In an increasingly competitive world where adolescents are constantly under pressure to achieve and excel – at school, on the sports field, at home, among friends – it comes as no surprise that suicide is one of the leading causes of teen deaths, worldwide as well as in South Africa.
Statistics, trends
“Suicidal thoughts are common amongst the youth, with about 1 in 6 females and 1 in 10 males between ages 12-16 experiencing suicidal thoughts in the past 6 months. The rates of completed suicides are higher in males than females,” Dr Kerryn Armstrong, specialist psychiatrist at Akeso Clinic in Milnerton advises.
The South African Anxiety and Depression Group (SADAG) also points out South Africa’s high teen suicide rate and concerns about the trend: “In South Africa, 9.5% of all teen deaths are due to suicide – and this figure is on the increase. In the 15-24 age group, suicide is the second leading – and fastest growing – cause of death. Children as young as 6 years old have committed suicide in South Africa. Every day 23 people (adults and adolescents) take their lives. Suicide is on the increase and the question is why?”
An infographic on the SADAG website in lieu of Teen Suicide Prevention week (14-21 February 2016) furthermore revealed the following:
· 17.6% of teens had considered attempting suicide;
· 17.8% had one or more suicide attempts;
· 15.6% had made a plan to commit suicide;
· 31.5% of teen suicide attempts required medical treatment;
· 1 in 4 teens had experienced sad or hopeless feelings;
· 21.9% of 18-year-olds had one or more suicide attempts; and
· 43.6% had tried to seek help (counselling) after considering suicide
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Key indicators
According to Dr Armstrong, a range of indicators and tell-tale signs should act as “alarm bells” for adolescent suicide risk. These include:
· Communication of suicidal thoughts, presence of a suicide plan, preparation for suicide/saying goodbye
· Low mood, feelings of hopelessness
· Deterioration in schoolwork, loss of interest in activities
· Social withdrawal
· Increased irritability, aggression, moodiness
· Reckless behaviour
· Abuse of substances
· Prominent symptoms of unstable personality
· History of risk factors discussed above
Risk factors
Suicide results from a complex interaction between individual, psychosocial and mental health factors.
Major risk factors for teen suicide include:
· Previous suicide attempt (the most important predictor)
· Mental health problems
· Major depression (very important) and other mood disorders such as substance use disorders
· Dysfunctional/unstable personality characteristics
· Feelings of hopelessness and worthlessness
· Impulsive anger outbursts
· Family contributors
· Family history of depression or suicide
· Loss of a parent or close relationship
· Family conflict
· Poor support structures, lack of friends, feelings of isolation
· Unsupportive or negative response from family, friends or community when “coming out” or dealing with gender identification issues
· Bullying or victimisation
· High pressure/unrealistic expectations of achievement
· Lethal means available
· Exposure to suicide through family, friends, internet or media
Intervention
A holistic approach tailored to each individual’s unique personal and contextual needs should be followed, Dr Armstrong advises.
The patient, family and community should all be actively involved in planning and implementation of interventions.
Once the individual’s safety has been ensured, steps should be taken to:
· identify and treat underlying psychiatric disorders,
· decrease stress and demands on the individual,
· address contributing psychosocial stressors through family and school interventions, and optimise support for the individual going forward.
Prevention
Open communication with a caring adult who can listen without judgement to the concerns of the teen is the best form of prevention. It is vital for a teenager to have open communication yet, despite this, sometimes teens are unable to let someone know how much distress they feel.
By limiting their teenager’s access to guns, knives, alcohol, prescription pills and illegal drugs, parents can play a pivotal preventive role. Moreover, they should be very aware of who their child’s friends are and network with the other parents on a regular basis so that they can keep track of their child’s whereabouts and communications. Teenagers tend to complain about their right to privacy, but it is the parents’ job to keep them safe.
It is imperative that suicide prevention measures are taken seriously in order to decrease the occurrence of this devastating outcome,” Dr Armstrong stresses.
“Parents, families, teachers and healthcare providers need to be aware of the very real risk of adolescent suicide. They should be vigilant for indications of mental health problems and ensure that at-risk individuals receive urgent help. Steps should be taken to minimise stress and pressure placed on adolescents and foster a climate with close support and open communication. Restriction of means to suicide should be ensured,” she advises.
“Likewise, the media has a responsibility to educate the public about suicide in a way that avoids sensationalising or normalising suicide, but rather encourages help-seeking behaviour,” she concludes.
