Why are so many of our kids not just thinking about suicide but actually attempting it? It’s a difficult, disturbing question and not one with easy answers. I’ve seen this trend among adolescents requiring treatment for other mental health problems, such as the trauma that follows physical and sexual abuse. But a recent study of 45,806 high school students 15-16 years of age in 17 European countries suggests that we have a dangerous epidemic of mental health problems among adolescents that is population wide. We have no reason to believe these numbers would be any different here in North America.
It’s impossible to forget the children who suicide when you are part of their treatment team. It’s a tragic truth, that despite the very best of treatments, many young people intentionally, and often unintentionally, kill themselves. While we all hear about the troubled lives of Hollywood stars who get overwhelmed by their fame and accidentally overdose, the fact is that it has become commonplace for stressed young people to use troubling, self-harming behaviors to say “enough.” A number of years ago, I worked intensely with a young man who could never quite convince himself that he was worth anything. A large, brooding boy, he kept testing his body, hoping to either prove he was exceptional and immune to his addictions, or die trying. For him, life ended when, stoned, he drove a stolen car at twice the speed limit into a concrete wall. It was a horrible end to years of efforts by his family and community to help him heal.
As harsh as it sounds, we accept that a young man with a long history of conduct disorder, incarceration, and inpatient treatment could be suicidal. But the European study, published in one of the most respected child psychology journals, tells us that many more children than we ever thought possible have had a similar brush with death, albeit less lethal. It is perhaps even more distressing that at a time when we think young women are experiencing more opportunities than ever before, their rates of attempted suicide are twice that of their male counterparts.
There are definitely warning signs to watch out for. Adolescents who smoke, use drugs, and of course associate with delinquent peers may be at greater risk for suicide, though it isn’t always easy to predict who is and who is not at risk. In fact, if the adolescent lives in a community where smoking, drugs, or delinquency is common, then behaviors like these are actually less likely to predict suicide attempts. In other words, before worrying about your child, ask yourself, how usual are problem behaviors among my child’s peers. It seems that the less your child stands out from the rest of the children in your neighbourhood, the less you need worry.
Though worry, you should if you ever sense that your child has been feeling disconnected from others, or if they are showing signs of depression. These may range from anger and running away to wanting to be alone, a dramatic change in appetite, or sleep pattern. Unfortunately, all of this is enough to make any parent paranoid as all of our children go through periods of ups and downs and what look to us adults like dramatic changes in sleep, diet, and friendship patterns.
While we can spend a lot of effort diagnosing the disease and educating children on the warning signs for mental health problems, we may not get the results we want. A recent systematic review of two school based suicide prevention programs, SOS and Yellow Ribbon, found that neither could be shown to be effective, at least using conventional research methods such as randomized control trials. That’s not to say they don’t have a positive impact, but how they influence youth suicide may not be measurable across a general population. It could also be that these and other school-based programs may be only effective in some geographic regions where rates of suicide are much higher than national averages.
There are, however, other dangers to talking about suicide in the schools. As strange as this sounds, we can create a lot more of the very problem we are trying to solve. Anecdotally, when I talk to teachers and guidance counsellors in schools that have been receiving mental health programs that focus on the signs of mental illness, they get many, many young people coming to them with self-diagnosed symptoms of depression when all they are really experiencing is normal adolescent anxiety.
How much information is enough? After all, we don’t publicize the dozens, if not hundreds of suicides that occur on public transit systems in every major city. If we did, we’d see the epidemic instantly. But public health experts know that advertising the number of people who kill themselves under subway cars would only escalate the problem. It would give those thinking about suicide a plausible strategy.
Confused yet? Adolescent suicide is a complicated problem to solve.
If we flip our point of view, however, and look at how we can build resilience, we may get some very different strategies for combatting suicide. For example, we know that when young people feel engaged and attached at school, in their community, and with their families (or in at least one of these three spaces), they tend to report much better mental health. In fact, a large study of children in British Columbia, Canada, in 2008 showed that among children who had been physically and sexually abused, self-reports of suicidal thoughts dramatically declined among those children who felt connected at their schools. In other words, the most effective treatment that would do the greatest good for the most children might not be individualized therapy, or school-based programs that focus on symptoms of disorder, but simple efforts to promote well-being among children, especially those who are most vulnerable.
As parents, we might ask ourselves, “Why is my child choosing to smoke, do drugs, or hang out with delinquent peers?” What is the child getting that is compensating for a life that he or she experiences as troubling? Ultimately, youth suicide is not something we are going to be able to fix with individual treatment. There are too many children making attempts on their lives. We need instead to think about this as a problem needing a multilevel response. The more we make children’s worlds safe, healthy places to grow up in, with manageable amounts of risk and responsibility, and opportunities to feel a sense of belonging and purpose, the more our children will get what they need. For the few who still feel deeply upset, individual treatments are a necessity, but only after we’ve done what we can for all youth.
Maybe, just maybe, suicidal thoughts and behaviors will be less necessary when our children feel a little bit stronger and given what they need to meet all their needs.
Kokkevi, A., Rotsika, V., Arapaki, A., & Richardson, C. (2012). Adolescents’ self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries. Journal of Child Psychology and Psychiatry, 53(4), 381-389.
McCreary Centre Society. (2009). A Picture of Health: Highlights from the 2008 BC Adolescent Health Survey. Vancouver: McCreary Centre Society.