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By: Lynn Margolies, Ph.D. 
Teen suicide awakens us to the pain and suffering of
teens, and the risk of contagion.
Suicide is the 3rd leading cause of death among
adolescents and young adults, second to accidents and homicides. Most youth
suicides don’t come on suddenly but, rather, after a long period of inner
torment.
Many suicidal teens are preoccupied with death and suicide
and talk or write about feeling hopeless and wanting to die. 90% of teens who
commit suicide have expressed suicidal feelings and intent either directly or
indirectly. Yet, the majority of suicidal youth are not receiving mental health
services (National Institute of Mental Health, 2012).
Parents with an emotion avoidant, or conflict avoidant,
style may have difficulty noticing or responding to painful affect in their
children. Also, families with overwhelming problems and/or chronically troubled
kids can become exhausted and desensitized, making it difficult to respond with
needed urgency in each situation. However, any expressions of hopelessness,
feeling like a burden, feeling trapped, and/or threat or attempt to hurt
oneself should always be taken seriously and never dismissed as teen "drama,” a
ploy to "get attention,” or shut down with reassurance that things are not that
bad.
Warning signs:
Warning signs of suicide include changes in personality
and behavior such as: withdrawing from people and activities that once brought
pleasure, hopelessness, deterioration in academic functioning, sudden,
unexplained energy/relief from depression, giving things away, physical/medical
complaints (a manifestation of depression) irritability, sleep problems,
revenge fantasies, increased alcohol, recklessness, and substance abuse
(Suicide Prevention Resource Center, 2011)
Risk
factors:
Risk factors for suicide include:
depression or other psychological conditions, prior suicide attempt, suicidal
thoughts, non-suicidal self-injury, exposure to a suicide, access to lethal
means, impulsivity, aggression, family history of psychiatric disorder or
suicide, family conflict, academic
stress, history of physical and/or sexual abuse, peer victimization,
alcohol/substance abuse. Use of substances or alcohol play a role in more than
half of all suicides - exacerbating depression, impulsivity, disinhibition, and
impaired judgment (Juhnke, Granello, & Haag-Granello, 2011; "Teen
Suicide," n.d.).
Triggers:
Suicide attempts vin teens are often
triggered by common stressors such as family conflict, relationship break-ups,
loss, major disappointments, and/or recent disciplinary action. Although such
events are often precipitants, they are never the "cause” of suicide, but may
activate a teen already at risk.
Though the risk factors and warning signs give us a map,
teens can be at risk without meeting the risk profile. Understanding teens
cannot be formulaic. If it is, teens will not open up and it will be easy to
miss signs that are not on our list.
Teens concealing from adults
Teens don’t feel safe talking to adults about suicide.
Some suicidal teens may be good actors - showing us what we want to see. They
may be afraid to open up because they feel ashamed, fear disappointing parents,
or don’t believe anyone should or can help them. 93% of teens surveyed said
they would consult a friend before telling an adult. Only 25% would tell an
adult if they or a friend were suicidal (Centers for Disease Control and
Prevention, 2010). However, most teens who attempt or commit suicide express
their feelings and intent and do so through text, Twitter, Facebook, Instagram,
and other social media (Dunlop, More, & Romer, 2011).
These finding remind us that it makes sense
to "friend” our kids on Facebook,
explaining to them that - just as we want to know their friends and activities
off line to protect them - we also want to be aware of their online friends and
activities.
Helping teens talk
to adults
We must help teens understand why they should tell an
adult if they or a friend want to hurt themselves. They need to know that
people who are considering suicide are in a very dangerous and complicated
situation.
Telling an adult a friend is in trouble is
an act of courage and friendship - not betrayal. Even if it seems otherwise,
suicidal teens are reaching out for help. No one really wants to die. People
kill themselves in desperation - intending to escape, give themselves the
illusion of control, and/or communicate through desperate actions when they are
unable to effectively communicate in words (Juhnke, Granello, &
Haag-Granello, 2011).
Teens should be told that failing to ask an
adult for help may leave them with a terrible burden of guilt if a friend
commits suicide. Teens connected with the recent victims need help with these
and other feelings, including: helplessness, guilt, grief, anger, confusion,
unsafety.
Suicide contagion:
Although we don’t think of suicide as contagious, one of the
strongest predictors of suicide attempts in youth is learning that a friend or
family member attempted or committed suicide. Teens
exposed to suicide - even of someone they don’t know, are at significantly
higher risk of suicide for 2 years (Mayer, 2013). Additional exposure to
suicide online through YouTube videos about suicide, and online forums with
pro-suicide content (Dunlop, More, & Romer, 2011), increase
self-destructive fantasy and risk.
Research offers guidelines for parents, teachers, mentors
and the media to reduce the risk of contagion. Guidelines include refraining
from giving details or images of the method or place where the victim was found
(Centers for Disease Control and Prevention, 1994; Sudak & Sudak, 2005).
Care should be taken not to focus on the immediate
external precipitant as the cause of the suicide, for example, a break-up, or
other things with which teens can easily identify (Mayer, 2013). Doing so can
inadvertently increase teens identification with the victim and convey that
suicide could also be a solution to their problems. A related risk is allowing
memorializing to go too far, feeding into idealization of death and suicide or
reinforcing suicide as a solution to problems (Centers for Disease Control and
Prevention, 1994; Sudak & Sudak, 2005).
Vulnerable teens, feeling unpopular or alone in their
pain, may envy the compassion others feel for the victim, seeing suicide as an
effective means of becoming popular and getting others to finally say good
things about them, care about them, recognize their pain and/or take them
seriously. To protect against this, it is important not to portray the victim
and what happened in a simplified or one-dimensional way (Mayer, 2013; Sudak
& Sudak, 2005).
Adults can help teens recognize that people who resort to
suicide have complicated psychological conditions. Such conditions temporarily
cause overwhelming feelings and desperation. They affect our ability to think
clearly and flexibly, find solutions to problems, have hope and perspective. We
should alert teens that when people are going through this, they don’t
recognize that they are caught in a distorted way of thinking and painful
emotional state which will not last, and from which they can recover.
Teens should be warned that that this frame of mind can
trick them into believing they are seeing life clearly, which is why it’s
important to tell an adult they trust at the first sign that they or a friend
want to hurt themselves or die.
Parental support:
Above and beyond the content of what we say, we
communicate whether it’s safe to talk to us through our own feelings, reactions
and behavior. Behaviors that discourage teens from talking include: lecturing,
talking too much, being preoccupied, giving unsolicited advice, using emotional
force or guilt, taking teen’s feelings personally, pulling away, and reacting
to our own anxiety.
Behaviors that encourage teens to trust us: being grounded
and calm, admitting when we are wrong, having presence of mind, being
emotionally available instead of reactive even when they pull away, listening
with respectful curiosity, asking questions that show interest in how they
think and feel, and being accepting and refraining from judgment.
Teens feel safe to talk when parents are interested and
open, without unconsciously rigging teen’s responses with our own anxiety, need
for control and/or need for reassurance. If we are open to hearing the truth,
we’ll be able break secrecy and open the door for teens to get help. Our
relationship with teens is our most valuable resource.
References
Centers
for Disease Control and Prevention. (1994, April). Suicide contagion on the reporting of suicide:
recommendations from a national workshop. MMWR, 43(RR-6), 9-18. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/00031539.htm
Centers
for Disease Control and Prevention. (2010, June). Youth risk behavior surveillance – United
States, 2009. MMWR,
59(SS05). Retrieved from http://www.cdc.gov/MMWR/preview/mmwrhtml/ss5905a1.htm
Dunlop,
S. M., More, E., & Romer, D. (2011, October). Where do youth learn about suicides on the internet, and what influence does
this have on suicidal ideation? Journal
of Child Psychology and Psychiatry, 52(10), 1073-80.
Friedman,
M. (n.d.). Preventing tragedy: bringing
an end to youth suicide. Retrieved from www.tapartnership.org/docs/preventingTragedy.pdf
Juhnke,
G. A., Granello, P. F., & Haag-Granello, D. (2011). Suicide, self-injury and violence in the schools:
assessment, prevention, and intervention strategies. Hoboken, NJ: John Wiley
& Sons, Inc.
Mayer,
A. (2013, May). Needed: new approaches to
defuse ‘suicide contagion’ among teens. Retrieved from http://www.cbc.ca
Sudak,
H. S. & Sudak, D. M. (2005). The media and suicide. Academic Psychiatry, 29, 495-499.
Youth
Suicide Prevention School-Based Guide. (2012). Risk factors: how can a school identify a student at-risk
for suicide?
Retrieved from http://theguide.fmhi.usf.edu/pdf/2012PDFs/IB-3b
About the Author...
Dr. Lynn Margolies is a psychologist and former Harvard Medical School faculty and fellow. She has helped people from all walks of life with relationship, family, and life problems. Dr. Margolies has worked in inpatient, outpatient, residential and private practice settings. She has supervised other practitioners, and consulted to clinics, hospitals, universities, newspapers. Dr. Margolies has appeared in media—on news and talk shows, and written columns for various publications. Dr. Margolies is currently in private practice in Newton Centre, MA.
Click here to contact or learn more about Dr. Lynn Margolies Last Update: 11/8/2013
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