Teen suicide is becoming more common every year in South America. In fact, only car accidents and homicides (murders) kill more people between the ages of 18 and 30, making suicide the third leading cause of death in teens and overall in youths ages 14 to 22 years old.
Thinking About Suicide It’s common for teens to think about death to some degree. Teens’ thinking capabilities have matured in a way that allows them to think more deeply – about their existence in the world, the meaning of life, and other profound questions and ideas. Unlike kids, teens realize that death is permanent. They may begin to consider spiritual or philosophical questions such as what happens after people die. To some, death, and even suicide, may seem poetic (consider Romeo and Juliet, for example). To others, death may seem frightening or be a source of worry. For many, death is mysterious and beyond our human experience and understanding.
Thinking about suicide goes beyond normal ideas teens may have about death and life. Wishing to be dead, thinking about suicide, or feeling helpless and hopeless about how to solve life’s problems are signs that a teen may be at risk – and in need of help and support. Beyond thoughts of suicide, actually making a plan or carrying out a suicide attempt is even more serious.
What makes some teens begin to think about suicide – and even worse, to plan or do something with the intention of ending their own lives? One of the biggest factors is depression. Suicide attempts are usually made when a person is seriously depressed or upset. A teen who is feeling suicidal may see no other way out of problems, no other escape from emotional pain, or no other way to communicate their desperate unhappiness.
The Link Between Depression and Suicide
The majority of suicide attempts and suicide deaths happen among teens with depression. Consider these statistics about teen suicide and teen depression: about 1% of all teens attempts suicide and about 1% of those suicide attempts results in death (that means about 1 in 10,000 teens dies from suicide). But for adolescents who have depressive illnesses, the rates of suicidal thinking and behavior are much higher. Most teens who have depression think about suicide, and between 15% and 30% of teens with serious depression who think about suicide go on to make a suicide attempt.
Keep in mind that most of the time for most teens depression is a passing mood. The sadness, loneliness, grief, and disappointment we all feel at times are normal reactions to some of the struggles of life. With the right support, some resilience, an inner belief that there will be a brighter day, and decent coping skills, most teens can get through the depressed mood that happens occasionally when life throws them a curve ball.
But sometimes depression doesn’t lift after a few hours or a few days. Instead it lasts, and it can seem too heavy to bear. When someone has a depressed or sad mood that is intense and lingers almost all day, almost every day for 2 weeks or more, it may be a sign that the person has developed major depression. Major depression, sometimes called clinical depression, is beyond a passing depressed mood – it is the term mental health professionals use for depression that has become an illness in need of treatment. Another form of serious depression is called bipolar disorder, which includes extreme low moods (major depression) as well as extreme high moods (these are called manic episodes).
Though children can experience depression, too, teens are much more vulnerable to major depression and bipolar illness. Hormones and sleep cycles, which both change dramatically during adolescence, have an effect on mood and may partly explain why teens (especially girls) are particularly prone to depression. Believe it or not, as many as 20% of all teens have had depression that’s this severe at some point. The good news is that depression is treatable – most teens get better with the right help.
It’s not hard to see why serious depression and suicide are connected. Serious depression (with both major depression and bipolar illness) involves a long-lasting sad mood that doesn’t let up, and a loss of pleasure in things you once enjoyed. It also involves thoughts about death, negative thoughts about oneself, a sense of worthlessness, a sense of hopelessness that things could get better, low energy, and noticeable changes in appetite or sleep.
Depression also distorts a person’s viewpoint, allowing them to focus only on their failures and disappointments and to exaggerate these negative things. Depressed thinking can convince someone there is nothing to live for. The loss of pleasure that is part of depression can seem like further evidence that there’s nothing good about the present. The hopelessness can make it seem like there will be nothing good in the future; helplessness can make it seem like there’s nothing you can do to change things for the better. And the low energy that is part of depression can make every problem (even small ones) seem like too much to handle.
When major depression lifts because a person gets the proper therapy or treatment, this distorted thinking is cleared and they can find pleasure, energy, and hope again. But while someone is seriously depressed, suicidal thinking is a real concern. When teens are depressed, they often don’t realize that the hopelessness they feel can be relieved and that hurt and despair can be healed.
What Else Puts Teens at Risk for Suicide?
In addition to depression, there are other emotional conditions that can put teens at greater risk for suicide – for example, girls and guys with conduct disorder are at higher risk. This may be partly because teens with conduct disorder have problems with aggression and may be more likely than other teens to act in aggressive or impulsive ways to hurt themselves when they are depressed or under great stress. The fact that many teens with conduct disorder also have depression may partly explain this, too. Having both serious depression and conduct disorder increases a teen’s risk for suicide.
Substance abuse problems also put teens at risk for suicidal thinking and behavior. Alcohol and some drugs have depressive effects on the brain. Misuse of these substances can bring on serious depression, especially in teens prone to depression because of their biology, family history, or other life stressors.
Besides depressive effects, alcohol and drugs alter a person’s judgement. They interfere with the ability to assess risk, make good choices, and think of solutions to problems. Many suicide attempts occur when a teen is under the influence of alcohol or drugs. Teens with substance abuse problems often have serious depression or intense life stresses, too, further increasing their risk.
Life Stress and Suicidal Behavior
Let’s face it – being a teen is not easy for anyone. There are many new social, academic, and personal pressures. And for teens who have additional problems to deal with, life can feel even more difficult. Some teens have been physically or sexually abused, have witnessed one parent abusing another at home, or live with lots of arguing and conflict at home. Others witness violence in their neighborhoods. Many teens have parents who divorce, and others may have a parent with a drug or alcohol addiction.
Some teens are struggling with concerns about sexuality and relationships, wondering if their feelings and attractions are normal, if they will be loved and accepted, or if their changing bodies are developing normally. Others struggle with body image and eating problems, finding it impossible to reach a perfect ideal, and therefore having trouble feeling good about themselves. Some teens have learning problems or attention problems that make it hard for them to succeed in school. They may feel disappointed in themselves or feel they are a disappointment to others.
All these things can affect mood and cause some people to feel depressed or to turn to alcohol or drugs for a false sense of soothing. Without the necessary coping skills or support, these social stresses can increase the risk of serious depression and, therefore, of suicidal ideas and behavior. Teens who have had a recent loss or crisis or who had a family member who committed suicide may be especially vulnerable to suicidal thinking and behavior themselves.
Guns and Suicide Risk
Finally, having access to guns is extremely risky for any teen who has any of the other risk factors. Depression, anger, impulsivity, life stress, substance abuse, feelings of alienation or loneliness – all these factors can place a teen at major risk for suicidal thoughts and behavior. Availability of guns along with one or more of these risk factors is a deadly equation. Many teen lives could be saved by making sure those who are at risk don’t have access to guns.
Different Types of Suicidal Behaviors
Teen girls attempt suicide far more often (about nine times more often) than teen guys, but guys are about four times more likely to succeed when they try to kill themselves. This is because teen guys tend to use more deadly methods, like guns or hanging. Girls who try to hurt or kill themselves tend to use overdoses of medications or cutting. More than 60% of teen suicide deaths happen with a gun. But suicide deaths can and do occur with pills and other harmful substances and methods.
Sometimes a depressed person plans a suicide in advance. Many times, though, suicide attempts are not planned in advance, but happen impulsively, in a moment of feeling desperately upset. Sometimes a situation like a breakup, a big fight with a parent, an unintended pregnancy, being harmed by abuse or rape, being outed by someone else, or being victimized in any way can cause a teen to feel desperately upset. In situations such as these, teens may fear humiliation, rejection, social isolation, or some terrible consequence they think they can’t handle. If a terrible situation feels too overwhelming, a teen may feel that there is no way out of the bad feeling or the consequences of the situation. Suicide attempts can occur under conditions like this because, in desperation, some teens – at least for the moment – see no other way out and they impulsively act against themselves.
Sometimes teens who feel or act suicidal mean to die and sometimes they don’t. Sometimes a suicide attempt is a way to express the deep emotional pain they’re feeling in hopes that someone will get the message they are trying to communicate.
Even though a teen who makes a suicide attempt may not actually want or intend to die, it is impossible to know whether an overdose or other harmful action they may take will actually result in death or cause a serious and lasting illness that was never intended. Using a suicide attempt to get someone’s attention or love or to punish someone for hurt they’ve caused is never a good idea. People usually don’t really get the message, and it often backfires on the teen. It’s better to learn other ways to get what you need and deserve from people. There are always people who will value, respect, and love you – sure, sometimes it takes time to find them – but it is important to value, respect, and love yourself, too.
Unfortunately, teens who attempt suicide as an answer to problems tend to try it more than once. Though some depressed teens may first attempt suicide around age 13 or 14, suicide attempts are highest during middle adolescence. Then by about age 17 or 18, the rate of teen suicide attempts lowers dramatically. This may be because with maturity, teens have learned to tolerate sad or upset moods, have learned how to get support they need and deserve, and have developed better coping skills to deal with disappointment or other difficulties.
Depto. Ciencias Forenses, Cat. de Medicina Legal
Facultad de Medicina, U.B.A.