By Daniel Brown, M.A., Art A. Bennett, M.A. and Frank J. Moncher, Ph.D.
Suicide is the third leading cause of death in people ages 15-29 (after accidents and homicide), and the sixth leading cause for children ages 5-14. Long a problem for teenage boys, the suicide rate for teenage girls (ages 10-17) and young women (18-24) has tripled in the past 25 years. While girls are more prone to depression than boys, teen boys and young men are four times more likely to commit suicide.
In the next 24 hours 1,439 teens will attempt suicide, and 12 young people between the ages of 15 and 24 will die by committing suicide.1
Why do young people do this? The literature2 points to several possibilities: 1) to make a change; a desperate attempt to force another (e.g. a parent or ex-boyfriend) to see them differently; 2) to make a choice when no choices appear available; 3) to escape a desperate situation (e.g., being in trouble with the law); 4) to relieve guilt over bad decisions, thus self-punishing (e.g., involvement in abortion against one's value system may cause one to feel unworthy of living); and/or 5) to inflict harm or punishment on another (a youth may wish to harm himself to hurt his parents or for revenge, for example).
The fact that some teens have resorted to such desperate means to make a change or communicate their distress shows how our culture has lost its bearings. Youth suicide is another consequence of society valuing only what is "useful," and rejecting whatever does not show an immediate, material benefit. The diminishing respect for human life complicates problems for youth. It is no longer generally understood that we are created in God's image and destined for eternal happiness in union with God and, for that reason, that life is infinitely valuable. The increasing public advocacy for "assisted suicide" to avoid emotional or physical suffering can encourage youth to entertain suicide as an option. The cheapening of life seen in tolerance for abortion and abortifacient contraceptives can be expected to inevitably do the same.
Factors in Suicidal Behavior
According to the American Association of Suicidology, a prior suicide attempt, exposure to suicide or to another's suicidal ideation (thoughts), and/or a recent severe stressor (e.g., out-of-wedlock pregnancy, significant loss) increase the likelihood of suicide. Furthermore, having access to lethal means, such as guns or pills, greatly increases the chance of a successful attempt.
Certain developmental realities are critical to understanding and preventing teen's suicidal behavior. Among these are (a) the natural tendency for youth to turn inward as they strive to understand their identity; (b) the important changes in the parent-child relationship as the youth begins to emancipate and develop significant peer relationships; and (c) the increased cognitive ability to think abstractly and to understand - though at times naively - the deeper issues of life.
To understand better how these factors interact to create an environment where suicidal behavior might occur, we need to review issues such as the young person's psychological status, family environment, peer or dating relationships, and spiritual life.
Psychological Factors. A psychological disorder or emotional difficulty increases the risk of suicide in an already troubled youth. Risk factors include a variety of psychiatric diagnoses (i.e., depression, borderline personality disorder, conduct disorder, schizophrenia, panic disorders), interpersonal problems, adaptive skill problems (poor impulse control, hopelessness), and past developmental experiences (i.e., trauma).3 Depression that is severe, and accompanied by hopelessness, social isolation, aggressive behavior, or anxiety is particularly predictive. The impulsive tendency to act without thinking through a plan and its consequences is a symptom of a number of these mental disorders and has been linked to suicidal behavior.4
Family Environment Factors. Family factors are also important to understand, as there is much that parents can do to reduce the risk of suicide. But we must understand that recent changes in American family structures have resulted in increased emotional and behavioral problems for teens, including suicide, criminal activity, unplanned pregnancy, and alcohol use.5 Family loss or instability, a broken home, alcoholic parents, or formation of a new family with step-parents and step-siblings,6 etc. also increase the risk for depression and suicide.
Research conducted by Drs. Felitti and Anda7 showed a link between adverse family and childhood experiences and suicide. Certain experiences were especially predictive of future depression and suicide risk, as well as substance use and adolescent pregnancy. Essentially, a buildup of stressful, traumatic events relates to a greater risk for depression and suicide. The most predictive were child abuse and neglect (of any kind), domestic violence, parental crime, and being raised by an alcoholic, substance-abusing or mentally ill parent (especially bipolar disorder, major depression, schizophrenia, and certain personality disorders).8 Nearly 20% of youth experiencing four or more of these negative events have attempted suicide.
The poor parent-child communication often present in difficult environments intensifies self-doubts and depression.9 Suicide can appear to be a solution to escape these difficulties.10 For example, a youth who feels that parents are lacking compassion; who feels that he/she "doesn't matter"; or who perceives little warmth, positive affect or intimacy with his/her parents, may start to believe internal attributions (e.g., "I'm bad", or "I'm worthless"), leading to depression and increased risk of suicide.11
Positive relationships with parents are a key factor in helping a youth feel free to discuss concerns with parents, thereby lessening any tendency towards depression. In other words, youth who experience stressful events in the context of a warm and loving family environment are less likely to develop depression. A healthy parent-child relationship is key in lessening the range of emotional and behavioral problems among youth.12 So parents should not feel that they are helpless with these problems, but should redouble their efforts to be supportively and actively involved in their teens' lives.
It is also important for parents to work as a team to support their teens. A youth who feels caught in the middle or that he will inevitably disappoint one parent or the other is at higher risk. If youths live in a family where there is constant pressure to choose between parental views, they live under a constant threat of rejection. As a result, possible rejection from a larger social context becomes unbearably threatening, as there is no safe and supportive home to which to return. Some parents, on the other hand, prematurely disengage from their children in a well-intended effort to promote maturity or independence. However, some youths may require more guidance, supervision, and nurturing, and could feel rejection because of the parental distance, increasing the risk of suicidal behavior.
Peer Relationships and Sexuality. Factors related to peer relationships are also important to understanding suicide risk. Not surprisingly, teens who are promiscuous, have abortions, or begin sexual activity at an early age experience high levels of emotional distress and are thus at risk for suicidal behavior. Also, youth involved in peer violence, either as perpetrators or as victims, are at higher risk for suicide attempts.13 Additionally, excessive emotional reliance on others,14 lack of social support from friends, and low self-rated social competence result in higher risk. Finally, broken relationships and promiscuity appear to indirectly increase the risk for suicidality, through increased depression.
Sexually active teens are more likely than peers to have negative emotional consequences (e.g., guilt, regret),15 contract sexually transmitted diseases, and have interpersonal problems,16 all of which contribute to their higher risk. It's not surprising that over 65% express regret for having had sex.17 Rejection in a physically intense relationship can be devastating to a young person. For example: a twelve-year old girl was coming to counseling with suicidal thoughts because her boyfriend left her for another.18 Although many of the above circumstances are avoidable through appropriate education and formation, most school curricula do not deal adequately with long-term emotional and moral aspects of teenage sexuality. In fact, they often fail to provide students with an understanding of the appropriate peer relationships needed to develop healthy loving relationships as adults, increasing the importance of the early formation provided in the home. If parents are monitoring and protecting their teens from entering into damaging peer relationships, and are a support to help their teens navigate through friendships, risk of problems can be lowered.
Spiritual Life. The depth and nature of a youth's spiritual life can also be an important factor in the decision whether to harm oneself. Because the Bible teaches that life is sacred and each of us is made in the image and likeness of God,19 young people with strong religious convictions are better able to inhibit impulsive temptations to suicide and to seek avenues of understanding and support. They are also more likely to be in contact with peers and adults who would offer viable coping alternatives to suicide. However, even devout Catholics at times are not fully free in their choices due to psychological factors, and it is important not to assume that faith is a panacea against suicidal behavior.
SIGNS A YOUTH IS SUICIDAL
What are signs one should look for in the suicidal youth? The following list should raise doubt as to the mental and emotional health of a youth, especially within the context of any of the circumstances mentioned in the article.
- Deterioration in personal habits
- Increased sadness, moodiness, and sudden tearful reactions
- Deliberate self-harming
- Impulsive and aggressive behavior
- Frequent expressions of rage
- Feelings of hopelessness, especially when accompanied by anxiety
- The expression or communication of thoughts of suicide, death, dying or the afterlife (in a context of sadness, boredom, or negative feelings)
- Declining school performance: consistently declining grades, absences, and falling behind in credits.
- Loss of pleasure/interest in social and sports activities
- Sleeping too little or too much
- Significant changes in weight or appetite
- Use of alcohol and drugs
- Sudden withdrawal from family and friends
Parents should not feel helpless even though their teen is arching toward independence. They still need their parents' help, guidance, and support. Parents are key in helping the depressed or suicidal youth. Parents should support their child by listening, avoiding undue criticism, and remaining closely connected.20 Factors found to be protective against suicidal behavior include a supportive network to provide immediate discussion of actions that help prevent or delay suicidal actions; consistent, structured, non-stressful surroundings; and the youth's commitment to not acting to harm himself or herself.21
The Christian family, in particular, should create a climate where listening and charity are reinforced. As John Paul II writes in Familiaris Consortio: "Acceptance, love, esteem, many-sided and united, material, emotional, educational and spiritual concern for every child that comes into this world, should always constitute a distinctive, essential characteristic of ... the Christian family" (no. 26). In addition, all parents should make an effort to become informed about the complicated lives today's youth often confront, through resources available in their local library or Internet22 (e.g. see www.afsp.org and www.suicidology.org). The key questions families need to ask themselves are: When rejected at the peer level, can the youth return home to somebody who is mindful and caring? Can the family acknowledge the youth as a person of value and dignity in himself, and not just as an achiever or by some other external standard?23
Girls and boys often need an outlet to discuss their concerns with objective, caring adults; although parents are the first line of defense, when issues become dangerous it is wise to have others available for your child.24 For those parents whose child is already showing signs of depression, or has mentioned suicidal feelings in himself or a friend, it is important to get immediate help through a medical or mental health professional (your parish priest or local diocese should have referrals available). The confidentiality of a counseling session can sometimes provide a setting where they can divulge their difficulties. Furthermore, if a youngster has a friend who is in trouble, encourage the youth to take his or her friend's actions seriously.25 Parents can encourage their child to suggest that the friend seek professional help, and even accompany him/her for moral support. Caring parents appreciate being notified of their child's needs and the offer of resources to help. Your child shouldn't be left alone in helping a friend.
A variety of treatment modalities have shown success in assisting the suicidal youth. Cognitive-behavioral therapy helps investigate and correct irrational ideas about the world and the options open to the person.26 For example, if suicide is seen as the only solution to a problem, the therapist would intervene by helping the client thoroughly investigate his or her reasons for living, teach alternate problem-solving solutions for the problems that are causing doubt, and, through the use of role-playing or other techniques, rehearse strategies that will help in countering the next crisis situation. Through this type of therapy, the troubled individual will also learn how to identify and control negative feelings that can often lead to suicidal actions, before these feelings become overwhelming.
Another treatment option is family therapy. Involving parents and family members in treatment is recommended to help reduce parent-child conflict by improving family communication, support, empathy, warmth, and conflict resolution skills.27 Improved family relations will often lead to a decrease in hopelessness and anger in the troubled youth by releasing difficult, held-in feelings that have plagued him or her. While adolescents must be accepted for who they are, this does not mean accommodating their every whim. Instead, parents must tolerate the inevitable frustrations and stay connected with them, while not treating them as fragile and vulnerable to the point of overly protecting or shielding them from the natural stresses of life. This balance can be difficult to achieve, but is essential to ensure that children are emotionally stable prior to being sent forth into the world where they will face additional challenges.28 Of course, none of this should be interpreted as blaming parents who have lost a child to suicide. It should be remembered that suicidal behavior is caused by multiple factors, and that the families who are surviving such a loss need our understanding, compassion, and support.
Finally, it is important to note that some psychological disorders, such as depression, can be heavily influenced by one's biological state. Medication or other medical intervention may therefore be a necessary component of addressing the underlying cause of suicidal behavior. In addition, group therapy (often in the form of peer support groups) can help youth decrease their sense of isolation and develop social support and opportunities to share problems, and can be a useful addition to individual and family-oriented therapies.
Youth suicidal behavior is a serious problem in American society. Our contemporary culture, with its emphasis on material success, can hamper the ability to find meaning in situations where suffering occurs. The effective responses, however, are embedded in the Catholic Church's teachings on the role of the family in guiding and nurturing children in the domestic church, as well as on utilizing the best that science has to offer (e.g., psychotherapy, counseling or medication) in ways that support Christian moral truths. As clergy and lay leaders in the church become more aware of the warning signs, and as more mental health professionals see the value of a person's spiritual beliefs in aiding their emotional functioning, the appropriate resources can be brought to bear and aid these youth in distress.
The authors provide outpatient counseling and psychotherapy to clients at the Alpha Omega Clinic and Consultation Services, Vienna, Virginia and Bethesda, Maryland. The clinic's mission is to integrate professional expertise in the fields of psychology, mental health and social work with the principles of the Catholic faith to enhance personal, professional, familial and marital development. Dr. Moncher also teaches at the Institute for the Psychological Sciences (IPS), Arlington, Virginia, an educational institution dedicated to the development and promotion of approaches to psychology founded in the Catholic vision of the human person.
Mr. Brown is a doctoral student at IPS. Mr. Bennett is also the host of the radio program, "Healthy Minds/ Healthy Souls" on WUST 1120 am, or on the web at www.wust1120.com.
- What is Happening to our Children. American Society of Suicidology, Youth Suicide Fact Sheet, available at www.suicidology.org, 2004. Witmer, D., What is happening to our Children? available at http://parentingteens.about.com/cs /familylife/a/statistics.htm, 2004.
- M. G. Conner, Understanding and dealing with the risk of suicide, available at http://www.crisiscounseling.com/Suicide/SuicideRisk.htm, 2004.
- Pfeffer, Suicidal Behavior, in J. Noshpitz (ed.), Handbook of Child and Adolescent Psychiatry, Vol. 5. New York: John Wiley and Sons,1999. Also, National Institute of Mental Health, Frequently Asked Questions about Suicide, available at www.nimh.nih. gov/suicideprevention/suicidefaq.cfm, 2004.
- National Institute of Mental Health, Frequently Asked Questions about Suicide, available at www.nimh.nih.gov/suicideprevention/suicidefaq.cfm, 2004.
- National Center for Health Statistics, Monthly vital statistics report; 43(12), Washington, 1995. Also, Statistical Abstracts of the United States, 2000. Also, Centers for Disease Control, Death Rates for 72 Selected Causes by 5-year Age Groups, Race, and Sex: United States, 1978-98, available at http://www.cdc.gov/nch/datawh/stab/ unpubd/mortabs/gmwk291.htm. Also, S. Ventura et al., Nonmarital childbearing in the United States, 1940-1999 (National Vital Statistics Reports 48), Washington: National Center for Health Statistics; 2000, table 4.
- M. Mylant, B. Ide, E. Cuevas, & M. Meehan, 2002, Adolescent children of alcoholics: Vulnerable or resilient? Journal of the American Psychiatric Nurses Association, 8 (2), 57-64.
- V. Felitti and R. Anda, The relationship of adverse childhood experiences to adult health status, 1998, available at http://nacestudy.org/GoldintoLead.pdf
- J. A. Adams and P. L. East, Past physical abuse is significantly correlated with pregnancy as an adolescent. Journal of Pediatric and Adolescent Gynecology, 12 (3), 1999, pp. 133-138.
- American Foundation for Suicide Prevention, 2004, Suicide Risk Factors, available at www.afsp.org/about/riskfact.htm; www.afsp.org/education/teen/index3.htm; www.afsp.org/about/treatmen.htm.
- American Academy of Child and Adolescent Psychiatry (1998). Teen Suicide. Available at http://www.aacap.org/publications/factsfam/suicide.htm.
- L. M. Sagrestano, R. L. Paikoff, G. N. Holmbeck, & M. Fendrich. A longitudinal examination of familial risk factors for depression among inner-city African-American adolescents. Journal of Family Psychology, 17 (1), 2003, pp. 108-120.
- F. J. Moncher and A. M. Josephson, Religious and spiritual aspects of family assessment, Child and Adolescent Psychiatric Clinics of North America, 2004, 13, 49-70.
- W. P. Evans, R. M. Marte, & S. Betts, Adolescent suicide risk and peer-related violent behaviors and victimization. Journal of Interpersonal Violence, 16, 2001, pp. 1330-1348.
- P. M. Lewinsohn, P. Rohde, & J. R. Seely. Adolescent suicidal ideation and attempts: Prevalence, risk factors, and clinical implications. Clinical Psychology: Science and Practice, 3, 1996, pp. 25-46.
- R. E. Rector, K. A. Johnson, & L. R. Noyes. Sexually active teenagers are more likely to be depressed and to attempt suicide. Available at http://www.heritage.org/Research/Family /cda0304.cfm, 2004. See also, J. Snell, & S. Mekies (2002). Teen mothers and social pathology. Psychology & Education: An Interdisciplinary Journal, 39(2), 64-65.
- T. Lickona and J. Lickona, Sex, love, and you, Notre Dame, IN: Ave Maria Press, 1994. See also, S. D. White and R. R. DeBlassie, Adolescent sexual behavior. Adolescence, 1992, 27: 183-91.
- R. E. Rector, et al., supra, note 15.
- T. Phillips, Teen girls more likely to commit suicide. Available at http://www.family.org/cforum/fnif/news/a0030900.cfm, 2004.
- Catechism of the Catholic Church, no. 1708-1709.
- American Foundation for Suicide Prevention, Suicide Risk Factors.
- Pfeffer, Handbook of Child and Adolescent Psychiatry, 1999. supra, note 3.
- www.afsp.org and www.suicidology.org
- H.C. Fishman, Treating Troubled Adolescents: A Family Therapy Approach. New York: Basic Books, 1988.
- American Academy of Child and Adolescent Psychiatry, Teen Suicide.
- American Foundation for Suicide Prevention.
- M. J. Rotheram-Borus, J. Piacentini, S. Miller, F. Graae, & D. Castro-Blanco, Brief Cognitive-Behavioral treatment for adolescent suicide attempters and their families. Journal of the Academy of Child and Adolescent Psychiatry, 33, Washington: U.S. Census Bureau, 1994, 508-517. Also, American Foundation for Suicide Prevention.
- American Foundation for Suicide Prevention.
- H.C. Fishman. supra, note 23.