Generally, the absence of mental illness and substance abuse, as well as the presence of a strong social support system, decrease the likelihood that a person will kill him- or herself. Having children who are younger than 18 years of age also tends to be a protective factor against mothers committing suicide.
What are some possible causes of suicide?
Although the reasons why people commit suicide are multifaceted and complex, life circumstances that may immediately precede someone committing suicide include the time period of at least a week after discharge from a psychiatric hospital or a sudden change in how the person appears to feel (for example, much worse or much better). Examples of possible triggers (precipitants) for suicide are real or imagined losses, like the breakup of a romantic relationship, moving, loss (especially if by suicide) of a friend, loss of freedom, or loss of other privileges.
Firearms are by far the most common methods by which people take their life, accounting for nearly 60% of suicide deaths per year. Older people are more likely to kill themselves using a firearm compared to younger people. Another suicide method used by some individuals is by threatening police officers, sometimes even with an unloaded gun or a fake weapon. That is commonly referred to as "suicide by cop." Although firearms are the most common way people complete suicide, trying to overdose on medication is the most common means by which people attempt to kill themselves.
What are the effects of suicide?
The effects of suicidal behavior or completed suicide on friends and family members are often devastating. Individuals who lose a loved one to suicide (suicide survivors) are more at risk for becoming preoccupied with the reason for the suicide while wanting to deny or hide the cause of death, wondering if they could have prevented it, feeling blamed for the problems that preceded the suicide, feeling rejected by their loved one, and stigmatized by others. Survivors may experience a great range of conflicting emotions about the deceased, feeling everything from intense emotional pain and sadness about the loss, helpless to prevent it, longing for the person they lost, and anger at the deceased for taking their own life to relief if the suicide took place after years of physical or mental illness in their loved one. This is quite understandable given that the person they are grieving is at the same time the victim and the perpetrator of the fatal act.
Individuals left behind by the suicide of a loved one tend to experience complicatedgrief in reaction to that loss. Symptoms of grief that may be experienced by suicide survivors include intense emotion and longings for the deceased, severely intrusive thoughts about the lost loved one, extreme feelings of isolation and emptiness, avoiding doing things that bring back memories of the departed, new or worsened sleeping problems, and having no interest in activities that the sufferer used to enjoy.
What are some possible causes of suicide?
Although the reasons why people commit suicide are multifaceted and complex, life circumstances that may immediately precede someone committing suicide include the time period of at least a week after discharge from a psychiatric hospital or a sudden change in how the person appears to feel (for example, much worse or much better). Examples of possible triggers (precipitants) for suicide are real or imagined losses, like the breakup of a romantic relationship, moving, loss (especially if by suicide) of a friend, loss of freedom, or loss of other privileges.
Firearms are by far the most common methods by which people take their life, accounting for nearly 60% of suicide deaths per year. Older people are more likely to kill themselves using a firearm compared to younger people. Another suicide method used by some individuals is by threatening police officers, sometimes even with an unloaded gun or a fake weapon. That is commonly referred to as "suicide by cop." Although firearms are the most common way people complete suicide, trying to overdose on medication is the most common means by which people attempt to kill themselves.
What is suicide?
Suicide is the process of purposely ending one's own life. The way societies view suicide varies widely according to culture and religion. For example, many Western cultures, as well as mainstream Judaism, Islam, and Christianity tend to view killing oneself as quite negative. One myth about suicide that may be the result of this view is considering suicide to always be the result of a mental illness. Some societies also treat a suicide attempt as if it were a crime. However, suicides are sometimes seen as understandable or even honorable in certain circumstances, such as in protest to persecution (for example, hunger strike), as part of battle or resistance (for example, suicide pilots of World War II; suicide bombers) or as a way of preserving the honor of a dishonored person (for example, killing oneself to preserve the honor or safety of family members).
Nearly 1 million people worldwide commit suicide each year, with anywhere from 10 million to 20 million suicide attempts annually. About 30,000 people reportedly kill themselves each year in the United States. The true number of suicides is likely higher because some deaths that were thought to be an accident, like a single-car accident, overdose, or shooting, are not recognized as being a suicide. Suicide is the eighth leading cause of death in males and the 16th leading cause of death in females. The higher frequency of completed suicides in males versus females is consistent across the life span. In the United States, boys 10-14 years of age commit suicide twice as often as their female peers. Teenage boys 15-19 years of age complete suicide five times as often as girls their age, and men 20-24 years of age commit suicide 10 times as often as women their age. Gay, lesbian, and other sexual minority youth are more at risk for thinking about and attempting suicide than heterosexual teens.
Suicide is the third leading cause of death for people 10-24 years of age. Teen suicide statistics for youths 15-19 years of age indicate that from 1950-1990, the frequency of suicides increased by 300% and from 1990-2003, that rate decreased by 35%. However, from 2000-2006, the rate of suicide has gradually increased, both in the 10-24 years and the 25-64 years old age groups. While the rate of murder-suicide remains low at 0.0001%, the devastation it creates makes it a concerning public-health issue.
The rate of suicide can vary with the time of year, as wells as with the time of day. For example, the number of suicides by train tend to peak soon after sunset and about 10 hours earlier each day. Although professionals like police officers and dentists are thought to be more vulnerable to suicide than others, important flaws have been found in the research upon which those claims are based.
As opposed to suicidal behavior, self-mutilation is defined as deliberately hurting oneself without meaning to cause one's own death. Examples of self-mutilating behaviors include cutting any part of the body, usually of the wrists. Self-tattooing is also considered self-mutilation. Other self-injurious behaviors include self-burning, head banging, pinching, and scratching.
Physician-assisted suicide is defined as ending the life of a person who is terminally ill in a way that is either painless or minimally painful for the purpose of ending suffering of the individual. It is also called euthanasia and mercy killing. In 1997, the United States Supreme Court ruled against endorsing physician-assisted suicide as a constitutional right but allowed for individual states to enact laws that permit it to be done. As of 2009, Oregon and Washington were the only states with laws in effect that authorized physician-assisted suicide. Physician-assisted suicide seems to be less offensive to people compared to assisted suicide that is done by a non-physician, although the acceptability of both means to end life tends to increase as people age and with the number of times the person who desires their own death repeatedly asks for such assistance.
Why Do People Commit Suicide?
No suicide attempt should be dismissed or treated lightly!
A suicide attempt is a clear indication that something is gravely wrong in a person’s life. No matter the race or age of the person; how rich or poor they are, it is true that most people who commit suicide have a mental or emotional disorder.
The most common underlying disorder is depression, 30% to 70% of suicide victims suffer from major depression or bipolar (manicdepressive) disorder.
Warning Signs of Someone Considering Suicide
Any one of these symptoms does not necessarily mean the person is suicidal, but several of these symptoms may signal a need for help:
• Verbal suicide threats such as, “You’d be better off without me.” or “Maybe I won’t be around.”
• Expressions of hopelessness and helplessness.
• Previous suicide attempts.
• Daring or risk-taking behavior.
• Personality changes.
• Depression.
• Giving away prized possessions.
• Lack of interest in future plans.
Remember: Eight out of ten suicidal persons give some sign of their intentions. People who talk about suicide, threaten to commit suicide, or call suicide crisis centers are 30 times more likely than average to kill themselves.
Suicide and Adolescents
Over the past 60 years, the overall rate of suicide among adolescents has tripled making it the third leading cause of death among 15-to-25-year-olds and the second leading cause of death among college students.
It’s important for parents, teachers and counselors to become familiar with the facts about teens and young adults, especially when it comes to depression and suicide. When teens’ moods disrupt their ability to function on a day-to day basis, it may indicate a serious emotional or mental disorder that needs attention - adolescent depression. Sometimes teens feel so depressed that they consider ending their lives.
Studies show that suicide attempts among young people may be based on long standing problems triggered by a specific event. Suicidal adolescents may view a temporary situation as a permanent condition. Feelings of anger and resentment combined with exaggerated guilt can lead to impulsive, self-destructive acts.
Recognizing The Warning Signs
Four out of five teens who attempt suicide have given clear warnings. Pay attention to these warning signs:
• Suicide threats, direct and indirect
• Obsession with death
• Poems, essays and drawings that refer to death
• Dramatic change in personality or appearance
• Irrational, bizarre behavior
• Overwhelming sense of guilt, shame or reflection
• Changed eating or sleeping patterns
• Severe drop in school performance
• Giving away belongings
What To Do If You Think Someone Is Suicidal
Trust your instincts that the person may be in trouble.
Talk with the person about your concerns. Communication needs to include LISTENING.
Ask direct questions without being judgmental. Determine if the person has a specific plan to carry out the suicide. The more detailed the plan, the greater the risk.
Get professional help, even if the person resists.
Do not leave the person alone.
Do not swear to secrecy.
Do not act shocked or judgmental.
Do not counsel the person yourself.
Helping Suicidal Teens
Offer help and listen. Encourage depressed teens to talk about their feelings. Listen, don’t lecture.
Trust your instincts. If it seems that the situation may be serious, seek prompt help. Break a confidence if necessary, in order to save a life.
Pay attention to talk about suicide. Ask direct questions and don’t be afraid of frank discussions. Silence is deadly!
Seek professional help. It is essential to seek expert advice from a mental health professional who has experience helping depressed teens. Also, alert key adults in the teen’s life - family, friends and teacher.
Helping a Suicidal Person
No single therapeutic approach is suitable for all suicidal persons or suicidal tendencies. The most common ways to treat underlying illnesses associated with suicide are with medication, talk therapy or a combination of the two.
Cognitive (talk therapy) and behavioral (changing behavior) therapies aim at relieving the despair of suicidal patients by showing them other solutions to their problems and new ways to think about themselves and their world. Behavioral methods, such as training in assertiveness, problem-solving, social skills, and muscle relaxation, may reduce depression, anxiety, and social ineptitude.
Cognitive and behavioral homework assignments are planned in collaboration with the patient and explained as experiments that will be educational even if they fail. The therapist emphasizes that the patient is doing most of the work, because it is especially important for a suicidal person not to see the therapist as necessary for their survival. Recent research strongly supports the use of medication to treat the underlying depression associated with suicide. Antidepressant medication acts on chemical pathways of the brain related to mood. There are many very effective antidepressants.
Antidepressant medications are not habit-forming. Although some symptoms such as insomnia, often improve within a week or two, it may take three or four weeks before you feel better; the full benefit of medication may require six to eight weeks of treatment. Sometimes changes need to be made in dosage or medication type before improvements are noticed. It is usually recommended that medications be taken for at least four to nine months after the depressive symptoms have improved. People with chronic depression may need to stay on medication to prevent or lessen further episodes.
Suicide
Suicide has become much more common in children and adolescents than it used to be. For children under age 15, about 1-2 out of every 100,000 children will commit suicide. For those 15-19, about 11 out of 100,000 will commit suicide. These are statistics from the USA. (2) Suicide is the fourth leading cause of death for children ages 10-14 and the third leading cause of death for teenagers 15-19. (3) Recent evidence suggests it is the lack of substance abuse, guns, and relationship problems in younger children which accounts for the lower suicide rates in those under age 15.(5)
The main way children kill themselves depends on what lethal means are available and their age. In countries where guns are readily available, such as the USA, that is the usual cause of suicide. Other causes are strangling and poisoning.(3)
Suicide attempts that do not result in death are more common. In any one year, 2-6% of children will try to kill themselves. About 1% of children who try to kill themselves actually die of suicide on the first attempt. On the other hand, of those who have tried to kill themselves repeatedly, 4% succeed. About 15-50% of children who are attempting suicide have tried it before.(4) That means that for every 300 suicide attempts, there is one completed suicide.(17)
But my son has never mentioned suicide.Unfortunately, parents are aware of only a small proportion of suicidal attempts and suicidal thinking. In a study of 59 adolescents who had thought about suicide, the parents were aware in only 6 cases. Even more worrisome, out of 36 children who had made suicide attempts, the parents were only aware of this in two cases! (4)Parents do better at figuring this out if one of the parents has had depression, if the child has multiple psychiatric problems, or there had been lots of trouble in the home. The bottom line is that you should assume that all teens that are seriously depressed are thinking about suicide until proven otherwise. That means you should ask all seriously depressed teens about suicide on a regular basis.
How can you tell which child will commit suicide?
This is very hard to predict. Studying children and adolescents who have committed suicide can help us know what to look for. In children ages 10-14 in the USA,the most important factors for actually committing suicide are-
Suicide AttemptsA suicide attempt means a child is trying to kill his or herself but survives.
What makes a child more likely to attempt suicide?
If a child has major depressive disorder, he or she is seven times more likely to try suicide. About 22% of depressed children will try suicide. Looking at it another way, children and teenagers who attempt suicide are 8 times more likely to have a mood disorder, three times more likely to have an anxiety disorder, and 6 times more likely to have a substance abuse problem.(7). A family history of suicidal behavior and guns that are available also increase the risk.
A very major factor is family members who have committed suicide. If a girl's biological parent has committed suicide, she is 4-5 times as likely to make a suicide attempt. If a girl's sibling has committed suicide, she is 11 times more likely to try to kill herself. (36) The vast majority (almost 90%) of children and adolescents who attempt suicide have psychiatric disorders. Over 75% have had some psychiatric contact in the last year. (6) If a number of these are present, suicide risk needs to be carefully assessed regularly. If children are constantly dwelling on death and think being dead would be kind of nice, they are more likely to make a serious attempt. (15).
Abuse is also a major predictor of children trying to kill themselves. Being abused as a child makes you 3 to 4 times more likely to become depressed or suicidal as a teenager or adult. Sexual abuse is the type of abuse that is most strongly associated with suicide attempts. It is thought that 15- 20% of all suicide attempts in teenagers and young adults can be linked to child sexual abuse. (26)
Many people have thought that the main reason that children and adolescents try to kill themselves is to manipulate others or get attention or as a "cry for help". However, when children and adolescents are actually asked right after their suicide attempts, their reasons for trying suicide are more like adults. For a third, their main reason for trying to kill themselves is they wanted to die. Another third wanted to escape from a hopeless situation or a horrible state of mind. Only about 10% were trying to get attention. Only 2% saw getting help as the chief reason for trying suicide. The children who truly wanted to die were more depressed, more angry, and were more perfectionistic.(16). Furthermore, most children and adolescents who try suicide believe that the method they have chosen will really kill them. (36)
Factors which make a Suicide attempt more likely -
Depression
Substance abuse
Child Abuse victim
Close Family members have committed suicide
Close Family Members have tried Suicide
Previous Suicide Attempts
Access to Guns
Bipolar Disorder
Relationship problems
Attention Deficit Hyperactivity Disorder
Suicidal thinkingThis means a person is thinking about suicide but has no plan. This is not uncommon. About 3-4% of adolescents will have considered suicide in the last two weeks. However, these thoughts are much more likely, and more likely to be serious, if the child has previously made a suicide attempt is depressed, or is pessimistic. Children who are still depressed and have made previous suicide attempts are extremely likely to be thinking seriously about suicide. (17)
Example:
Jenna is 13. She is quite depressed. She has most of the symptoms mentioned. She sleeps poorly, she has no energy, can't concentrate on her work and is super cranky. She thinks about running away or how nice it would be to out of this horrible life. She thinks sometimes about killing herself, but she doesn't think about how she might do it. At the moment, she says she is too scared to actually do something. This is suicidal thinking.
Suicidal plansThis means that you are thinking about suicide and have a way to do it in mind.
Example
Allan is 12. From what he can see, life gets worse every year. He can not imagine living like this for 50 more years. He is very irritable, is always getting in fights with his parents, and mostly says and thinks that "Life sucks!". He goes out for walks and thinks about two things. First, jumping in front of a truck. He doesn't do this because he is afraid it won't work. That is, he will end up hurt but not dead. Second, he thinks about going down to the wharf and jumping off. He is not exactly sure how to do this to make sure no one saves him.
Tina is 15. She is also very depressed. She is waiting until Friday night. Her parents are going out and leaving her home. She has been collecting Tylenol and her Grandmother's heart pills for the last two weeks. She has almost 100 pills. She has been working on a suicide note. She is scared that she will "blow it" and tell someone.
Ryan is 15. He is depressed, but has not been thinking about suicide. In fact, he told his mother this a few days ago. He told the doctor the week before that he wasn't thinking about suicide. But now, at 10:15 at night, he has had it. His mom will not let him go and see his girlfriend. That is, his ex-girlfriend. She told him on the phone this evening that she just wants to be friends. Ryan can't take it anymore. He has decided to break a light bulb and cut his wrists and just see what happens. If he dies, fine. That's okay with him.
These are all suicidal plans. Some suicide plans are well thought out, like Tina's. Others are very impulsive, like Ryan. Others are not that serious yet, like Allan's.
Suicide attemptsThis means you have actually tried to hurt yourself. These can be medically serious or not serious. They can be psychologically serious or not. About 40% of teenagers will have thought about suicide for only a half hour or so before they try something. The most frequent reason for these impulsive suicide plans are relationship problems.
Medically non-serious, Psychologically non-seriousJanet is 13. She has dysthymia but has never been treated. She has a new boyfriend who is very nice to her. The only problem is that her parents will not let her go out with him by herself. He is 17, does not go to school, and is on probation for selling cigarettes to other children. That is how he met Janet. Janet's parents have told that she is not to have any contact with him. She has decided to show her parents how much this hurts her. She went and took a pop can lid and scratched her wrists and then walked by her parents so they could see this. She had no intention of hurting herself seriously. She wanted to drive her parents nuts. It was successful. They were more excited about this than anything she had ever done!
Janet was not trying to kill herself. What she was doing was not going to really hurt her. She needs help, but probably not this very minute.
Medically non-serious, Psychologically seriousWayne is 16. He has been very depressed for the last year and has a full depressive syndrome. He is now failing in school, refusing to do work around the house, and all he does is sit in his room and listen to his stereo with the headphones on loud. He overheard his mother mention that the pills she was taking for her nerves were quite strong, so she was only taking a half. So he thought that sounded like a good way to go. He took the 7 remaining pills. They were .5 mg Ativan (Lorazepam) pills and this was a very small dose. He took them, fell asleep, and woke up a little tired the next morning. His mom asked if he had seen her pills and he told her the story.
Wayne was really trying to kill himself. He just did not know that what he was doing was not that serious. Wayne needs to be seen in the next day or so and watched carefully before then.
Medically serious, Psychologically non-seriousDiane is 13. She just found out that she will not be going to her best friend's house for a sleep over birthday party. She has gone to her house for abut three years. Now her best friend has invited some new friends and Diane is not going. The other girls who are going are all talking about it at school. It seems to Diane that they are just doing it to bug her. Diane has been pretty irritable lately, and that may or may not have something to do with why she was not invited. She has decided to take some pills on the night of the party so they will be really sorry. She has decided to take some tylenol, which she believes is very safe. She takes 30. Nothing happens. She goes to tell her mom, but her mom is on the phone. She goes up to her room and falls asleep. The next morning she tells her mom. Diane is very surprised when she ends up in the hospital with IV medications to counteract the tylenol.
Diane did not really want to kill herself. She wanted to make a point. Unfortunately, she did not realize how dangerous tylenol overdoses can be.
Medically Serious, Psychologically seriousYvon is 16. His girlfriend has left him after he lost his temper with her. He was suspended from school for swearing at the teacher last week. His parents are constantly yelling at him for nothing. He has a headache all the time and feels like the world would be a much better place without him. While his dad is out fishing, he goes to the shed and gets some rope and sets it up to hang himself. He kicks away the chair just as the door opens. His dad forgot the bait bags. His father always told the story afterwards how his forgetfulness saved his son's life.
Managing Suicidal thoughts and behaviorWhen a person has thoughts about killing themselves or actually makes an attempt, There are a number of things that need to be done.
Take it seriouslyIf a child is saying he or she wants to die, it is worthy of attention. Maybe it is really nothing. At the very least, it requires a heart to heart talk. Many adults believe that children and teenagers do not really mean it when they talk about suicide. Data collected in the last two decades clearly suggests that sometimes children do mean it.
Take away the taboo from talking about suicideIf you have a depressed child, they certainly may be thinking about suicide. Not talking about it will not make this possibility go away. At the very least, openly ask the child if they are thinking about suicide. If some stressor has occurred (for example, girl friend and boyfriend troubles) ask again.
Get some helpSuicidal thinking or attempts almost always means that some sort of professional help is indicated. Most children and adolescents who have suicidal thoughts or have made suicidal attempts have at least one, and sometimes more than one, psychiatric disorder. These disorders obviously need to be identified and treated. For medically serious attempts, it usually means going directly to a hospital, and then seeing a psychiatrist once the medical emergency has passed. Sometimes it means psychiatric hospitalization. For less serious attempts, it means getting seen in the next week or so.
SupervisionIf your child makes a suicide attempt or has a plan, you need to make sure they are not alone. They need to be watched until they can be carefully assessed. This may just be a matter of a day or so, or it could be longer. No one likes being watched all the time, and it is exhausting to all concerned. If a child has 5-6 risk factors for suicide and says they are thinking about it, I would assume they are trying to kill themselves unless they are being watched.
What if the child promises they will not hurt themselves?I would not trust a promise a child makes not to hurt themselves. These attempts are usually too impulsive for that to work. It also gives people false confidence that no attempt will be made. I do not make much of such promises.
Avoiding manipulationSome people will use suicidal thoughts or attempts to get what they want or to get out of things they do not want to do. People try suicide to hurt others, to try to get back at boy or girl friends, and to get out of work or school. By keeping this possibility in mind, most parents (with a little help) can prevent it suicidal behavior from becoming a habit.
Preventing suicide by restricting access to guns, pills, etc.Sometimes people forget that the most important thing to do about suicidal children is to make sure they don’t have access to the common methods people use. That means putting away all medications in a locked cabinet. It means guns should not be in the home, even if they are locked up. It means that razors for shaving are kept in the same place medications are. These simple suggestions can make a great deal of difference (20)
Preventing suicide with medicationOne medication has been found to be very helpful in preventing suicide, and that is Lithium. Since the early 1990s, there have been many studies that have shown this.
If adults take lithium, they are less likely to attempt suicide.
If adults take lithium they are less likely to commit suicide.
Even if it does not help their depression, adults who take lithium are less likely to commit suicide.
Adults with bipolar disorder who take lithium have suicide rates the same as the general population.
One third of adults with bipolar disorder, who have tried suicide, and have taken lithium for at least a year and then stop their lithium, commit suicide. (1,2)
Because it is not the safest thing in the world
You have to have blood tests regularly
Other medications for Suicide preventionOf course, if an antidepressant results in a child no longer having depression, it will certainly make suicide less likely. Proving this in a large study has been more difficult. There is some data that suggests that other antidepressants help prevent suicide. Compared to the data on lithium, it is more like a hint. (3)
The main way children kill themselves depends on what lethal means are available and their age. In countries where guns are readily available, such as the USA, that is the usual cause of suicide. Other causes are strangling and poisoning.(3)
Suicide attempts that do not result in death are more common. In any one year, 2-6% of children will try to kill themselves. About 1% of children who try to kill themselves actually die of suicide on the first attempt. On the other hand, of those who have tried to kill themselves repeatedly, 4% succeed. About 15-50% of children who are attempting suicide have tried it before.(4) That means that for every 300 suicide attempts, there is one completed suicide.(17)
But my son has never mentioned suicide.Unfortunately, parents are aware of only a small proportion of suicidal attempts and suicidal thinking. In a study of 59 adolescents who had thought about suicide, the parents were aware in only 6 cases. Even more worrisome, out of 36 children who had made suicide attempts, the parents were only aware of this in two cases! (4)Parents do better at figuring this out if one of the parents has had depression, if the child has multiple psychiatric problems, or there had been lots of trouble in the home. The bottom line is that you should assume that all teens that are seriously depressed are thinking about suicide until proven otherwise. That means you should ask all seriously depressed teens about suicide on a regular basis.
How can you tell which child will commit suicide?
This is very hard to predict. Studying children and adolescents who have committed suicide can help us know what to look for. In children ages 10-14 in the USA,the most important factors for actually committing suicide are-
- having a mood disorder,
- having made an attempt in the past,
- and having a gun in the house.
Suicide AttemptsA suicide attempt means a child is trying to kill his or herself but survives.
What makes a child more likely to attempt suicide?
If a child has major depressive disorder, he or she is seven times more likely to try suicide. About 22% of depressed children will try suicide. Looking at it another way, children and teenagers who attempt suicide are 8 times more likely to have a mood disorder, three times more likely to have an anxiety disorder, and 6 times more likely to have a substance abuse problem.(7). A family history of suicidal behavior and guns that are available also increase the risk.
A very major factor is family members who have committed suicide. If a girl's biological parent has committed suicide, she is 4-5 times as likely to make a suicide attempt. If a girl's sibling has committed suicide, she is 11 times more likely to try to kill herself. (36) The vast majority (almost 90%) of children and adolescents who attempt suicide have psychiatric disorders. Over 75% have had some psychiatric contact in the last year. (6) If a number of these are present, suicide risk needs to be carefully assessed regularly. If children are constantly dwelling on death and think being dead would be kind of nice, they are more likely to make a serious attempt. (15).
Abuse is also a major predictor of children trying to kill themselves. Being abused as a child makes you 3 to 4 times more likely to become depressed or suicidal as a teenager or adult. Sexual abuse is the type of abuse that is most strongly associated with suicide attempts. It is thought that 15- 20% of all suicide attempts in teenagers and young adults can be linked to child sexual abuse. (26)
Many people have thought that the main reason that children and adolescents try to kill themselves is to manipulate others or get attention or as a "cry for help". However, when children and adolescents are actually asked right after their suicide attempts, their reasons for trying suicide are more like adults. For a third, their main reason for trying to kill themselves is they wanted to die. Another third wanted to escape from a hopeless situation or a horrible state of mind. Only about 10% were trying to get attention. Only 2% saw getting help as the chief reason for trying suicide. The children who truly wanted to die were more depressed, more angry, and were more perfectionistic.(16). Furthermore, most children and adolescents who try suicide believe that the method they have chosen will really kill them. (36)
Factors which make a Suicide attempt more likely -
Depression Substance abuse Child Abuse victim Close Family members have committed suicide Close Family Members have tried Suicide Previous Suicide Attempts Access to Guns Bipolar Disorder Relationship problems Attention Deficit Hyperactivity DisorderSuicidal thinkingThis means a person is thinking about suicide but has no plan. This is not uncommon. About 3-4% of adolescents will have considered suicide in the last two weeks. However, these thoughts are much more likely, and more likely to be serious, if the child has previously made a suicide attempt is depressed, or is pessimistic. Children who are still depressed and have made previous suicide attempts are extremely likely to be thinking seriously about suicide. (17)
Example:
Jenna is 13. She is quite depressed. She has most of the symptoms mentioned. She sleeps poorly, she has no energy, can't concentrate on her work and is super cranky. She thinks about running away or how nice it would be to out of this horrible life. She thinks sometimes about killing herself, but she doesn't think about how she might do it. At the moment, she says she is too scared to actually do something. This is suicidal thinking.
Suicidal plansThis means that you are thinking about suicide and have a way to do it in mind.
Example
Allan is 12. From what he can see, life gets worse every year. He can not imagine living like this for 50 more years. He is very irritable, is always getting in fights with his parents, and mostly says and thinks that "Life sucks!". He goes out for walks and thinks about two things. First, jumping in front of a truck. He doesn't do this because he is afraid it won't work. That is, he will end up hurt but not dead. Second, he thinks about going down to the wharf and jumping off. He is not exactly sure how to do this to make sure no one saves him.
Tina is 15. She is also very depressed. She is waiting until Friday night. Her parents are going out and leaving her home. She has been collecting Tylenol and her Grandmother's heart pills for the last two weeks. She has almost 100 pills. She has been working on a suicide note. She is scared that she will "blow it" and tell someone.
Ryan is 15. He is depressed, but has not been thinking about suicide. In fact, he told his mother this a few days ago. He told the doctor the week before that he wasn't thinking about suicide. But now, at 10:15 at night, he has had it. His mom will not let him go and see his girlfriend. That is, his ex-girlfriend. She told him on the phone this evening that she just wants to be friends. Ryan can't take it anymore. He has decided to break a light bulb and cut his wrists and just see what happens. If he dies, fine. That's okay with him.
These are all suicidal plans. Some suicide plans are well thought out, like Tina's. Others are very impulsive, like Ryan. Others are not that serious yet, like Allan's.
Suicide attemptsThis means you have actually tried to hurt yourself. These can be medically serious or not serious. They can be psychologically serious or not. About 40% of teenagers will have thought about suicide for only a half hour or so before they try something. The most frequent reason for these impulsive suicide plans are relationship problems.
Medically non-serious, Psychologically non-seriousJanet is 13. She has dysthymia but has never been treated. She has a new boyfriend who is very nice to her. The only problem is that her parents will not let her go out with him by herself. He is 17, does not go to school, and is on probation for selling cigarettes to other children. That is how he met Janet. Janet's parents have told that she is not to have any contact with him. She has decided to show her parents how much this hurts her. She went and took a pop can lid and scratched her wrists and then walked by her parents so they could see this. She had no intention of hurting herself seriously. She wanted to drive her parents nuts. It was successful. They were more excited about this than anything she had ever done!
Janet was not trying to kill herself. What she was doing was not going to really hurt her. She needs help, but probably not this very minute.
Medically non-serious, Psychologically seriousWayne is 16. He has been very depressed for the last year and has a full depressive syndrome. He is now failing in school, refusing to do work around the house, and all he does is sit in his room and listen to his stereo with the headphones on loud. He overheard his mother mention that the pills she was taking for her nerves were quite strong, so she was only taking a half. So he thought that sounded like a good way to go. He took the 7 remaining pills. They were .5 mg Ativan (Lorazepam) pills and this was a very small dose. He took them, fell asleep, and woke up a little tired the next morning. His mom asked if he had seen her pills and he told her the story.
Wayne was really trying to kill himself. He just did not know that what he was doing was not that serious. Wayne needs to be seen in the next day or so and watched carefully before then.
Medically serious, Psychologically non-seriousDiane is 13. She just found out that she will not be going to her best friend's house for a sleep over birthday party. She has gone to her house for abut three years. Now her best friend has invited some new friends and Diane is not going. The other girls who are going are all talking about it at school. It seems to Diane that they are just doing it to bug her. Diane has been pretty irritable lately, and that may or may not have something to do with why she was not invited. She has decided to take some pills on the night of the party so they will be really sorry. She has decided to take some tylenol, which she believes is very safe. She takes 30. Nothing happens. She goes to tell her mom, but her mom is on the phone. She goes up to her room and falls asleep. The next morning she tells her mom. Diane is very surprised when she ends up in the hospital with IV medications to counteract the tylenol.
Diane did not really want to kill herself. She wanted to make a point. Unfortunately, she did not realize how dangerous tylenol overdoses can be.
Medically Serious, Psychologically seriousYvon is 16. His girlfriend has left him after he lost his temper with her. He was suspended from school for swearing at the teacher last week. His parents are constantly yelling at him for nothing. He has a headache all the time and feels like the world would be a much better place without him. While his dad is out fishing, he goes to the shed and gets some rope and sets it up to hang himself. He kicks away the chair just as the door opens. His dad forgot the bait bags. His father always told the story afterwards how his forgetfulness saved his son's life.
Managing Suicidal thoughts and behaviorWhen a person has thoughts about killing themselves or actually makes an attempt, There are a number of things that need to be done.
Take it seriouslyIf a child is saying he or she wants to die, it is worthy of attention. Maybe it is really nothing. At the very least, it requires a heart to heart talk. Many adults believe that children and teenagers do not really mean it when they talk about suicide. Data collected in the last two decades clearly suggests that sometimes children do mean it.
Take away the taboo from talking about suicideIf you have a depressed child, they certainly may be thinking about suicide. Not talking about it will not make this possibility go away. At the very least, openly ask the child if they are thinking about suicide. If some stressor has occurred (for example, girl friend and boyfriend troubles) ask again.
Get some helpSuicidal thinking or attempts almost always means that some sort of professional help is indicated. Most children and adolescents who have suicidal thoughts or have made suicidal attempts have at least one, and sometimes more than one, psychiatric disorder. These disorders obviously need to be identified and treated. For medically serious attempts, it usually means going directly to a hospital, and then seeing a psychiatrist once the medical emergency has passed. Sometimes it means psychiatric hospitalization. For less serious attempts, it means getting seen in the next week or so.
SupervisionIf your child makes a suicide attempt or has a plan, you need to make sure they are not alone. They need to be watched until they can be carefully assessed. This may just be a matter of a day or so, or it could be longer. No one likes being watched all the time, and it is exhausting to all concerned. If a child has 5-6 risk factors for suicide and says they are thinking about it, I would assume they are trying to kill themselves unless they are being watched.
What if the child promises they will not hurt themselves?I would not trust a promise a child makes not to hurt themselves. These attempts are usually too impulsive for that to work. It also gives people false confidence that no attempt will be made. I do not make much of such promises.
Avoiding manipulationSome people will use suicidal thoughts or attempts to get what they want or to get out of things they do not want to do. People try suicide to hurt others, to try to get back at boy or girl friends, and to get out of work or school. By keeping this possibility in mind, most parents (with a little help) can prevent it suicidal behavior from becoming a habit.
Preventing suicide by restricting access to guns, pills, etc.Sometimes people forget that the most important thing to do about suicidal children is to make sure they don’t have access to the common methods people use. That means putting away all medications in a locked cabinet. It means guns should not be in the home, even if they are locked up. It means that razors for shaving are kept in the same place medications are. These simple suggestions can make a great deal of difference (20)
Preventing suicide with medicationOne medication has been found to be very helpful in preventing suicide, and that is Lithium. Since the early 1990s, there have been many studies that have shown this.
If adults take lithium, they are less likely to attempt suicide. If adults take lithium they are less likely to commit suicide. Even if it does not help their depression, adults who take lithium are less likely to commit suicide. Adults with bipolar disorder who take lithium have suicide rates the same as the general population. One third of adults with bipolar disorder, who have tried suicide, and have taken lithium for at least a year and then stop their lithium, commit suicide. (1,2) Because it is not the safest thing in the world You have to have blood tests regularlyOther medications for Suicide preventionOf course, if an antidepressant results in a child no longer having depression, it will certainly make suicide less likely. Proving this in a large study has been more difficult. There is some data that suggests that other antidepressants help prevent suicide. Compared to the data on lithium, it is more like a hint. (3)
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