Risk Factors Predicting Youth Suicide Attempts

Youth suicide represents a significant public health issue and one particularly important given that young people often have fewer tools to deal with their suicidal thoughts.

Demographics

Suicide is the 4th leading cause of death for youth in Canada (Statistics Canada, 2011). There are between 50 and 200 suicide attempts per suicide death in adolescents (Schwartz, 2003).

This rate is higher than the estimated 25 attempts per suicide death in adults (McIntosh, 2012), which could be due to an underestimation of lethality, as Kartakis (1999) noted in an adult population, or because of an ambivalence, a desire not to die. Given youth often have trouble communicating their emotional needs either one could contribute.

The Role of Attitudes and Beliefs about Suicide

One study, by Lake, Kandasamy, Kleinman & Gould (2013) looked at the attitudes of adolescents towards the causes of suicidal behaviour and identified two distinct belief systems:

• Stress model, that believes that suicidal behaviour is the result of overwhelming stress
• Medical model, that believes suicidal behaviour is the result of mental illness.

This is backed up by Muehlenhamp & Gutierrez (2004) that found attitudes towards dying in a sample of high school students were associated with suicide attempts but not self-harm.

Youth who believed in the stress model were more likely to believe suicide was something that happened to everyone and that it was not treatable or curable. Assessing youth attitudes towards suicide may therefore represent an opportunity to intervene before suicidal thoughts begin.

Risk Factors for Adolescent Suicide

Taliferro & Muehlenkamp (2014) identify a number of risk and protective factors. Some of them are similar to adult risk factors while others are specific to youth.

• Alcohol and Drug Use (Cash & Bridge, 2009)
• Anxiety
• Bullying Behaviour / Fighting
• Impulsiveness (Klonsky and May, 2010)
• Mental Health Issues
• Parental Substance Abuse
• Running Away from Home
• Self-Injurious Behaviour
• Victim of Childhood Abuse

In addition, a few risk factors were associated more suicidal behaviour in one gender than the other. In males, smoking (cigarettes or marijuana) and truancy were risk factors in males, while being victims of dating violence, having same-sex experiences and perceiving one’s self as being overweight were risk factors in females.

A Note on Impulsiveness

Impulsiveness has been noted in other sources (e.g. the Counseling on Access to Lethal Means course) as a risk factor in that youth can act on suicidal impulses before someone has a chance to intervene, however Klonsky & May (2010) revealed that it was not the impulsiveness that was the danger (when comparing youth who attempted suicide from youth who didn’t), but rather a poor ability to forsee the consequences for their actions.

Protective Factors for Adolescent Suicide

The following protective factors were identified as well:

• Academic Achievement (Borowsky, Ireland & Resnick, 2001)
• Enjoying School
• Parental and Non-Parental Connectedness (trusted adults)
• Supportive Friendships
• Involvement in Sports
• School Engagement and Safety

It’s important to note that liking school was more a protective factor for females, while feeling safe in school was more a protective factor for males.

Bibliography

Borowsky, I.W., Ireland, M., Resnick, M.D. (2001) Adolescent Suicide Attempts: Risks and Protectors. Journal of Pediatrics. 107(3). 485-493. doi: 10.1542/peds.107.3.485

Cash, S.J. and Bridge, J.A. (2009) Epidemiology of Youth Suicide and Suicidal Behaviour. Current Opinions in Pediatrics. 21(5). 613-619.

J.L. McIntosh. (2012) “USA Suicide 2009 Official Final Data” Accessed May 5, 2015 from http://www.isu.edu/irh/projects/ysp/downloads/2009NationalData-AAS.pdf

Kartakis, P. (1999) The Persistently Suicidal: Perceived Lethality, Intent and Hopelessness Among Multiple Attempters. MA Thesis, York University.

Klonsky, E.D., May, A. (2010) Rethinking impulsivity in suicide. Journal of Suicide and Life Threatening Behavior. (40)6. 612-9. doi: 10.1521/suli.2010.40.6.612

Lake, A.M., Kandasamy, S., Kleinman, M., Gould, M.S. (2010) Adolescents’ attitudes about the role of mental illness in suicide, and their association with suicide risk. Journal of Suicide and Life Threatening Behaviour. 43(6):692-703. doi: 10.1111/sltb.12052.

Muehlenkamp, J. J. and Gutierrez, P. M. (2004), An Investigation of Differences Between Self-Injurious Behavior and Suicide Attempts in a Sample of Adolescents. Journal of Suicide and Life-Threatening Behaviour, 34: 12–23. doi: 10.1521/suli.34.1.12.27769

Schwartz, M.W. (2003) The 5-minute Pediatric Consult. Lippincott Williams & Wilkins. pp 796.

Statistics Canada. Table 102-0561 – Leading causes of death, total population, by age group and sex, Canada, annual, CANSIM (database). Accessed May 7, 2015.

Taliaferro, L.A., & Muehlenkamp, J. J. (2014). Risk and protective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year. Journal of Suicide & Life-Threatening Behavior, 44, 6-22.