Young People and Suicide
1. Overview
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Throughout the 1980s the suicide rate amongst young men in the
UK and Republic of Ireland increased. However, between 1992 and
2002 fell by 11%.
In 2002, the rate per 100,000 for 25 - 34 year old men was 25 per
100,000 as opposed to a rate of 10 per 100,000 for all ages and all
sexes.
Between 2001 and 2002, the number of suicides amongst all 15 - 24
year-olds in the UK and Republic of Ireland dropped from 757 to
7161. This is a 5% fall. However,
within the 25 - 34 age group it increased from 1351 to
13781. This is a 2% increase.
In the US, 71% of all deaths among 10 - 24 year olds result from:
motor-vehicle accidents(32%), homicide(15%), other intentional
injuries(12%) and suicide(12%) (Grunbaum et al, 2003).
Only 1 in 5 16 - 24 year olds with suicidal thoughts would seek
help from a GP. Young men are particularly unlikely to do so unless
severely distressed and tend not to seek lay support (Biddle,L,
2004).
Method of suicide is often determined by factors which include
cultural and regional influences .
1 Office for National Statistics
(ONS), General Register Office for Scotland (GROS), General
Register Office for Northern Ireland (GRONI), Central Statistics
Office (CSO) - Republic of Ireland.
2. Deliberate self-harm and attempted suicide
A conservative estimate is that there are 24,000 cases of
attempted suicide by adolescents (of 10-19 years) each year in
England and Wales, which is one attempt every 20 minutes (Hawton et
al, 1999b).
Young people with a past history of suicide attempts are at greater
risk of engaging in further suicide attempts (Pfeffer et al, 1993,
Lewinsohn et al, 1994).
In the US, 17% of students had seriously considered attempting
suicide during the 12 months preceding a survey by Grunbaum et al
in 2004. Overall, the prevalence of having considered attempting
suicide was higher among female (21%) than male (13%) students;
higher among white female (21%), black female (15%), and Hispanic
female (23%) than white male (12%), black male (10%), and Hispanic
male (13%) students, respectively.
A recent study found that four times more adolescent females
self-harmed than adolescent males (Samaritans, 2003).
Prevalence of deliberate self-harm
and suicidal thoughts by gender (previous year).
In the same study suicidal thoughts were most common amongst
white adolescents. Deliberate self-harm was most common amongst the
'other' group which mainly consisted of adolescents that described
themselves as 'mixed race' (Samaritans, 2003).
Prevalence of deliberate self-harm and suicidal thoughts by
ethnicity (previous year)
The two most common reasons given by adolescent males and females
for engaging in deliberate self-harm was 'to get relief from a
terrible state of mind' and 'wanting to die' (Samaritans,
2003).
Reasons given for engaging in
deliberate self-harm in the previous year, by gender.
Adolescents engaging in self-harm had experienced more problems
and life events in the year before the survey, than those who
reported suicidal thoughts. Those with suicidal thoughts had
experienced more problems and life events than adolescents with
neither deliberate self-harm nor suicidal thoughts (Samaritans,
2003).
Prevalence of life events and
problems
3. Cultural Differences (also see Section 10 - Suicide and
young women)
The NHS National Service Framework for Mental Health identified
that among women living in England, those born in India and East
Africa have a 40% higher suicide rate than those born in England
and Wales (NHS National Service Framework for Mental Health, 1999)
.
In a survey of African Americans and 'Latino' young people 15% had
seriously considered suicide in the previous year, 13% had made a
suicide plan, 11% had attempted suicide and 4% reported multiple
attempts (O'Donnell et al, 2004) .
In the same survey, risk factors for suicidal ideation include
being female, having basic unmet needs, engaging in same gender
sex, and depression. Resiliency factors include family closeness,
and, marginally, religious beliefs. (O'Donnell et al, 2004)
In the same survey, risk factors related to reports of suicide
attempts are being female, Hispanic, and depression. Family
closeness was identified as the strongest resiliency factor
(O'Donnell et al, 2004) .
4. Suicidal ideation, hopelessness, impulsivity,
self-esteem
In a recent Samaritans study, adolescents who engaged in
self-harm were more anxious and depressed and had lower self-esteem
than those who did not (Samaritans, 2003).
Adolescents with suicidal thoughts were more anxious, depressed and
had lower self-esteem than those who did not report such ideas
(Samaritans, 2003).
Adolescents who reported self-harm and those who reported suicidal
thoughts were more impulsive than those who did neither
(Samaritans, 2003).
Anxiety, Depression, Impulsivity and
Self-Esteem scores by self-harm group
Many studies of adolescent suicidal behaviour have noted
impulsivity to be a common feature of attempts in this age group
(Aggleton et al, 2000).
Research in New Zealand found that the more suicidal young people
feel, the less likely they are to seek professional help (Carlton
& Deane, 2000).
Young people attempting suicide who persistently express suicidal
ideas, particularly where there is evidence of planning and strong
intent to die, are at an increased risk of re-attempting suicide
(Aggleton et al, 2000).
Young people frequently express suicidal thoughts in the year
before the suicide, to relatives, professionals, partners and
friends (Hawton 1999b).
Hopelessness is an important factor to assess with adolescent
suicides because it has been associated with suicide attempts and
also with completed suicide (Beck et al, Hawton et al 1982a, Hawton
at al 1982b).
5. Alcohol and other drugs
Young adult deaths from accidents, suicides, homicides and open
verdicts involving drugs, and poisonings due to drug abuse and drug
dependence, accounted for 6% of all deaths during the early 1980s.
By 2001, this proportion had increased to 13% for young adult men.
For young adult women it rose slightly to 7% (Office for National
Statistics, 2003).
Approximately one in three adolescents who die by suicide is
alcohol intoxicated at the time of death, and a further number are
under the influence of drugs (Brent et al, 1986).
In young adult women, suicide was the most common form of
drug-related poisoning death - nearly two-thirds of these deaths
over the period studied (Office for National Statistics, 2003).
A Samaritans study in 2003 asked a number of adolescents that had
contacted Samaritans how many times they had been drunk in the
previous year. Interestingly, those who had contacted the
Samaritans, compared with those that had not, had been drunk and
reported being drunk more than 10 times (Samaritans, 2003).
Number of times drunk in the past year
Alcohol and/or substance misuse have been shown to be important
predictors of eventual suicide amongst young people who attempt
suicide (Hawton et al 1993); with young suicides having a high rate
of alcohol and substance misuse and dependence (Appleby et al,
1999).
The Department of Health states: "The implications for prevention
and intervention are clear: focusing on drug and alcohol abuse
would have a greater impact on adolescent suicide rates than any
other primary prevention programme", (NHS Health Advisory Service,
1994) This approach was re-inforced by a study carried out by
Appleby (Appleby et al, 1999) .
It has been found amongst young people that the percentage change
in alcohol consumption has the single highest correlation with
changes in suicide rates (Diekstra, 1989).
Alcohol and substance misuse are significant factors in youth
suicide which affect thinking and reasoning ability, and may have a
disinhibiting effect thus precipitating a suicidal act (Shaffer
1988).
6. Mental health
6 per cent of males and 16 per cent of females aged 16-19 are
thought to have some form of mental health problem (Mental Health
Foundation, 2003) .
Whereas women are likely to suffer from depression and anxiety, men
are far more likely to suffer from substance misuse disorders and
antisocial behaviours (Walters et al, 2003) .
Schizophrenia is equally distributed between the sexes but men have
a worse prognosis, with the illness running a more severe course
(Walters et al, 2003) .
Research suggests that mental illness is the strongest risk factor
for youth suicide. Also important is a family history of mental
illness and/or suicide (Agerbo E et al, 2002) .
Other research also suggests that the strongest risk factors for
youth suicide are mental disorders, in particular, affective
disorders, substance use disorders, antisocial behaviours and a
history of psychopathology (Beautrais, 2000).
7. Social fragmentation
Suicide by young people has been associated with a number of
social and interpersonal factors such as being unemployed, socially
isolated, unmarried, and recent interpersonal life events or
difficulties with parents, peers or partners (Appleby et al, 1999)
.
Significant associations between unemployment and suicide in both
males and females, aged 15-44, have been found with the strongest
associations among younger men and women (Gunnell et al, 1999).
In general, adolescent suicide attempters appear to grow up in
families with more turmoil than other groups of adolescents, coming
more often from broken homes (due to death or divorce), homes where
there is parental unemployment, mental illness, or addiction
(Kienhorst et al, 1995).
8. Other risk factors
Extreme and traumatic events such as physical and sexual abuse
have been shown to distinguish suicidal adolescents from those who
are depressed but experience no self-destructive thoughts or
behaviours (Kienhorst et al, 1995).
Young suicide attempters report more "significant others" i.e.
people who have been important in their lives, who have attempted
or died by suicide than other groups (Kienhorst et al, 1995).
Adolescent attempters report less perceived support and
understanding from their parents (specifically) than do depressed
adolescents (Kienhorst et al, 1995). This does not appear to be the
case for others in their social network such as friends, other
family members and peers.
Research in New Zealand found that suicidal behaviour can depend on
cumulative exposure to social, family, personality and mental
health factors (Fergusson et al, 2000).
Violence plays an extensive role in the lives of those young people
that are suicidal when compared with the non-suicidal. This could
be through bullying or violence from an adult. It might also
involve their own violent attitude to others (Katz et al,
1999).
Adolescents who are bullied, as well as those who are the bullies,
are at an increased risk of depression and suicidal ideation
(Kaltiala-Heino et al, 1999). Among girls, severe suicidal ideation
was associated with being frequently bullied or being a bully, and
for boys it was associated with being a bully.
A study of 11-16 year olds who had self-poisoned found that poor
family relationships, poverty and poor peer relationships were
strongly associated with self-poisoning (Kerfoot et al, 1996).
An American study has shown a slightly but not significantly higher
rate of homosexual experience amongst teenage suicides compared to
teenage controls and also found that the risk factors for suicide
amongst gays were no different to those for straight teenagers,
i.e. alcohol and substance abuse, and psychiatric illness (Shaffer
et al, 1995).
However, a study in the UK showed a higher rate of suicidal
ideation and behaviour amongst homo- and bisexual young individuals
than among heterosexual youngsters. A common occurrence of suicidal
ideation as well as attempted suicide was especially true amongst
young lesbian and/or bisexual girls (Vincke & van Heeringen,
1998).
9. Suicide and young men
Suicide is the most common cause of death in men aged under 35
(Men's Health Forum, 2002) .
In 2001, drug abuse/dependence accounted for over 40% of all
drug-related poisoning deaths in young adult men compared to 13% in
1979 (Office for National Statistics, 2003) .
In the UK and Republic of Ireland, the rate per 100,000 in 2002 for
15 - 24 year old men, continued on its five-year downward trend
(from a five-year high of 18 per 100,000 in 1997) to 14 per
100,000, a level not seen since the late 1980's. This compares with
an overall suicide rate in the general population of 12 per 100,000
(ONS, GROS,GRONI).
In the Republic of Ireland, suicide amongst 15 - 24 year old men
rose in the 1990s, reaching a peak of 36 per 100,000 in 1998.
However in 2002 this rate showed a substantial fall to a rate of 24
per 100,000 (CSO).
The rate amongst 15 - 24 year old men in Scotland, which stood at
36 per 100,000 in 2000, has shown a fall to stand at 30 per 100,000
in 2002 (GROS) .
Within Scotland the suicide rate for the 25 - 34 year old men
increased from 40 per 100,000 to 54 per 100,000 between 2001 and
2002 (GROS) .
Within this same age group in the Republic of Ireland the rate fell
slightly between 2001 and 2002. However, over the last 10 years the
number per 100,000 has increased by 30% (CSO).
In Northern Ireland the number per 100,000 for 25 - 34 year olds
has increased by 104%. It is worth pointing out however, that
percentages can sometimes be exaggerated when dealing with small
figures (GRONI).
Suicidal young men are 10 times more likely to use a drug to
relieve stress. Suicidal young men were also more likely to feel
that they had been pressurised into taking drugs. This group also
spent far more on drugs than the non-suicidal: 29% of the suicidal
compared with 4% of the non-suicidal (Katz et al, 1999).
Suicidal young men are 8 times more likely than non-suicidal
counterparts to be living alone, in care or hostels or without a
family structure (Katz et al, 1999).
Suicidal young men are significantly more likely to have a father
who is absent (Katz et al, 1999).
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10. Suicide and young women
Between 1979 and 2001, suicide was the most common form of
drug-related poisoning death, accounting for nearly two-thirds of
these deaths over the period studied (Office for National
Statistics, 2003) .
The number and rate of suicides amongst 15 - 34 year old women has
remained relatively static over the last 10 years, in general
varying from 4 to 6 per 100,000 (ONS, GROS,GRONI).
In Scotland, the number of females suicides within the 25 - 34 year
old age group over the last 10 years have decreased by 32%
(GROS).
In the Republic of Ireland the number has increased by 100% - from
7 to 14. It is important to note that we are dealing with very
small numbers (CSO).
Young women aged 15-24 who are of South Asian origin (i.e. Indian,
Pakistani or Bangladeshi) show a very high risk of dying by suicide
in comparison with the average risk for women living in England and
Wales (Karmi et al, Soni Raleigh & Balarajan, 1992).
Young women born in the Indian sub-continent also show higher rates
of attempted suicide (Merrill & Owens) where culture conflict,
family and marital problems are commonly cited problems (Soni
Raleigh & Balarajan, 1992).
11 Methods
In the UK, the most common method is to take an overdose of
drugs. Other methods include: hanging; gassing; cutting; drowning;
throwing ones-self from a building or in front a moving object; or
shooting (in the USA, this is the most common method for both men
and women).
Method of suicide is often determined by factors which include
cultural and regional influences. Preferences change over time due
sometimes to new circumstances or fashion and sometimes to closure
of a favoured route (as in the replacement of town gas by natural
gas).
Imitation: a temporary trend may be set in motion if someone famous
attracts publicity by using a particular method.
12. Media influence
There is conflicting evidence on the effect of the media's
treatment of (fictional and non-fictional) suicide or suicide rates
in the overall population, however experts do feel that a media
effect exists, particularly in individual cases, and that the young
are especially susceptible (Hawton 1995). A recent study showed
that young people get their information on suicide from the media
(Beautrais et al, 2004) .
Guidelines have been published in the US by the American Foundation
for Suicide Prevention which recommended that:
Certain ways of describing suicide in the news contribute to
'copycat' suicide.
Research suggests that inadvertently romanticizing suicide or
idealising those who take their own lives by portraying suicide as
a romantic or heroic act may encourage others to identify with the
victim.
Exposure to suicide methods through media reports can encourage
vulnerable individuals to imitate it.
Presenting suicide as the inexplicable act of an otherwise healthy
or high-achieving person may encourage identification with the
victim.
Samaritans has also published some media guidelines: "Media
guidelines - Portrayals of Suicide" available at www.samaritans.org
13. Samaritans and young people
Text messaging
In August 2002, Samaritans completed a report of young people's
use of text messaging as a means of communication and interaction
with others. This report was created as a response to Samaritans
growing awareness of young people's emotional needs. It appears
that text messaging is the preferred option of contact for young
people, over and above using the phone. Young people seem to
experience text messaging as a wholly anonymous service that also
overcomes the embarrassment or shyness barriers of talking about
problems.
The long-term goal of the project is to create an additional
'gateway' through which young people can contact Samaritans. It
aims to be completed by April 2006.
Email Service
Since it was introduced in 1995, Samaritans email service has
been used by many young people as their preferred way of discussing
difficult feelings. Usage of this service has increased by almost
80% over the last three years. jo@samaritans.org
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