Booklet Front Cover

YOUTH SUICIDE PREVENTION

A PARENT'S GUIDE

provided by

THE SCOUT ASSOClATION OF AUSTRALIA



CONTENTS



An Australian Scout Publication


The Scout Association of Australia expresses its thanks to Dr Paul Lee for his preparation of the material contained in this publication.
Published by the authority of the National Executive Committee of The Scout Association of Australia.

Copyright © The Scout Association of Australia
First published in Australia, February 1996




Comments by a teenager

I was extremely astonished at a number of things when I read this newspaper article. We used to hear of suicides on the news, but now they're so common they aren't reported. I think a lot more attention must be focused on this issue, with the percentages of teenage suicides increasing dramatically.

Often when something has gone wrong I say to myself 'I am going to kill myself', but I never do. It may be because I am scared, afraid or just said I was going to kill myself without really taking note of what I'd said. For some people this saying is becoming far too close to reality.

Life is getting tougher and tougher everyday and it's harder than ever to be employed. This means people have to study and get good marks to have any hope of achieving a supporting occupation. This then leads to stress, tension and depression. Some people just can't handle it. There are usually other factors involved too, including drugs, peer pressure and sexual abuse. Surely it's more important to live than to worry about getting a job. Ñ(Comments from a 15-year-old teenager on youth suicide)




INTRODUCTION

...The suicide rate of young people, especially males, has increased during the past two decades even though the suicide rate in adults has remained relatively static. The current rate of suicide is estimated to be around 15 per 100,000 for youths between 15-24 years of age. After traffic accidents, suicide is the leading cause of death in this age group.

...The estimated suicide rate is still an under-estimation of the true rate as deaths by suicide may be reported as accidental deaths or attributed to other causes. For example, some single motor vehicle deaths may in fact be the result of suicide. Deaths related to drug overdoses may be suicidal in nature rather than accidental.

...The incidence of attempted suicide is difficult to ascertain. Many youths who have tried to harm themselves never disclose their attempts or seek professional help. School and community surveys have found that 10-15% of adolescents may have attempted suicide at some stage. Many more have thought of suicide but never take any action.

It is estimated that for each completed suicide of a young male, there are 15 or more suicide attempts. For every completed female suicide, there are over 100 suicide attempts...

Males tend to use more violent methods to kill themselves than females. This is reflected in the suicide rate.



FACTS AND MYTHS

Youth suicide is such an emotional issue that it has, not surprisingly, remained a taboo subject, not open for discussion or research, until more recently. The act of suicide was seen as a sin, a crime or a family disgrace. Parents would carry the brunt of the blame, shame and guilt. There are still many myths and much misinformation about suicide, as family members, relatives, friends, associates and society at large struggle to find an explanation for the suicidal act.

Using the technique of "psychological autopsy" (reviewing past records and interviewing friends and family members of the deceased), several facts have emerged and myths dispelled. However, more research is required if we are going to have better understanding and prevention of youth suicide.

There are several facts about suicide that we do know:

1. Suicide rate in young people has been increasing.
2. Suicide is uncommon in children under the age of 10 but its incidence increases after the onset of puberty and peaks at young adulthood.
3. There are many more attempted suicides than completed suicides.
4. Many youths (between 60-80%) have sought help within the previous month before the suicide.
5. There is an increased risk if the youth has a previous history of attempted suicide.
6. Many completed suicides are well planned with the youths intending to kill themselves.
7. Suicide has major impact on family members and the youth's peers.
8. "Copy cat" suicides can occur and may follow dramatic portrayals of suicides on television programs or media items.


There are also many myths about suicide:

1. It can't happen to my teenage child.
2. Talking about suicidal intent will lead to suicide.
3. Suicide attempt is a manipulative behaviour and therefore should be ignored or even punished.
4. Suicides occur only in lower socio-economic groups.
5. Suicides come out of the blue with little or no warning.
6. Teenagers will "leam" from their "mistakes" and they won't try again.
7. Depression and other mental disorders do not occur in young people.




RISK FACTORS

Findings from recent research have shown that most youth suicides are the result of an interaction between biological, psychological, socio-cultural, and family factors. A suicidal act can be seen as the result of an interaction between background personal and family factors, current emotional state and recent significant life event which lead to an intolerable mental anguish in the young person. The "ingredients" required for completed or attempted suicide vary from individual to individual. There are, however, common risk factors that we do know about.

Previous attempts
The most powerful predictor of completed youth suicide is a past history of attempted suicide. As the number of attempts increases, the risk of dying from an attempt also increases.

Depression
Mood changes are common in teenagers but persistent lowering or lability of mood may indicate the presence of an underlying major depression. Depressed youths, especially females, have a much higher risk of suicide. The risk of suicide is further increased if there is a family history of depression and suicide.

The symptoms of depression vary a great deal, depending on the age of the youth. The older they are the more likely they will have adult type of depressive symptoms.

Some common symptoms include:

- lowering of mood
- loss of interest in daily activities
- social withdrawal and isolation
- loss of energy and motivation
- fatigue
- lack of enjoyment in what the youth does
- sleep disturbance (sleeping poorly or sleeping excessively)
- change of appetite (loss of appetite or eating excessively)
- acting out behaviour, including drug and alcohol abuse
- school failure
- poor self esteem with self reproach
- guilty feeling
- a sense of hopelessness and helplessness
- expression of suicidal intent

Drug and alcohol abuse
It is estimated that substance abuse occurs in 1/3 of youth suicides. Many youths who have difficulties coping with their problems seek relief from drugs and alcohol. Because they can "escape" from their distresses temporarily with the use of drugs and alcohol, non-coping youths tend to keep using these substances. With increased use, the youth may become emotionally and physically dependent on the drugs to the point where he/she has to keep taking them to avoid withdrawal symptoms. Unfortunately alcohol and many drugs have depressant and disinhibiting effects.

When drugs and alcohol are used in depressed youths, they can become a lethal combination to precipitate the suicide. Drugs, includ ing the so called "recreational drugs", can bring on psychotic episodes with resultant hallucinations and delusions which may then lead to suicide. Under the influence of drug and alcohol, a youth may also develop the clouding of his/her conscious state with resultant loss of judgement and an increase in risk taking behaviour. An accidental death may follow.

Conduct disorder
Youths with a history of conduct disorder have a much higher risk of suicide because they tend to act out their feelings in a destructive manner. This is particularly true if they are isolated, angry, aggressive, impulsive and they are abusing drugs and alcohol. Many of these young people are in constant crises. For example, they may be homeless and they have frequent conflicts with the law because of their anti-social activities. They are rejected by others and they seek support from youths with similar background. They take risks in what they do and many of them are depressed individuals but reluctant to admit to themselves or to others of their true feelings or to ask for help.

Disruptlve and unsupportive family background
Adolescence is a period of rapid growth both physically, cognitively and emotionally. This is a time of stress and confusion for many adolescents. Their coping mechanisms may be stretched to the absolute limit and in many instances beyond their limits. Family support is particularly important in the normal development of young people. When this support is not available or inconsistent, or in some instances when the family is actually "toxic" (e.g. abusive, violent and in chronic discord) to the young person, depression and anger may ensue with dire consequences. Unrealistic, intrusive, over-bearing and over-protective families can be just as detrimental. Problems may also arise when the needs of the youth are not met by the family due to a poor "fit" between the parents and the adolescent child.

Relationship conflicts
Many attempted suicides occur in the context of relationship conflicts, e.g. following an argument with parents, boy/girl friend or other significant figure in the youth's life. The attempt can be seen as an expression of anger and also a cry for help. Fortunately, these conflicts are generally transient in nature and they are frequently resolved. When these conflicts are persistent and unresolved, the youth concerned may be constantly stressed to the point where he/she feels helpless, hopeless and trapped. Death may be seen as a solution to the problems.

Poor coping skills
Youths who have a past history of poor or inappropriate coping skills are more at risk of suicide. The demands on teenagers are great and these demands may stress beyond the coping capabilities of the already low functioning young people. As a result they can develop a sense of hopelessness and helplessness. They may then develop major psychological or behavioural symptoms or they use self harm as an alternative way to cope.

Psychiatric illnesses
Major psychiatric disorders such as schizophrenia, anorexia nervosa and major depression carry with them an increased risk of suicide. Symptoms of these conditions may first present themselves in adoles cence. A young person with schizophrenia may be directed to kill one self by a voice (auditory hallucination), even though the young person may not have any desire to die. Similarly a severely depressed youth may feel (as part of his/her depressive delusional belief) that one is better off dead, to spare the suffering by his/her family

The ready availability of lethal means to commit suicide
The higher rate of youth suicide in rural communities is presumably related to the comparative ease for young people to get hold of firearms. History has indicated that the method of suicide is directly related to the ease of access to the specific lethal substance/object.

Others
There are other risk factors of suicide including:

- recent bereavement
- chronic physical illness
- anniversary phenomenon (of past losses or major life events)
- early loss experiences
- school failure
- chronic unemployment
- perfectionists and over-achievers who have high expectations of themselves

Using the risk factors described above, the profile of a youth at risk of suicide can be painted as a severely depressed and drug dependent young person who is impulsive and has always struggled to cope. He/she is poorly supported by a abusive or over-involved family and he/she has poor resources or insight to seek help. This picture of course does not fit the description of all youths who commit suicide.

A "forgotten" group of youths are those who have been chronically depressed and non-coping, but stay in the background without others noticing their distress. Their suicides may come as a surprise.



PROTECTIVE FACTORS

Protective factors against youth suicide are less well studied. Some known protective factors are:

The presence of an important person in the youth's life
As long as there is an emotionally significant person in the youth's life to whom the youth can relate, this will decrease the likelihood of suicide. Many youths are ambivalent about suicide and they turn to others for help and support. The emotionally important person may be a parent, a teacher, a close friend or a youth worker. The person has become the life line to the teenager. The presence of a good supportive network is particularly important to those youths who have little or no family support.

Good coping skills
The more resourceful and skilled in problem solving, the more likely is the youth's ability to cope with stressful situations. Coping skills are generally related to the personality of the individual rather than the intelligence of the person. A person who is coping well may see a stressful situation as a challenge and an opportunity for change rather than as an occasion for despair.

A supportive and caring family
A warm, caring and understanding family is a good source of support for a young person in distress. Firm guidance, good communication, family stability and an ability to "grow" with the child are important ingredients for a well functioning family.

Interests and activities
Young people who are involved in group activities such as Scouts, Girl Guides, church groups and team sports can use these activities to channel their energy and frustration in a socially acceptable manner. They learn to relate to others in a semi-structured and fun filled environment under the guidance of responsible and caring adults. Their self esteem can be raised by their successes.



PREVENTION OF YOUTH SUICIDE

Youth suicide generally occurs in the context of the youth's emotional, family and social environment. Prevention and intervention strategies of youth suicide will need to take these factors into account.

Although the utopian concept of a society devoid of stress, family or social problem is unlikely, it does not mean that one should not strive for a better physical and emotional environment for our young people. Better education, employment, self development and leisure opportunities are just a few examples where we can help our youths to reduce their stresses. This decrease in stress and promotion of well-being is primary prevention. The early intervention when a problem arises, e.g. the prompt management of depressive symptoms, is known as secondary prevention. The prevention of complication, e.g. suicide as a result of depression, is known as tertiary prevention. Any effective preventive pro gram should include these levels of prevention.

WHAT CAN PARENTS DO TO PREVENT YOUTH SUICIDE?
There are several things that parents can do to prevent youth suicides. Some of these are general in nature whilst others are more specific.

1. Form a good relationship with the youth.
During early childhood development, children generally bond with their parents and they have a good and trusting relationship. They grow up trusting their outside world and see it as a safe place where they can continue to grow and develop. This growth reaches its peak during adolescence. The youth needs to come to terms with rapid physical growth; conflicts between parental and peer values and ideals; emotional and physical intimacy with the opposite sex and the uncertainty about his/her future career. These "developmental tasks" can generate a great deal of pressure but most young people complete them successfully without too much difficulties.

Despite popular belief to the contrary, most teenagers do want a close relationship with their parents even though they may not admit to it openly. The relationship with their parents may have changed in form and content but it is in fact a continuum of their past relationship. Parents have to grow and change in parallel with their teenagers. It is a two way process. If the relationship is there, teenagers generally acknowledge and respect their parents' values and they want their advice and support, especially at times of stress.

A good relationship will open up communication between the youth and his/her parents. This can be a life saving safety valve to the depressed and troubled teenager. Support and early intervention can be effected before the youth contemplate suicide as an option.

Relationship between teenagers and their parents can be improved by:

a. Providing a stable, safe physical and emotional home environment.
This may seem obvious but unfortunately this is not always the case as exemplified by the problem of homeless youths. With many families breaking up and dispute over the custody and access of children, the teenager may become the "pawn" of the parental battle.

b. Spending quality time with young people.
"Quality time"
is a cliche frequently used in child rearing literature and it is met with a certain degree of cynicism. However, a good relationship between a youth and his/her parents cannot occur unless they spend time together. It is common to hear parents and teenagers talk about their constant arguments about everything. The amount of time spent in conflict is huge. Why not spend some of this time having fun together?

c. LISTENING to teenagers, not only to what is being said, but also to the covert messages.
Teenagers commonly complain that their parents are keen to give advice but they don't listen to their points of view. Messages sent by teenagers may at times be tangential, contradicting and confusing. Parents will need to "de-code" these scrambled messages to get in touch with their children's feelings. In many instances this may mean an interpretation of their body language. Non-verbal action can "talk" much louder than conversational language.

d. Being supportive and not intrusive.
There is a fine line between being supportive and being intrusive. It is important for parents to acknowledge the upset and distress shown by their teenage children, but not interrogating and demanding to know the "secrets" of their distress. Teenagers will generally talk to their parents about their problems when they are ready. Respect the fact that they can solve many problems on their own without the support of others. Support is there for them to use but it must not be imposed on them.

e. Encouraging the appropriate expression of emotions.
Many teenagers tend to either hide their emotions or they show them in an explosive manner, thus leading to their parents' comments about their moodiness. Encourage them to show and share their feelings of joy, happiness, excitement in their successes. They can then show and share their sadness, anxiety, distress and disappointment. Both "positive" and "negative" feelings must be contained so that they are not running wild and out of control.

2. Early intervention in stressful situations.
Severe emotional symptoms are frequently found in individuals facing or following significant life events. Youths facing court appearances, family break-up, important examinations or those who have been sexually abused, expelled from school, rejected by love ones are a few examples of common stressful situations to which young people are subjected.

Support from parents and others is particularly important to prevent despair and suicidal ideation. This can be achieved by being in touch with the youth's emotional state. Just because teenagers don't show their feelings readily, it does not mean that they are not concerned about impending major life events or feel distressed after a personal disaster. Have empathy with them. They want to be understood by their parents. Sensitive listening and appropriate advice or debriefing will help.

The successful negotiation and resolution of a stressful situation can be a confidence booster to the youth.

3. Take suicidal threats seriously.
Whether a youth has "genuine" suicidal intent or not, take all suicidal threats seriously. Don't trivialise any suicidal threat. In many instances, the threat is a cry for help - "I am not coping". If this is ignored, the youth may decide to act out his/her threat. It is much safer to be cautious.

4. Early detection and management of psychiatric illness.
Like suicide, psychiatric illnesses carry with them stigmas and myths. Many major psychiatric disorders, e.g. schizophrenia, bipolar affective illness and anorexia nervosa have their onset in adolescence. Drug induced psychosis is another important condition in this age group. These conditions, which are responsive to treatment, carry with them a higher risk of suicide if they are not managed early and appropriately.

Without describing each psychiatric condition in detail, the following symptoms should be taken seriously by parents:

- Severe and persistent depressive mood
- Severe agitation and panic attacks
- Hallucination - The hearing of "voices" or seeing things in the absence of external stimulus.
- Delusion - a fixed and false belief system that is alien to the person's family and cultural background.
- Grossly elated mood
- The excessive pre-occupation with certain ideas (e.g. cleanliness or body weight) to the point of affecting the person's daily functioning.

The presence of any of these symptoms may indicate the onset of an underlying psychiatric illness. With the support and encouragement of parents, the youth may agree to professional advice. A proper assessment is required to plan ways to help the young person.

5. Appropriate intervention after a suicide attempt.
All suicide attempts should be taken seriously, particularly if the youth has planned the suicide. Don't dismiss the attempt as an attention seeking behaviour. The seriousness of the attempt is related to the intent of the youth rather than the method of self harm. Proper assessment is required after the attempt and this will generally mean professional intervention.

Apart from the suicidal youth, parents and other family members will also need a great deal of support and their needs must not be forgotten.

Parents can do several things to help their teenager after a suicide attempt:

- Ensure the physical safety of the teenager.
- Be available to support the teenager.
- Be caring but don't be over-protective.
- Close observation but not being intrusive.
- Return to routine as soon as practical.
- Removal of potentially dangerous substance/weapon.
- Discuss issues relating to the attempt only at the initiative of the youth, i.e. no interrogation.
- Seek help and advice. Don't sweep the problems "under the carpet".

6. Be vigilant of changes in behaviour.
Be wary if there is a sudden excessive elevation of the youth's mood in someone who was previously severely depressed. This does not necessarily mean that the youth is getting better. The youth may have in fact finally decided to commit suicide and there is a sense of relief and therefore the improved mood and activity level. The youth may give away his/her precious possessions or ask the parents to go out so that he/she can carry out the suicide act.

A teenager who is grossly agitated is also at risk. The agitation can be caused by drug, depression, anxiety or psychosis. In this instance, the suicide act may be the youth's attempt to relieve the internal distress and agitation. Watch out for the youth who paces the floor and acts like a "cat on a hot tin roof".

7. Seek advice or help from professionals if in doubt.
It is not easy for parents to come to accept that their teenager is emotionally troubled, not to mention suicide attempt. Parents tend to blame themselves and ask themselves many "if only" and "why" questions. Professional assistance is frequently required for not only the teenager, but also the family. Clinical psychologists, general medical practitioners, psychiatrists, and competent youth counsellors are some professionals who are available for consultation and advice if there is any doubt that a youth is at risk of suicide.

8. Removal of firearms or unnecessary medicines.
Lethality of attempted suicide is related to the method employed to harm oneself. Any potentially lethal material for suicide should be removed from the home environment especially if there are teenagers who are depressed or stressed.



SUICIDAL

The following are the key words:

Stress
Unsupported
Isolation
Calculated (intentional)
Impulsivity
Depression
Attempted previously
Low self-esteem



SUICIDE PREVENTION

The following are the key words to help in the prevention of suicide:

Support
Understanding
Identification of plan/intent
Communication with teenagers
Identification of any underlying psychiatric disorder
Depression management
Esteem improvement

Parental involvement
Removal of dangerous materials
Evaluation after an attempt
Ventilation of feelings
Early intervention
Never ignore suicide threat
Talk with teenagers
Involve professionals if required
Observe change of teenager's behaviour
Nonjudgmental



These excerpts are hereby presented solely for educational purposes in accordance with the copyright laws and such international treaties of the United States of America.