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Suicides among young people continue to be a serious
problem. Each year in the U.S., thousands of teenagers
commit suicide. Suicide is the third leading cause of
death for 15-to-24-year-olds, and the sixth leading
cause of death for 5-to-14-year-olds.
Teenagers experience strong feelings of stress,
confusion, self-doubt, pressure to succeed, financial
uncertainty, and other fears while growing up. For some
the formation of a new family with step-parents
and step-siblings, or moving
to a new community can be very unsettling and can
intensify self-doubts. For some teens, suicide may
appear to be a solution to their problems and stress.
and suicidal feelings are treatable mental disorders.
The child or adolescent needs to have his or her illness
and diagnosed, and appropriate treatment plans
developed. When parents are in doubt whether their child
has a serious problem, a psychiatric
examination can be very helpful.
Many of the signs and symptoms of suicidal feelings are
similar to those of depression.
Parents should be aware of the following signs of
adolescents who may try to kill themselves:
- change in eating and sleeping habits
- withdrawal from friends, family, and regular
actions, rebellious behavior, or running away
and alcohol use
- unusual neglect of personal appearance
- marked personality change
- persistent boredom, difficulty concentrating, or a
decline in the quality of schoolwork
- frequent complaints about physical symptoms, often
related to emotions, such as stomachaches, headaches,
- loss of interest in pleasurable activities
- not tolerating praise or rewards
A teenager who is planning to commit suicide may also:
- complain of being a bad person or feeling rotten
- give verbal hints with statements such as: I won't
be a problem for you much longer, Nothing matters,
It's no use, and I won't see you again
- put his or her affairs in order, for example, give
away favorite possessions, clean his or her room,
throw away important belongings, etc.
- become suddenly cheerful after a period of
- have signs of psychosis (hallucinations or bizarre
If a child or adolescent says, I
want to kill myself, or I'm going to commit suicide,
always take the statement seriously and immediately seek
assistance from a qualified mental health professional.
People often feel uncomfortable talking about death.
However, asking the child or adolescent whether he or
she is depressed or thinking about suicide can be
helpful. Rather than putting thoughts in the child's
head, such a question will provide assurance that
somebody cares and will give the young person the chance
to talk about problems.
If one or more of these signs occurs, parents need to
talk to their child about their concerns and seek professional
help from a physician or a qualified mental health
professional. With support from family and appropriate
treatment, children and teenagers who are suicidal can
heal and return to a more healthy path of development.
Suicide is Preventable
Teen suicide is a growing health concern. It is the
third-leading cause of death for young people ages 15 to
What the Research Shows
Teen suicide is a growing health concern. It is the
third-leading cause of death for young people ages 15 to
24, surpassed only by homicide and accidents, according to
the U.S. Center for Disease Control and Prevention.
According to experts Michelle Moskos, Jennifer
Achilles, and Doug Gray, causes of suicidal distress can
be caused by psychological, environmental and social
factors. Mental illness is the leading risk factor for
suicide. Suicide risk-factors vary with age, gender,
ethnic group, family dynamics and stressful life events.
According to a 2004 report distributed by the National
Institute of Mental Health, research shows that risk
factors for suicide include depression and other mental
disorders, and substance-abuse disorders (often in
combination with other mental disorders). More than 90
percent of people who die by suicide have these risk
factors. The risk for suicide frequently occurs in
combination with external circumstances that seem to
overwhelm at-risk teens who are unable to cope with the
challenges of adolescence because of predisposing
vulnerabilities such as mental disorders. Examples of
stressors are disciplinary problems, interpersonal
losses, family violence, sexual orientation confusion,
physical and sexual abuse and being the victim of
National suicide prevention efforts have focused on school
education programs, crisis center hotlines, screening
programs that seek to identify at-risk adolescents, media
guidelines (suicide prevention strategies that involve
educating media professionals about the prevalence of
copy-cat suicides among adolescents, in an effort to
minimize the impact of news stories reporting suicide) and
efforts to limit firearm access.
Screening programs have proven to be helpful because
research has shown that suicidal people show signs of
depression or emotional distress. Referrals can be made
for treatment, and effective treatment can be employed
when signs are observed in time. Intervention efforts for
at-risk youth can put them in contact with mental health
services that can save their lives.
Suicide is a relatively rare event and it is difficult to
accurately predict which persons with these risk factors
will ultimately commit suicide. However, there are some
possible warning signs such as:
Talking About Dying -- any mention of
dying, disappearing, jumping, shooting oneself, or other
types of self harm
Recent Loss -- through death, divorce,
separation, broken relationship, self-confidence,
self-esteem, loss of interest in friends, hobbies,
activities previously enjoyed
Change in Personality -- sad,
withdrawn, irritable, anxious, tired, indecisive,
Change in Behavior -- can't concentrate
on school, work, routine tasks
Change in Sleep Patterns -- insomnia,
often with early waking or oversleeping, nightmares
Change in Eating Habits -- loss of
appetite and weight, or overeating
Fear of losing control - acting
erratically, harming self or others
Low self esteem -- feeling worthless,
shame, overwhelming guilt, self-hatred, "everyone would be
better off without me"
No hope for the future -- believing
things will never get better; that nothing will ever
What the Research Means
One in five teenagers in the U.S. seriously considers
suicide annually, according to data collected by the CDC.
In 2003, 8 percent of adolescents attempted suicide,
representing approximately 1 million teenagers, of whom
nearly 300,000 receive medical attention for their
attempt; and approximately 1,700 teenagers died by suicide
each year. Currently, the most effective suicide
prevention programs equip mental health professionals and
other community educators and leaders with sufficient
resources to recognize who is at risk and who has access
to mental health care.
How We Use the Research
The Teen Screen® Program is a community-based
mental health screening program for young people that
accurately identifies youth who are suffering from mental
illness or are at risk of suicide. The program's primary
objective is to help young people and their parents
through the early identification of mental health
problems, such as depression. Parents of youth found to be
at possible risk are notified and helped with identifying
and connecting to local mental health services where they
can obtain further evaluation. Most importantly, mental
health screening detect youth with depression and other
emotional disorders before they fall behind in school and
end up in serious trouble, or worst of all end their
Stop a Suicide Today! is a school-based suicide
prevention program that has experienced success with a
documented reduction in self-reported suicide attempts.
Developed by Harvard psychiatrist Douglas Jacobs, MD, Stop
a Suicide, Today! teaches people how to recognize the
signs of suicide in family members, friends and
co-workers, and empowers people to make a difference in
the lives of their loved ones. It emphasizes the
relationship between suicide and mental illness and the
notion that a key step in reducing suicide is to get those
in need into mental health treatment.
National Suicide Prevention Lifeline 1-800-273-TALK or
visit their Web site.
The National Suicide Prevention Lifeline's mission is to
provide immediate assistance to individuals in suicidal
crisis by connecting them to the nearest available suicide
prevention and mental health service provider through a
toll-free telephone number: 1-800-273-TALK (8255). It is
the only national suicide prevention and intervention
telephone resource funded by the Federal Government.
Berman, A., Jobes, D., & Silverman, M., (2006)
Adolescent suicide: Assessment and intervention (2nd ed.)
Washington, DC: American Psychological Association, 456
National Suicide Prevention Lifeline or 1-800-273-TALK
Suicide Awareness Voices of Education (SAVE) or call:
Center for Disease Control
Suicide Fact Sheet
Gould, M., Greenberg, T., Velting, D., Shaffer, D. (2003).
Youth suicide risk and preventive interventions: A review
of the past 10 years. Journal of the American Academy of
Child & Adolescent Psychiatry. 42(4):386-405.
Achilles, J., Gray, D., Moskos, M. (2004). Adolescent
Suicide Myths in the United States. Crisis: The Journal of
Crisis Intervention and Suicide Prevention. 25(4):176-182.
Beautrais, A. (2005). National strategies for the
reduction and prevention of suicide. Crisis: The Journal
of Crisis Intervention and Suicide Prevention.26(1);1-3
- Suicide is a leading cause of death among young
people, second only to motor vehicle accidents.
- Suicide rates among 15-24 year old males have
trebled between 1960 and 1990.
- In remote rural Australia suicide rates for young
males are nearly twice those of males living in
- Suicide is rare in childhood (<14 years) but
becomes much more common during adolescence. The
rise in suicide is most rapid between the ages of 15
to 19 years but there is a further increase between
the age of 20 to 24 years.
- Rates of suicide in Indigenous communities have
been increasing since the 1970's. The majority of
Aboriginal people who suicide are under the age of
29. Overall, the suicide rate in Indigenous
communities may be 40% higher than the rate of
Suicide attempts and
Surveys conducted at the Centre for Adolescent Health
indicate that approximately 5% of young people engage
in self harming behaviour.
Females are more likely than males to engage in
self-harming behaviours, and young people have higher
rates of deliberate self-harm than adults.
Australian studies have found that between 23.5% and
49% of teenagers have thoughts of suicide at some
Prevention of Youth
Research indicates that the scope for the prevention
of youth suicide is broad, should occur within a
developmental context and should take into account not
just individual characteristics of a young person such
as emotional well being but also risk factors which
derive from important social environments such as
school, the family and the community. There is a need
for a continuum of interventions. Some risk factors
for youth suicide such as antisocial behaviour, poor
family cohesion and parental mental health issues are
evident from early childhood. Others including
academic failure, school drop-out, depressive symptoms
and substance abuse become manifest in later childhood
and adolescence. However, some risk factors are even
more proximal eg suicidal behaviour and stressful life
events. If you think a young person is suicidal, you
should inform the person's parents, guardians or
school counsellor and they should act immediately to
ensure his or her safety. The management of an acutely
suicidal person is an emergency.
- Burns J, Sanci, L. Youth Suicide: A risk factor
based approach to prevention. Medical Observer.
Continuing Medical Education Program (invited paper,
7 August 1998).
- Burns JM, Patton GC. Preventive Interventions for
Youth Suicide: a risk factor based approach.
Australian and New Zealand Journal of Psychiatry,
- Harrison, J. Moller, J. Bordeauz, S. Youth Suicide
and Self-Injury in Australia. Australian Institute
of Health and Welfare, 1997.
Suicide Prevention Australia (SPA)
in collaboration with the University of New England has
published a groundbreaking research report on Understanding
the Exposure and Impact of Suicide in Australia
national research project highlights the
far-reaching impact of suicide as a public health issue
in Australia. The research is based on the input
of more than 3,000 respondents from across the
country who have been affected by suicide. This valuable
information allows us to better understand how
individuals are impacted by suicide and
to inform where funds and expertise are
directed in suicide prevention. The
full report is now available for download.
In November 2015, as part of its response to the
National Mental Health Commission Review of mental
health programs, the Government announced a renewed
approach to suicide prevention through the establishment
of a new National Suicide Prevention Strategy. The new
- a systems-based regional approach to suicide
prevention led by Primary Health Networks (PHNs) in
partnership with Local Hospital Networks, states and
territories, and other local organisations with
funding available through a flexible funding pool;
- national leadership and support activity, including
whole of population activity and crisis support
- refocussed efforts to prevent suicide in Aboriginal
and Torres Strait Islander communities, taking into
account the recommendations of the Aboriginal and
Torres Strait Islander Suicide Prevention Strategy;
- joint commitment by the Australian Government and
states and territories, including in the context of
the Fifth National Mental Health Plan, to prevent
suicide and ensure that people who have self-harmed or
attempted suicide are given effective follow-up
New data on causes of death from the Australian
Bureau of Statistics shows that youth suicide rates
remain unacceptably high.
In 2013, 348 young people aged 15 to 24 years died by
suicide – more than any other cause, including road
accidents, cancer, and assault. Concerningly, the new
data shows an upward trend in the rate of suicide among
young people aged 15–19, and the overall rate of suicide
among young people aged 20–24 remains stubbornly stable.
Nearly three times as many young men died by suicide
than young women, with young men aged 20–24 exhibiting
the highest rate of suicide among all young people aged
15–24. The previously observed upward trend in the
overall rate of suicide by young women aged 15–19
remained high but reduced year-on-year.
“Addressing youth suicide is one of the greatest
challenges of our time. Given the strong link between
poor mental health and suicide, these findings reconfirm
the need to intervene as early as possible, focusing on
the prevention of mental illness and, in turn, suicide,”
said ReachOut CEO Jono Nicholas.
The National Mental Health Commission’s Review of
Programs and Services is anticipated to be released
soon, providing an opportunity to rebalance the mental
health system making it more efficient and effective,
enabling more people to access help.
“We’re encouraged by the Federal Government’s deep
consideration of the Commission’s review, and look
forward to working together with the sector on reforming
the mental health system,” said Nicholas.
“Large-scale reform of the system is greatly needed,
but it will take time to implement. We must consider
what can be done right now to expand the reach of
existing, effective interventions, as we cannot afford
to allow another generation to experience the
devastating effects of mental illness and suicide,” he
Online interventions have been found to be highly
effective in engaging young people vulnerable to mental
illness and suicide. Twenty per cent of young visitors
say they’ve come to ReachOut specifically for
information on self harm and/or suicide, and more than
75 per cent of young visitors are in high or very high
E-mental health services such as ReachOut enable
self-care and peer support that helps a young person
deal with what they’re going through. ReachOut also
motivates young people to seek further professional
help, with 46 per cent of visitors saying they’re more
likely to do so after using the service.2
“Online services can be expanded right now, and to
great scale – connecting any person with internet access
to the help they need,” said Nicholas.
“70 per cent of young Australians experiencing a mental
health difficulty aren’t getting the help they need. We
must invest in prevention and early intervention, and
better integrate face-to-face and e-mental health
services in order to get the right help to those who
need it.” 3
ReachOut Australia and Ernst & Young will soon
release A Way Forward: Equipping
Australia’s Mental Health System for the Next
Generation, a new report exploring how
the system can cost-effectively connect more young
people to the help they need as quickly as possible.
SUICIDE RESOURCE TOOLKIT
In 2009, in Canada, there were 145 male suicides (and a
12.6 per 100,000 suicide rate) in the 15-19 age range.
For females, there were a total of 57 deaths (and a
corresponding suicide rate of 5.2 per 100,000).These
numbers rise sharply (especially for males) when they
reach their twenties and beyond. Males reach a peak rate
of 27 per 100,000 in the 40-44age range with a recorded
number of 337 deaths in 2009. See Statistics Canada for
recent figures: http://bit.ly/LgmTuO
to adolescent suicide prevention
Marcia Kostenuik, MD CCFP
Family and emergency physician at the
Royal Victoria Hospital in Barrie, Ont, and a volunteer
for and co-founder of No Youth Left Behind, Simcoe
Correspondence: Dr Marcia A. Kostenuik, Royal
Victoria Hospital, Emergency Medicine, 201 Georgian Dr,
Barrie, ON L4M 4S2; telephone 705 728-9090; e-mail
Author Affiliations Master’s degree
candidate in the Department of Health Policy, Management
and Evaluation at the University of Toronto in Ontario
OBJECTIVE To provide family physicians with an approach
to suicide prevention in youth.
SOURCES OF INFORMATION A literature review was performed
using Ovid MEDLINE with the key words suicide, attempted
suicide, and evaluation studies or program evaluation,
MAIN MESSAGE Youth suicide might be prevented by earlier
recognition and treatment of mental illness. Family
physicians can and should screen for mental illness in
youth; there are many diagnostic and treatment resources
available to assist with this.
CONCLUSION Earlier detection and treatment of mental
illness are the most important ways family physicians
can reduce morbidity and mortality for youth who are
Mental Health Board's 2005 A Call to Action: The Alberta
Suicide Prevention Strategy can be found here
Suicide Prevention, Intervention and Postvention
Initiative for B.C. from 2009 can be found here
Framework for Suicide Prevention Planning in Manitoba
can be found here
and from Manitoba Healthy Living (2008), Reclaiming
Hope: Manitoba’s Youth Suicide Prevention Strategy can
be found here.
stragegy from 2007, called Connecting to Life:
Provincial Suicide Prevention Program, can be found here
Strategic Framework to Address Suicide can be found here.
Suicide Prevention Strategy can be found here
from 1998, Help for Life: Québec’s Strategy for
Preventing Suicide found here.
Northwest Territories, Ontario, Prince Edward Island,
Yukon Territory, Saskatchewan: No strategy at
The Nation-wide, there is
the Canadian Association for Suicide Prevention
strategy, from 2009, found here.
CASP provides educational material and resources.
The Canadian Association for Suicide Prevention (CASP)
provides information and resources to reduce the
suicide rate and minimize the harmful consequences of
your local Crisis Centre, please click the button
The last thing that most people expect is that
they will run out of reasons to live. But if you
are experiencing suicidal thoughts, you need to
know that you’re not alone. By some estimates, as
many as one in six people will become seriously
suicidal at some point in their lives.
Some Important Facts We Would Like to Share with
Suicidal thinking is usually associated with
problems that can be treated.
Clinical depression, anxiety disorders, chemical
dependency, and other disorders produce profound
emotional distress. They also interfere with
effective problem-solving. But you need to know
that studies show that the vast majority of people
who receive appropriate treatment improve or
recover completely. Even if you have received
treatment before, you should know that different
treatments work better for different people in
different situations. Several tries are sometimes
necessary before the right combination is found.
If you are unable to think of solutions other
than suicide, it is not that solutions don’t
exist, only that you are currently unable to see
Therapists and counselors (and sometimes friends)
can help you to see solutions that otherwise are
not apparent to you.
Suicidal crises are almost always temporary.
Although it might seem as if your unhappiness
will never end, it is important to realize that
crises are usually time-limited. Solutions are
found, feelings change, unexpected positive events
occur. Suicide is sometimes referred to as “a
permanent solution to a temporary problem.” Don’t
let suicide rob you of better times that will come
your way when you allow more time to pass.
Problems are seldom as great as they appear at
Job loss, financial problems, loss of important
people in our lives – all such stressful events
can seem catastrophic at the time they are
happening. Then, months or years later, they
usually look smaller and more manageable.
Sometimes, imagining ourselves “five years down
the road” can help us to see that a problem that
currently seems catastrophic will pass and that we
Reasons for living can help sustain a person in
A famous psychologist once conducted a study of
Nazi concentration camp survivors, and found that
those who survived almost always reported strong
beliefs about what was important in life. You,
too, might be able to strengthen your connection
with life if you consider what has sustained you
through hard times in the past. Family ties,
religion, love of art or nature, and dreams for
the future are just a few of the many aspects of
life that provide meaning and gratification, but
which we can lose sight of due to emotional
Do not keep suicidal thoughts to yourself!
Help is available for you, whether through a
friend, therapist, or member of the clergy. Find
someone you trust and let them know how bad things
are. This can be your first step on the road to
a crisis centre.
Source: American Association for
What is it? Is it curse or blessing or
both? The sense of having no hope deepens our
despair. One of the worst things we say to another human
being is that they are hopeless.
We speak of being hopeful… of feeling hopeless.
We cannot give another person hope. Reality
teaches us that what is hope to one may be a burden to
another. In other words, my hope is not your
hope. The challenge is to find a definition of
hope that is truly our own.
The key to this illusive concept of hope is finding our
own definition of what it means in the midst of life.
As we struggle with darkness, fear, despair and apathy
we can feel that there is no hope. Perhaps that
feeling comes from our understanding of what hope has
been in the past. Perhaps what we experience in
the extremity of struggle is a whole new definition of
Victor Havel writes, “Hope is not the conviction that
something will turn out well, but the certainty that
something makes sense regardless of how it turns out.”
Experience teaches us that our understanding of hope
changes throughout our life time. When we are
children hope is what makes us happy. As we age,
hope is a goal, a vision, a dream. It is far less
immediate. Something we might attain, rather than
a state we can dwell in, right her and right now.
Hope, at the darkest moments in our life, is not a
comprehensive commitment to faith and belief. At
those times hope can be as simple and as profound as the
voice of another human being who appears to hear our
fear; hope can be the knowledge that the sun will rise
tomorrow, hope can be the smell of fresh spring rain, or
the first snow flake, or the photo of someone we
love. When despair seems to overcome us we feel
disconnected, isolated, lost. What we need most in
those moments is a means of re-connection, relationship
and belonging. This “means” can be surprisingly
simple or deeply complex. What matters at the
moment is that we find this path of meaning in this
life, here and now.
As someone who studied the science of hope, Ronna Jevne
writes, “Hope; we ridicule those who have too much of
it. We hospitalize those who have too
little. It is dependent on so many things yet
indisputably necessary to most. Those who have it
live longer. Words cannot destroy it.
Science has overlooked it. A day without it is
dreadful. A day with an abundance of it guarantees
If you are reading these words; you have hope.
Try not to compare it with anyone else’s expression of
hope. Try not to get caught in the dualism of good
– bad, hopeful and hopeless, worthwhile and worthless…
the only kind of hope that will succeed is one that
melts all the need of competition and comparison.
When we can come to this understanding we experience a
sense of peace, both within and beyond ourselves.
In this state we trust life to be a journey of
adventure, meaning and worth.
Imagine hope as an energy that melts the difference
between life and death. Life then is no longer
either/or, it becomes more than we can even
imagine. Ending life then is not the option for
the end of struggle because life is not an endurance
test of endless struggle. It is rather a mixture
of struggle and strength. This is radical hope
because it is often born in a sense of
hopelessness. It is a new definition of the
meaning of hope, which is not about happiness – rather
it is about fullness, meaning and connection. It
is being constantly reshaped and redefined, and it is
constantly inviting us to the never-ending story of
This is how hope becomes energy for whatever we have to
face in life. It is not optimism, rather it is
strength of seeking and realism.
Hope irks many professionals. Professionals are
trained to know. Yet the choice is ours to make in
relation to hope. We can open ourselves to the
mystery or stay with the illusion of certainty.
Books abound on the topic of hope, but before you begin
reading take some time to read from the book of your own
life. Here some questions that may help you define
your meaning of hope:
- Who are the most hopeful people you have known in
- Who would you call to help with your hope right now?
- What images do you have of hope: music,
smells, objects, colors, etc.?
- How do you nurture and care for your hope?
What do you do to increase and strengthen it?
- What most threatens your hope?
- What do you think false hope is?
- Where do you look for hope when you feel hopeless?
- Can you remember a story of hope from your own life?
- When you close your eyes and try to imagine a
picture of hope what do you see?
- What most threatens your hope?
- If a child asked you right now, “What is hope?” how
would you respond?
- Do you have a practice of hope? What if you
began each day asking, what do I hope for in this
day? What if you ended each day with the
reflective question, “Where did I find hope today?”
If you would like to know more about the study of the
science of hope, and resources connected to a deeper
understanding of hope you can contact:
Review A Youth Suicide Prevention Plan for Canada: A
Systematic Review of Reviews
Kathryn Bennett, PhD; Anne E Rhodes, PhD; Stephanie
Duda, BSc; Amy H Cheung, MD, MSc4; Katharina Manassis,
MD; Paul Links, MD, MSc; Christopher Mushquash, PhD;
Peter Braunberger, MD; Amanda S Newton, PhD, RN; Stanley
Kutcher, MD; Jeffrey A Bridge, Ph; Robert G Santos, PhD;
Ian G Manion, PhD, CPsych; John D McLennan, MD, PhD;
Alexa Bagnell, MD; Ellen Lipman, MD, MSc; Maureen
Rice, MA, MLIS; Peter Szatmari, MD, MSc.
de Práctica Clínica sobre la Depresión Mayor en la
Infancia y en la Adolescencia
suicidio en niños y adolescentes problema creciente de
Y PREVENCION DE LA CONDUCTA SUICIDAEN NIÑOS Y
ADOLESCENTES: UN ESTUDIO DE CASO
COMISIÓN PARA LA PREVENCIÓN DEL SUICIDIO
Uniforme para la Prevención del Suicidio
e prevenzione del suicidio in Svizzera Rapporto in
esecuzione del postulato Widmer