Suicide: Specific Adolescent Risk Factors
Many specific risk factors have been identified for adolescent suicide. In fact, to name all of them would be almost as unhelpful as naming all adolescent thoughts, emotions, and behaviors. Therefore, what we list below are the demographic, psychological, cognitive, and environmental risk factors that are most supported through research and are most prevalent among adolescents at risk.
Demographic Risk Factors
Completed suicides in adolescence remain a primarily Caucasian male occurrence, with 73% of suicides in this age range committed by white males. However, rates are rising among African American males, doubling in the past 20 years, making them the population with the greatest increase in risk. Additionally, there is concern that suicide rates among young African American males may be masked by high homicide rates, with some research suggesting that many of the homicides may include elements of suicide (Lyon et al., 2000).
Although suicide completion in adolescence is primarily the purview of males (who complete suicide four to five times as often as females), suicidal ideation and attempts are much more common in females. Over one third of adolescent females rate themselves as significantly depressed or hopeless almost every day for more than two weeks during the past 12 months, compared with 22% of males. Female adolescents (24%) were significantly more likely than males (14%) to have considered suiccide in the past year, and females were significantly more likely (18%) than males (12%) to have developed a plan (Centers for Disease Control and Prevention, 2004).
Emotional Risk Factors
Adolescent suicide attempters and completers have overall higher rates of psychological distress than their nonsuicidal peers. All major classifications of mental health disorders are represented in the at-risk population at higher rates than in the population of those not at risk (Wetzler et al., 1996), and approximately 90% of completers have at least one major psychiatric disorder. A review of autopsy studies (Brent et al., 1993) found the most prevalent mental health disorders among adolescent suicide completers were as follows:
- Affective disorders: Studies show that a range of 35-76% of adolescent suicide completers suffered from an affective disorder, most commonly depression followed by bipolar disorder and anxiety.
- Schizophrenia: Studies show that from 0-17% of adolescent completers have schizophrenia. However, most research demonstrates that individuals with schizophrenia are at the highest risk for suicide during their thirties and forties.
- Substance abuse: Typically between one third and two thirds of me sample in most studies of adolescent completers have a substance abuse disorder. Substance abuse is more likely to be a risk factor when it occurs in the presence of a coexisting affective disorder.
Other psychological risk factors include problems with identity, fluctuating mood states, hopelessness, anger and impulsivity (Wetzler et al., 1996), and antisocial personality disorder/conduct disorder (Apter, Bleich, Plutchik, Mendelsohn, & Tyano, 1988; Brent et al., 1993). Anxiety (Sareen, Cox, Clara, & Asmundsen, 2005; Strauss et al., 2000) also has been linked to suicidal behaviors, particularly when a person has both anxiety and depression.
As with all age groups, the depressive factor of hopelessness appears to be the most salient in moving from a general depression to a high risk for suicide (Beautrais, Joyce, & Mulder, 1999). Adolescents who have no hope for the future or cannot envision a future, a more and more common occurrence among inner-city youths, appear to be at very high risk.
The psychological trait of impulsivity is particularly disturbing and has only recently received attention in the literature. A 2001 study found that among nearly lethal suicide attempts of young people (ages 13-34 years), almost one quarter (24%) of the attempts occurred with less than five minutes between the decision to attempt suicide and the actual attempt (Simon et al., 2001).
Substance abuse increases the suicide risk in adolescents. Youths who reported alcohol or illicit drug use over the past year are much more likely to be at risk for suicide. Those who use alcohol have more than double the risk, and those who use illicit drugs have nearly three times the risk of suicide than those who do not (National Household Survey on Drug Abuse, 2002).
Chemically dependent adolescents have been found to have higher rates of suicide attempts before treatment than chemically dependent adults (36% versus 26%) (Holland & Griffin, 1984). Further studies have shown that chemical abuse or dependence may be secondary to an affective disorder in determining suicide risk. That is, adolescents who are depressed and use substances appear to be more at risk than those with depression or substance abuse alone.
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