SUICIDE AMONG ADOLESCENTS

  Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of attempted and completed youth suicide in Western societies and other countries are high. Youth suicide attempts are more common among girls, but adolescent males are the ones who usually carry out suicide.Suicide occurs more often in older than in younger people, but is still one of the leading causes of death in late childhood and adolescence worldwide. This not only results in a direct loss of many young lives, but also has disruptive psychosocial and adverse socio-economic effects. 

                 From the perspective of public mental health, suicide among young people is a main issue to address.Suicide is defined as a fatal self-injurious act with some evidence of intent to die. Worldwide, more than 800,000 people die due to suicide each year. It is estimated that about 1.5 million people will die due to suicide by the year 2020. The suicide mortality rate in 2015 was 10.7 per 100,000, which means about one death every 20 s. Suicide accounts for 1.4% of all deaths, and is the 15th leading cause of death globally. Many more men than women die by suicide. The male-to-female ratio varies between 4 to 1 (Europe and Americas) and 1.5 to 1 (Eastern Meditarranean and Western Pacific region), and is highest in richer countries. These suicide figures are probably still an underestimation of the real cases.

              Registering a suicide is a complicated process, often involving judicial authorities. Suicide deaths may not be recognized or may be misclassified as an accident or another cause of death. Sometimes suicide is not acknowledged or reported, due to its sensitive nature and the taboo that still surrounds it. Suicide attempts, i.e. non-fatal suicidal behavior, are much more frequent, and are estimated to be about 10–20 times more frequent than actual suicide. The estimated global annual prevalence of self-reported suicide attempts is approximately 3 per 1,000 adults. About 2.5% of the population makes at least one suicide attempt during their lifetime .There is also an increasing awareness in the general population about the tremendous negative consequences of youth suicidality, not only because of the direct loss of many young lives but also in the disruptive psychosocial and adverse socio-economic effects on a large societal scale. The teen years are an anxious and unsettling period as boys and girls face the difficulties of transition into adulthood. It is a period in life that is often confusing, leaving teens feeling isolated from family or peers. Unfortunately, some may at one point or another perceive suicide as a permanent answer to problems that are more often than not just temporary. The self doubts, confusion, and pressures to succeed or conform can come at a high price for troubled adolescents.. From the perspective of public mental health, suicide among young people is one of the main issues to address through effective preventive measures. Therefore it is important to gain as much insight as possible in the risk factors contributing to suicidal behavior in youth. 

CAUSES

Many troubling and difficult situations can make a teen consider suicide. The same emotional states that make adults vulnerable to considering suicide also apply to adolescents. Those with good support networks (e.g., among family and peers, or extracurricular sport, social, or religious associations) are likely to have an outlet to help them deal with their feelings. Others without such networks are more susceptible during their emotional changes, and may feel that they're all alone in times of trouble. The teen years are a stressful time. They are filled with major changes. These include body changes, changes in thoughts, and changes in feelings. Strong feelings of stress, confusion, fear, and doubt may affect a teen’s problem-solving and decision-making. He or she may also feel a pressure to succeed.For some teens, normal developmental changes can be very unsettling when combined with other events.Apart from the normal pressures of teen life, specific circumstances can contribute to an adolescent's consideration of suicide. It's especially difficult when adolescents are confronted with problems that are out of their control. 

Most common causes of suicide are, 

•divorce

•a new family formation (e.g., step-parents and step-siblings)

•moving to a different community

•physical or sexual abuse

•emotional neglect

•exposure to domestic violence

•alcoholism in the home

•substance abuse

•Impulsive behaviors

•Undesirable life events such as being bullied or recent losses, such as the death of a parent

•Family history of mental or substance abuse problems

•Family history of suicide

•Family violence, including physical, sexual, or verbal or emotional abuse

•Past suicide attempt

•Imprisonment

•Exposure to the suicidal behavior of others, such as from family or peers, in the news, or in fiction stories

Many suicides are committed by people who are depressed. Depression is a mental health disorder. It causes chemical imbalances in the brain, which can lead to despondency, lethargy, or general apathy towards life. Almost half of 14- and 15-year-olds have reported feeling some symptoms of depression, which makes coping with the extensive stresses of adolescence all the more difficult. Symptoms of depression in youth are often overlooked or passed off as being typical "adolescent turmoil."

SYMPTOMS 

Suicidal tendencies don't just appear out of the blue: People usually display a number of warning signs when things seem so wrong in their lives that they've simply given up hope. Because adolescence is such a turbulent time, it may be difficult to distinguish the signs that lead to suicide from the changing, sometimes uncertain but otherwise normal behaviour of teens. 

Major behavior changes are, 

•Changes in eating and sleeping habits

•Loss of interest in normal activities

•Withdrawal from friends and family members

•Acting-out behaviors and running away

•Alcohol and drug use

•Neglecting one’s personal appearance

•Unnecessary risk-taking

•Obsession with death and dying

•More physical complaints often linked to emotional distress, such as stomachaches, headaches, and extreme tiredness (fatigue)

•Loss of interest in school or schoolwork.

Another warning sign is making plans or efforts towards suicide:

•Says “I want to kill myself,” or “I'm going to take my life.”

•Gives verbal hints, such as “I won't be a problem much longer,” or “If anything happens to me, I want you to know ....”

•Gives away favorite things or throws away important belongings

•Becomes suddenly cheerful after being depressed

•May express strange thoughts

•Writes 1 or more suicide notes.

                            Though many suicidal teens appear depressed or downcast, others hide their problems underneath a disguise of excess energy.More obvious signs that an adolescent may be suicidal include low self-esteem and self-deprecating remarks. Some teens come right out and talk or write about their suicidal thoughts - this should be taken seriously, and not ignored with the hope that it's a passing phase. Any previous attempts at suicide are loud and clear cries for help, which demand responses before it's too late.

HOW TO HELP

 The only way forward is to reduce these risk factors and strengthen protective factors as much as possible by providing integrated and multi-sector (primary, secondary and tertiary) prevention initiatives. Key prevention strategies can be population-based (e.g., mental health promotion, education, awareness by campaigns on mental resilience, careful media coverage, limited access to means of committing suicide) as well as targeting high-risk subgroups (e.g., specific school-based programmes, educating gatekeepers in different domains, providing crisis hotlines and online help, detecting and coaching dysfunctional families) or even focusing on individuals identified as suicidal (e.g., improving mental health treatment, follow-up after suicide attempts and strategies for coping with stress and grief) (41). To increase successful attempts to address youth suicide in the future, further unraveling of the complex suicide process must be accompanied by sustained and substantial efforts in scientifically underpinning and (re)evaluating ongoing and new prevention strategy plans, and this is largely a matter of policy priorities and commitment.

It's essential that you take suicidal behaviour or previous attempts seriously - and get assistance quickly. Aside from professional treatment, a suicidal teen needs to know there are people who care, and who are available to talk to. Good support means listening to what's troubling somebody without passing judgment on his or her feelings.