"Risk" is a Concept Used to Predict the Chance a Behavior Will Occur
"Risk" is a concept used to predict the chance a behavior will occur. Suicide risk factors are things that increase the potential for a person's suicide or suicidal behavior. Findings from recent research have shown that most youth suicides are the result of an interaction between biological, psychological, socio-cultural, and family factors. A person's age, gender, or ethnicity can increase the impact of certain risk factors or combinations of risk factors for them. A suicidal act can be seen as the result of an interaction between background personal and family factors, current emotional state and recent significant life event which lead to an intolerable mental anguish in the young person. The "ingredients" required for completed or attempted suicide vary from individual to individual. Understanding risk factors can help counteract the myth that suicide is a random act or results from stress alone. There are, however, common risk factors that we do know about: 1) previous attempts, 2) depression, 3) drug and alcohol abuse, 4) conduct disorder & behavioral factors, 5) a disruptive and unsupportive family background, 6) relationship conflicts, 7) social and cultural factors, 8) poor coping skills, 9) psychiatric illnesses, 10) the ready availability of lethal means to commit suicide, and 11) Other risk factors.
The most powerful predictor of completed youth suicide is a past history of attempted suicide. As the number of attempts increases, the risk of dying from an attempt also increases. Additionally, exposure to an attempted or completed suicide can be a factor. This can be in a number of ways:
Mood changes are common in teenagers but persistent lowering or lability of mood may indicate the presence of an underlying major depression. Depressed youths, especially females, have a much higher risk of suicide. The risk of suicide is further increased if there is a family history of depression and suicide. The symptoms of depression vary a great deal, depending on the age of the youth. The older they are the more likely they will have adult type of depressive symptoms. Some common symptoms include:
- lowering of mood
- loss of interest in daily activities
- social withdrawal and isolation
- loss of energy and motivation
- lack of enjoyment in what the youth does
- sleep disturbance (sleeping poorly or sleeping excessively)
- change of appetite (loss of appetite or eating excessively)
- acting out behaviour, including drug and alcohol abuse
- school failure
- poor self esteem with self reproach
- guilty feeling
- a sense of hopelessness and helplessness
- expression of suicidal intent
Drug and Alcohol Abuse
It is estimated that substance abuse occurs in 1/3 of youth suicides. Many youths who have difficulties coping with their problems seek relief from drugs and alcohol. Because they can "escape" from their distresses temporarily with the use of drugs and alcohol, non-coping youths tend to keep using these substances. With increased use, the youth may become emotionally and physically dependent on the drugs to the point where he/she has to keep taking them to avoid withdrawal symptoms. Unfortunately alcohol and many drugs have depressant and disinhibiting effects.
When drugs and alcohol are used in depressed youths, they can become a lethal combination to precipitate the suicide. Drugs, including the so called "recreational drugs", can bring on psychotic episodes with resultant hallucinations and delusions which may then lead to suicide. Under the influence of drug and alcohol, a youth may also develop the clouding of his/her conscious state with resultant loss of judgement and an increase in risk taking behaviour. An accidental death may follow.
Conduct Disorder & Behavioral Factors
Youths with a history of conduct disorder have a much higher risk of suicide because they tend to act out their feelings in a destructive manner. This is particularly true if they are isolated, angry, aggressive, impulsive and they are abusing drugs and alcohol. Many of these young people are in constant crises. For example, they may be homeless and they have frequent conflicts with the law because of their anti-social activities. They are rejected by others and they seek support from youths with similar background. They take risks in what they do and many of them are depressed individuals but reluctant to admit to themselves or to others of their true feelings or to ask for help. Other behavioral factors may include:
- Writing suicide notes and choosing suicide methods.
- Variations in work performance or daily lifestyle.
- Behavior indicating feelings of rejection, humiliation, hopelessness or isolation.
- Impulsive behavior and other conduct disorders, including rage, anger and hostility.
Disruptive and Unsupportive Family Background
Adolescence is a period of rapid growth both physically, cognitively and emotionally. This is a time of stress and confusion for many adolescents. Their coping mechanisms may be stretched to the absolute limit and in many instances beyond their limits. Family support is particularly important in the normal development of young people. When this support is not available or inconsistent, or in some instances when the family is actually "toxic" (e.g. abusive, violent and in chronic discord) to the young person, depression and anger may ensue with dire consequences. Unrealistic, intrusive, over-bearing and over-protective families can be just as detrimental. Problems may also arise when the needs of the youth are not met by the family due to a poor "fit" between the parents and the adolescent child. If considerable difficulties exits in childhood, there is more risk that the young person will attempt or complete suicide. Other family risk factors include:
- Death of a parent, caregiver or another family member.
- Partnership dissolution and separation.
- New family relationships
- Geographic and social mobility.
- Problems with friendships.
- Inconsistent parenting.
- Physical or psychiatric illness within the family.
- Family violence, including sexual abuse and other power relationships.
- Suicidal behaviour within the family
Many attempted suicides occur in the context of relationship conflicts, e.g. following an argument with parents, boy/girl friend or other significant figure in the youth's life. The attempt can be seen as an expression of anger and also a cry for help. Fortunately, these conflicts are generally transient in nature and they are frequently resolved. When these conflicts are persistent and unresolved, the youth concerned may be constantly stressed to the point where he/she feels helpless, hopeless and trapped. Death may be seen as a solution to the problems.
Social and Cultural Factors
These do not explain suicide, but there is a direct correlation with the increase in the rate of youth suicide. They must, therefore, be considered as risk factors, and include:
- Increased rates of violence accompanied by decreased levels of concern.
- Marriage dissolution, remarriage and changes in family structure.
- Increased mobility, with disruption of friendships and social networks.
- Uncertainty, through changes in employment, residence and access to education
- Change roles of men and women.
- Larger and less personal communities
Poor Coping Skills
Youths who have a past history of poor or inappropriate coping skills are more at risk of suicide. The demands on teenagers are great and these demands may stress beyond the coping capabilities of the already low functioning young people. As a result they can develop a sense of hopelessness and helplessness. They may then develop major psychological or Behavioral symptoms or they use self harm as an alternative way to cope.
Major psychiatric disorders such as schizophrenia, anorexia nervosa and major depression carry with them an increased risk of suicide. Symptoms of these conditions may first present themselves in adolescence. A young person with schizophrenia may be directed to kill one self by a voice (auditory hallucination), even though the young person may not have any desire to die. Similarly a severely depressed youth may feel (as part of his/her depressive delusional belief) that one is better off dead, to spare the suffering by his/her family.
The Ready Availability of Lethal Means to Commit Suicide
The higher rate of youth suicide in rural communities is presumably related to the comparative ease for young people to get hold of firearms. History has indicated that the method of suicide is directly related to the ease of access to the specific lethal substance/object.
There are other risk factors of suicide including:
- recent bereavement
- chronic physical illness
- anniversary phenomenon (of past losses or major life events)
- early loss experiences
- school failure
- chronic unemployment
- perfectionists and over-achievers who have high
- expectations of themselves
Profile of a Youth at Risk of Suicide
Using the risk factors described above, the profile of a youth at risk of suicide can be painted as a severely depressed and drug dependent young person who is impulsive and has always struggled to cope. He/she is poorly supported by a abusive or over-involved family and he/she has poor resources or insight to seek help. This picture of course does not fit the description of all youths who commit suicide.
A "forgotten" group of youths are those who have been chronically depressed and non-coping, but stay in the background without others noticing their distress. Their suicides may come as a surprise.