by Michiko Otsuki, Tia Kim, and Paul Peterson
Introduction Youth suicide is a major public health problem in the United States today. Each year in the U.S., thousands of teenagers commit suicide. Suicide is the third leading cause of death for 15-24 year olds, and the fifth leading cause of death for 5-14 year olds. (American Foundation of Suicide Prevention [AFSP], 2010; National Center for Health Statistics [NCHS],2006) The reduction of adolescent suicide is one of the major objectives of the Healthy People 2010 Initiative (Department of Health and Human Services, 2010). Scope of the Problem Age and gender differences Suicide is less common during childhood and the early teen years (Gould & Kramer, 2001). In 2006, the rate was .5 suicides per 100,000 children aged 10-14. (AFSP, 2010; NCHS, 2006) Suicide mortality increases considerably in the late teens and continues into the early twenties for both males and females. Although females are more likely than males to attempt suicide, males are roughly five times as likely to success in their suicide attempts. Ethnic differences American Indian/Alaska Native youth have the highest prevalence of suicide across all age groups. In this group males have the higher prevalence. European-American youth have the next highest prevalence. Their prevalence is higher than that of AfricanAmerican, Latino, and Asian-American/Pacific Islander youth. Although research suggests that Native American and Latino youth have the highest suicide-related fatalities (Centers for Disease Control [CDC], 2009), Latino female youth are more likely to attempt suicide than all other groups of youth (National Adolescent Health Information Center, 2006). Methods of youth suicide Firearm death remains the most prevalent method of suicide, regardless of age, gender, and ethnicity. It accounts for 46% of suicide deaths among youths (CDC, 2009). The 1
second and third most prevalent methods of youth suicide are hanging and poisoning, respectively. The gender difference in the rates of completed suicide is largely explained by the gender differences in suicide methods. Females are more likely to poison themselves whereas males are more likely to shoot themselves. Firearms are more lethal than poison. Nonlethal suicide behaviors For every completed suicide, an estimated 100 to 200 suicide attempts are made. Attempted suicides are a risk factor for successful suicide. Risk Factors Suicidal behaviors are complex and have multiple risk factors. Psychopathology The majority of youth who have completed suicide had significant psychiatric problems, including depressive disorders and substance abuse disorders. Major depression has been the most prevalent condition. The intensity of a person’s suicidal intent is associated with a history of depression and anxiety and current stress from a mental disorder (Koutek, Kocourkova, Hladikova & Hrdlicka, 2009). Although many mental disorders increase the odds of suicide ideation, disorders characterized by anxiety and poor impulse-control increase the odds of actual suicide attempts (Kwoy & Shek, 2009). Female youth suicides have a higher prevalence of an affective disorder than male youth suicides. Substance abuse is also a significant risk factor, especially for older adolescent male victims (Shaffer et al., 1996) and when co-occurring with an affective disorder (Gould & Kramer, 2001). Previous suicide attempts One quarter to one-third of youth suicide victims make suicide attempts prior to their completed suicide. Anxiety lowers the likelihood of one-time suicide attempts but increases the likelihood of repeated suicide attempts (Brezo, Paris, Herbert, Vitaro, Tremblay & Turecki, 2008). With each successive attempt, the risk of completed suicide increases -- for male adolescents the risk is thirty times higher,...