What Causes Suicidality in Young Adults?

A halting voice at the other end of the line asked if I had time to speak. My friend was calling with terrible news about a mutual friend. Expletives flew out of my mouth. My friend told me that Susan (name has been changed) took her life the other day. My first thought: How are Susan’s parents, my dear friends, going to cope with the loss of their 22-year-old daughter? Their lives revolved around Susan. Their daughter organized their very existence.

Suicide raises many questions and rarely produces answers. What could I do to console the parents? Could anything have been done to prevent this suicide? This young woman had made an attempt four years ago. Susan had always been open about suffering from chronic depression, anxiety, and Tourette's Syndrome. Her parents were highly attentive, took her condition very seriously, and connected her with excellent, experienced mental health clinicians in their area and beyond. Was there anything anyone could have done to reassure Susan that things would change for the better? And could anyone be sure that things would change for the better? In short, could anything have been done differently and saved Susan?

Susan came from a family with severe and persistent mental illness in its history. It’s hard to gauge which of her troubles were due to psychological factors influenced by the environment and which were due to internal and genetic factors that may have overridden any environmental support offered. My information is limited, Susan was not a patient of mine, but her suicide heightened my awareness of the need to take a new look at what we can understand and try to do.

In this first of two posts, I’ll look at risk factors and short-term approaches to suicide prevention. Though I emphasize suicidality in young people, much of what I write about pertains to people of all ages. My next post will cover longer-term causes and prevention plus societal level considerations.

Suicide Statistics

From the American Foundation for Suicide Prevention (AFSP)

• Suicide rates have gone up by more than 30 percent in half the states in the U.S. since 1999.
• In 2020, 1.2 million Americans attempted suicide, and 45,979 were successful in their attempts.
• Between 2000 and 2007, the suicide rate among youth ages 10 to 24 numbered 6.8 deaths per 100,000 people. The rate increased by 56 percent, to 10.6 deaths per 100,000 by 2017.
• In young people, by far the most suicide attempts were by teens who had recently had sex with someone of the same sex or people of both sexes. From the Youth Risk Behavior Survey, 2019.

10 Risk Factors Cited by the 2019 AFSP Youth Risk Survey

What would cause a young person like Susan who recently experienced her first taste of professional success, and had friends and loving parents, to feel so hopeless and lost?

Here’s the AFSP list that offers some insight—top characteristics of people who attempted suicide or reported suicidal ideation:

1. The leading cause of suicide is relationship problems.
2. In addition to severe and persistent mental illnesses like schizophrenia and bipolar disorder, other mental health conditions, such as depression, anxiety, conduct disorder, and substance use, are major risk factors. Personality factors like aggression (suicide is a form of self-directed aggression), mood changes, and poor to non-existent relationships are also red flags.
3. Serious medical conditions especially those that include chronic pain and brain injury.
4. External factors, including rejection, divorce, loss, and major transitions. Even a positive life transition signifying an achievement can cause self-doubt, dread, and destabilization. Susan had just received a prestigious job offer.
5. Chronic stressors such as bullying, unemployment, loneliness, and relationship issues.
6. A family or personal history of suicide or suicide attempt.
7. Depression suddenly gives way to an improved mood.
8. Youth who identified as gay or bisexual or who had had sex with same-sex partners, made significantly more attempts than those who had not.
9. Females attempt suicide at a higher rate (even higher in high school), but males have more successful attempts. American natives and Alaskan natives attempt at higher rates and mixed-race people commit suicide at higher rates than anyone other than middle-aged white men.

What Can We Do to Help Prevent a Suicide?

Here are eight preventive measures recommended by Jonathan B. Singer, Ph.D.:

1. Do not be afraid to ask the person whether they are sad, depressed, despairing, and finally, whether they are considering suicide or harming themselves. Most people who are depressed have passing thoughts about the relief afforded by death. This does not necessarily mean that they are considering suicide but as a non-clinician, you should Not Rely on an Answer of No if the person has been exhibiting concerning behavior.
2. If the person indicates that they have been considering suicide or self-harm, find out if they have a plan or a means such as firearms or drugs.
3. If they answer yes to any of the above, they must be hospitalized followed by intensive mental health care once they are discharged. Take away all means for suicide like drugs and weapons. Do not leave the person alone. Instead, open a space for them to talk to you.
4. Whether or not the person indicates a yes or no to any of these questions, it is very important to open up a space for them to talk, a lot. Listen actively without offering judgment or answers. Ask questions. Speak less. Show them that you understand and care. Give them solid examples and perspectives that this problem will pass. Let them know how they are cared for and important. Check in with them regularly and show that you are not forgetting them nor assuming they are cured.
5. In addition to anxiety and depression, look for other warning signals such as social media posts, changes in behavior, self-harm, sleeplessness, despair and despair fatigue, and animosity towards those they are not normally angry at.
6. Listen for sleep deprivation.
7. Note who they are spending time with. If they socialize with others who are or have been suicidal or who advocate for it on social media, encourage them to spend time with other more positive people.
8. Arrange for social support.

For Suicide and Crisis Help Call 988