Suicide Risk in Adolescents

Adolescents are the most highly studied and written about population for suicide risk. Adolescents have the highest ranking for suicide of all age groups: Suicide is the second leading cause of death for adolescents aged 15-19 years (after accidents). During the year 2000 alone, almost 4,000 adolescents (3,994) aged 15-24 years killed themselves. That works out to about 11 young people per day. What is even more alarming than the number of completed suicides is the amount of suicidal thoughts and behaviors in this age group. More than 60% of high school students report having had some degree of suicidal ideation during their lives, and approximately 9% report a suicide attempt during the past 12 months (Wetzler et al., 1996). The CDC noted that during the last half of the twentieth century, the adolescent suicide rate nearly tripled, from 4.5 per 100,000 in 1950 to 13.2 per 100,000 in 1995. Suicide rates for adolescents increased more rapidly than those for any other age group. What is even more alarming is the number of suicide attempts in this age group. Estimates range from 50 to 200 suicide attempts, of varying severity, for every completed suicide (McEvoy & McEvoy, 1994). In 1988, the state of Oregon became the only state to begin collecting data on suicide attempts for individuals 17 years old or younger who required medical attention. Between 1988 and 1993, suicide attempt rates were 326.4 per 100,000 for females and 73.4 per 100,000 for males. Completion rates were 6.4 per 100,000. Of those who completed suicide, 42% had a previous attempt. In spite of these numbers, only 36% of youths who are at risk for suicide receive mental health treatment or counseling (National Household Survey on Drug Abuse, 2002). Perhaps because the risk is so high and the potential loss so great, the adolescent population engenders much attention in the suicide literature and in the mental health profession at large.

Suicidal ideation (thinking about suicide), suicidal behaviors (self-injurious behaviors), and suicide attempts are surprisingly common among high school students. During a typical 12-month period, one in five high school students considers suicide, one in six develops a suicide plan, and one in 13 makes a suicide attempt. These high rates of suicidal ideations and behaviors mean that adolescents are, in general, at risk for completed suicide.

Adolescents use a variety of methods to attempt and commit suicide. Among males in the 15-19 age group, just over one half (55%) of completed suicides involve firearms. The remaining male suicides used hanging (34%), poisoning by solid or liquid substances (5%), and other (6%). Among female completers in this age group, handguns were used less often than among male completers (36%), and hanging (37%) was the most common method. Poisoning accounted for 19% of completions (CDC, 2004). In general, handguns are used less frequently by both males and females than they were in the previous decade, and hanging is increasing in frequency as the method of completion for both genders.

The following case demonstrates many of the risk factors for adolescent suicide.

Lucinda was a 17-year-old Hispanic female, the oldest of seven children. The family lived in a lower-middle-class suburb of Chicago. Lucinda's mother worked two jobs to try to keep a roof over the children's heads and food on the table. Many of the children in the family were from different fathers, and none of the fathers offered the family any financial or emotional support. As the oldest, Lucinda was responsible for taking care of her younger siblings while her mother was at work. She cooked and cleaned and kept an eye on the younger ones. Two of her younger brothers caused the family particular pain. Both were involved in gangs and lived lives of danger. Lucinda tried desperately to help her brothers, with little success. Much of the family energy and focus went into keeping her brothers alive and out of trouble with the law. Lucinda was an average student at her local high school, but she had few friends and did not participate in any extracurricular activities. Recently, her music teacher had tried to get Lucinda involved in a high school musical because during music class, Lucinda had demonstrated a real talent for singing. Lucinda refused to discuss the possibility, knowing that she had to go home after school to care for her siblings, but she did not tell her teacher the reason. She simply refused with the one word "no." This was typical of her interactions with others. She kept to herself and was socially isolated. Her classmates thought that she was odd and a loner. During middle school, they used to tease her, but by the time they all entered high school, her classmates had tired of teasing her because they got no reaction. For the most part, they simply left her alone.

By the beginning of Lucinda's senior year, most students in her class were making plans for their futures, applying for local colleges or trade schools or working part time. Lucinda was making no plans. She simply got up each morning, went to school, came home, took care of her siblings, went to bed, and arose to do it again the next day. She did not gain the attention of her teachers or her school counselor because she never exhibited any behavioral problems or got into trouble. In fact, after her suicide, many members of the high school student body and staff could not visualize what she looked like or who she was.

One night, after all of her siblings were in bed and her mother was at work, Lucinda curled up in her top bunk and took an entire bottle of sleeping pills, which had been prescribed to help her overworked and overwrought mother sleep at night. No one noticed that she was dead until the next morning, when she did not get up to help get the younger children ready for school.