Suicide Trends Among Youths and Young Adults Aged 10--24 Years --- United States, 1990--2004In 2004, suicide was the third leading cause of death among youths and young adults aged 10--24 years in the United States, accounting for 4,599 deaths (1,2). During 1990--2003, the combined suicide rate for persons aged 10--24 years declined 28.5%, from 9.48 to 6.78 per 100,000 persons (2). However, from 2003 to 2004, the rate increased by 8.0%, from 6.78 to 7.32 (2), the largest single-year increase during 1990--2004. To characterize U.S. trends in suicide among persons aged 10--24 years, CDC analyzed data recorded during 1990--2004, the most recent data available. Results of that analysis indicated that, from 2003 to 2004, suicide rates for three sex-age groups (i.e., females aged 10--14 years and 15--19 years and males aged 15--19 years) departed upward significantly from otherwise declining trends. Results further indicated that suicides both by hanging/suffocation and poisoning among females aged 10--14 years and 15--19 years increased from 2003 to 2004 and were significantly in excess of trends in both groups. The results suggest that increases in suicide and changes in suicidal behavior might have occurred among youths in certain sex-age groups, especially females aged 10--19 years. Closer examination of these trends is warranted at federal and state levels. Where indicated, health authorities and program directors should consider focusing suicide-prevention activities on these groups to help prevent suicide rates from increasing further.

Annual data on suicides in the United States during 1990--2004 (1) were obtained from the National Vital Statistics System via WISQARS™ (2) by sex, three age groups (i.e., 10--14, 15--19, and 20--24 years), and the three most common suicide methods (firearm, hanging/suffocation,* and poisoning†). Although coding of mortality data changed from the International Classification of Diseases, Ninth Revision (ICD-9) to the Tenth Revision (ICD-10) beginning in 1999, near total agreement exists between the two revisions regarding classification of suicides (3). Suicide trends during the 15-year period were examined for each sex-age group overall and by method, using a negative binomial rate regression model. Differences between observed rates and model-estimated rates for each year were evaluated using standardized Pearson residuals, which account for the general level of variability in the year-to-year rates. Standardized Pearson residuals >2 or <-2 were used to identify unusual departures from the modeled rate trends. A comprehensive explanation of these methods has been published previously (4).

Significant upward departures from modeled trends in 2004 were identified in total suicide rates for three of the six sex-age groups: females aged 10--14 years and 15--19 years and males aged 15--19 years (Table). The largest percentage increase in rates from 2003 to 2004 was among females aged 10--14 years (75.9%), followed by females aged 15--19 years (32.3%) and males aged 15--19 years (9.0%). In absolute numbers, from 2003 to 2004, suicides increased from 56 to 94 among females aged 10--14 years, from 265 to 355 among females aged 15--19 years, and from 1,222 to 1,345 among males aged 15--19 years.

In 1990, firearms were the most common suicide method among females in all three age groups examined, accounting for 55.2% of suicides in the group aged 10--14 years, 56.0% in the group aged 15--19 years, and 53.4% in the group aged 20--24 years. However, from 1990 to 2004, among females in each of the three age groups, significant downward trends were observed in the rates both for firearm suicides (p<0.01) and poisoning suicides (p<0.05), and a significant increase was observed in the rate for suicides by hanging/suffocation (p<0.01). In 2004, hanging/suffocation was the most common method among females in all three age groups, accounting for 71.4% of suicides in the group aged 10--14 years, 49% in the group aged 15--19 years, and 34.2% in the group aged 20--24 years. In addition, from 2003 to 2004, hanging/suffocation suicide rates among females aged 10--14 and 15--19 years increased by 119.4% (from 0.31 to 0.68 per 100,000 persons) and 43.5% (from 1.24 to 1.78), respectively (Figures 1 and 2). In absolute numbers, from 2003 to 2004, suicides by hanging/suffocation increased from 32 to 70 among females aged 10--14 years and from 124 to 174 among females aged 15--19 years. Aside from 2004, the only other significant departure from trend among females in these two age groups during 1990--2004 was in suicides by hanging/suffocation among females aged 15--19 years in 1996 (Figure 2).

Suicide Statistics

Background

The World Health Organisation (WHO) estimates that each year approximately one million people die from suicide, which represents a global mortality rate of 16 people per 100,000 or one death every 40 seconds. It is predicted that by 2020 the rate of death will increase to one every 20 seconds.

The WHO further reports that:

In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 (male and female). Suicide attempts are up to 20 times more frequent than completed suicides.

Although suicide rates have traditionally been highest amongst elderly males, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of all countries.

Mental health disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide.

However, suicide results from many complex sociocultural factors and is more likely to occur during periods of socioeconomic, family and individual crisis (e.g. loss of a loved one, unemployment, sexual orientation, difficulties with developing one's identity, disassociation from one's community or other social/belief group, and honour).

The WHO also states that:

In Europe, particularly Eastern Europe, the highest suicide rates are reported for both men and women.

The Eastern Mediterranean Region and Central Asia republics have the lowest suicide rates.

Nearly 30% of all suicides worldwide occur in India and China.

Suicides globally by age are as follows: 55% are aged between 15 to 44 years and 45% are aged 45 years and over.

Youth suicide is increasing at the greatest rate.

In the US, the Centre of Disease Control and Prevention reports that:

Overall, suicide is the eleventh leading cause of death for all US Americans, and is the third leading cause of death for young people 15-24 years.

Although suicide is a serious problem among the young and adults, death rates continue to be highest among older adults ages 65 years and over.

Males are four times more likely to die from suicide than are females. However, females are more likely to attempt suicide than are males.

Suicide within minority groups

Research indicates that suicide rates appear to be increasing within native and indigenous populations such as the Native Americans in the US and Alaska, and the Aborigines in Australia and New Zealand.

Suicide rates within migrant communities such as African and East Asian Americans or the Black British community are, also of growing concern. Statistics show a rise but in some countries it can be difficult to calculate. For example, in the UK the place of birth is recorded on the death certificate, not ethnicity, therefore reducing data on suicides amongst minority groups.

For further information about indigenous populations:Suicide Among Minority Groups - www.the-bright-side.orgAboriginal Communities - www.suicideinfo.ca

Sources of statistics

Statistics about suicide are difficult to collate, and may be inaccurate because of the sensitivity of the issue, particularly in countries where suicide is an absolute taboo. You can find suicide statistics on the following sites:

International Statistics: World Health Organisation - for international suicide statistics, including the most recent global stats by country.

The Lancet.Com - The Lancet - for international suicide articles

USA Statistics: American Association of Suicidology - for USA suicide statistics.

New Zealand Statistics: Suicide Prevention in New Zealand

Australian Statistics: Living is for Everyone

Canadian Statistics: Canada Statistics Agency - for Canadian suicide statistics (www.statcom.ca).

UK Statistics: Samaritans UK provides statistics for the United Kingdom and the Republic of Ireland.

Mind useful fact sheets on suicide statisticsUniversity of Oxford Centre for suicide researchOffice for National Statistics - trends in suicide rates

Suicide Prevention 

Many countries recognise the need and positive impact of Suicide Prevention Strategies, and are working to ensure they are in place.

The WHO states:

Strategies involving restriction of access to common methods of suicide have proved to be effective in reducing suicide rates. However, there is a need to adopt multi-sectoral approaches involving other levels of intervention and activities, such as crisis centres.

There is compelling evidence indicating that adequate prevention and treatment of depression, alcohol and substance abuse can reduce suicide rates.

School-based interventions involving crisis management, self-esteem enhancement and the development of coping skills and healthy decision making have been demonstrated to reduce the risk of suicide among the youth.

The International Association for Suicide Prevention (IASP) www.med.uio.no/iasp/index (link) provides a forum for national and local organisations, researchers, volunteers, clinicians and professionals to share knowledge, provide support and to collaborate in suicide prevention around the world.

Further suicide prevention links:

Suicide Prevention (SUPRE) - www.who.int/mental_health/prevention Centers of Disease Control and Prevention - www.cdc.govSuicide Prevention among Native Americans - www.ihs.gov - click onto ‘Nationwide Programs and Initiatives'.World Federation for Mental Health (WFMH) - www.wfmh.com

Reports and studies

Numerous studies have shown that lesbian, gay, and bisexual youth have a higher rate of suicide attempts than do

heterosexual youth. The Suicide Prevention Resource Center synthesized these studies and estimated that between 30 and

40% of LGB youth, depending on age and sex groups, have attempted suicide.[2] A U.S. government study, titled Report of

the Secretary's Task Force on Youth Suicide, published in 1989, found that LGBT youth are four times more likely to attempt

suicide than other young people.[3] This higher prevalence of suicidal ideation and overall mental health problems among gay

teenagers compared to their heterosexual peers has been attributed to Minority Stress.[4][5] "More than 34,000 people die by

suicide each year," making it "the third leading cause of death among 15 to 24 year olds with lesbian, gay, and bisexual

youth attempting suicide up to four times more than their heterosexual peers."[6]

It is important to note, however, that it is impossible to know the exact suicide rate of LGBT youth because sexuality and

gender minorities are often hidden and even unknown, particularly in this age group. Further research is currently being

done to explain the prevalence of suicide among LGBT youths.[7][8][9]

In terms of school climate, "approximately 25 percent of lesbian, gay and bisexual students and university employees have

been harassed due to their sexual orientation, as well as a third of those who identify as transgender, according to the study

and reported by the Chronicle of Higher Education."[10]

"LGBT students are three times as likely as non-LGBT students to say that they do not feel safe at school (22% vs. 7%) and

90% of LGBT students (vs. 62% of non-LGBT teens) have been harassed or assaulted during the past year."[11] In addition,

"LGBQ students were more likely than heterosexual students to have seriously considered leaving their institution as a result

of harassment and discrimination."[12] Susan Rankin, a contributing author to the report in Miami, found that “Unequivocally,

The 2010 State of Higher Education for LGBT People demonstrates that LGBTQ students, faculty and staff experience a

‘chilly’ campus climate of harassment and far less than welcoming campus communities."[12]

[edit]Institutionalized and internalized homophobia

Institutionalized and internalized homophobia may also lead LGBT youth to not accept themselves and have deep internal

conflicts about their sexual orientation.[13] Parents may force children out of home after the child's coming out.[14]

Homophobia arrived at by any means can be a gateway to bullying. As seen in the ten LGBTQ youth suicides reported by

news media in September 2010, severe bullying can lead to extremities such assuicide.[15] It does not always have to be

physical, but it can be emotional, viral, sexual, and racial, too. Physical bullying is kicking, punching, while emotional bullying

is name calling, spreading rumors and other verbal abuse. Viral, or cyber bullying, involves abusive text messages or

messages of the same nature on Facebook, Twitter, and other social media networks. Sexual bullying is inappropriate

touching, lewd gestures or jokes, and racial bullying has to do with stereotypes and discrimination.[16]

Bullying can be seen as a "rite of passage",[citation needed] but studies have shown it has negative physical and psychological

effects. "Sexual minority youth, or teens that identify themselves as gay, lesbian or bisexual, are bullied two to three times

more than heterosexuals", and "almost all transgender students have been verbally harassed (e.g., called names or

threatened in the past year at school because of their sexual orientation (89%) and gender expression (89%)") according

to GLSEN's Harsh Realities, The Experiences of Transgender Youth In Our Nation’s Schools.[17]

This issue has been a hot topic for media outlets over the past few years, and even more so in the months of September

and October 2010. President Barack Obama has posted an "It Gets Better" video on The White House website as part of

the It Gets Better Project. First lady Michelle Obama attributes such behaviors to the examples parents set as, in most

cases, children follow their lead.[18]

[edit]Suicide warning signs and prevention

Some warning signs of suicide[19] include:

increased isolation

substance abuse

self-deprecating attitudes

expressions of hopelessness

irregular behavior

signs of depression

suicidal thoughts or feelings

giving away of valued personal belongings

These thoughts and behaviors can be triggered by emotional trauma, like bullying or rejection, but suicide prevention is

possible.

The Trevor Project

"The Trevor Project was founded by writer James Lecesne, director/producer Peggy Rajski and producer Randy Stone,

creators of the 1994 Academy Award-winning short film, Trevor, a comedy/drama about a gay 13-year-old boy who, when

rejected by friends because of his sexuality, makes an attempt to take his life."[20]

An American non-profit organization that operates the only nationwide, offering around-the-clock crisis and suicide

prevention helpline for LGBTQ youth, the project "is determined to end suicide among LGBTQ youth by providing life-saving

and life-affirming resources including our nationwide, 24/7 crisis intervention lifeline, digital community and

advocacy/educational programs that create a safe, supportive and positive environment for everyone."[20]

ATLANTA — Suicides among children and young adults rose by an alarming 8

percent in 2004, the largest rise in 15 years, the U.S. Centers for Disease

Control and Prevention reported on Thursday.

In 2004, 4,599 children and adults aged 10 to 24 committed suicide, making it

the third leading cause of death in that age group, the CDC said.

The suicide rate for 10 to 24-year-olds rose to 7.32 deaths per 100,000 in 2004

from 6.78 deaths per 100,000 in 2003.

"This is the biggest annual increase that we've seen in 15 years. We don't yet

know if this is a short-lived increase or if it's the beginning of a trend," said Dr.

Ileana Arias, director of CDC's National Center for Injury Prevention and

Control.

In 2003, the U.S. Food and Drug Administration issued a warning that the use

of antidepressant drugs could increase the chances of suicidal thoughts or

actions in children and teenagers. The warnings were added in a "black box" on

the medications in October 2004.

Millions of Americans take antidepressants. Many psychiatrists have criticized

the warnings, saying they scare people away from effective treatment and may

have contributed to an increase in suicide in recent years.

Prior to 2003, the suicide rate among youth aged 10 to 24 had fallen by 28.5

percent over a 13-year period, from 1990 to 2003, the CDC said.

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But in 2003 to 2004, the suicide rate for girls ages 10-14 jumped 76 percent.

There were 94 suicides in that age group in 2004, compared to 56 in 2003.

That’s a rate of fewer than one per 100,000 population.

Recognize warning signs 

In 2004, about 161,000 youth and young adults between 10 and 24 received

medical care for self-inflicted injuries in hospital emergency rooms across the

nation.

"It is important for parents, health care professionals, and educators to

recognize the warning signs of suicide in youth," said Dr. Keri Lubell, who led

the study.

"Parents and other caring adults should look for changes in youth such as

talking about taking one's life, feeling sad or hopeless about the future. Also

look for changes in eating or sleeping habits and even losing the desire to take

part in favorite activities."1.

msnbc.com

The study also documented a change in suicide methods. In 1990, guns

accounted for more than half of all suicides among young females. By 2004,

though, death by hanging and suffocation became the most common suicide

method. It accounted for about 71 percent of all suicides in girls aged 10-14, 49

percent among those aged 15-19 and 34 percent between 20-24.

"While we can't say (hanging) is a trend yet, we are confident that's an

unusually high number in 2004," Lubell said.

Scientists speculated that hanging may have become the most accessible

method.

"It is possible that hanging and suffocation is more easily available than other

methods, especially for these other groups," Arias said.

The CDC is advising health officials to consider focusing suicide-prevention

programs on girls ages 10-19 and boys between 15-19 to reverse the trends. It

also said the suicide methods suggest that prevention measures focused solely

on restricting access to pills, weapons or other lethal means may have more

limited success.

As for why rates are up, Richard Lieberman, who coordinates the suicide

prevention program for Los Angeles public schools, said one cause could be a

rise in depression during tumultuous adolescent years.

"There's a lot of pressure in and around middle school kids. They're kind of all

transition kids. They're turbulent times to begin with," he said. "The hotline's

been ringing off the hook with middle school kids experimenting with a wide

variety of self-injurious behavior, exploring different ways to hurt themselves."

Arias said the declining use of antidepressants in those age groups might play a

role. But it's "not the only factor" that health officials will be studying.

"It is true that antidepressant prescriptions in pediatric patients has come

down and that coincides with this one-year uptick in adolescent suicides.

Obviously, that is a concern for us," the FDA's Dr. Tom Laughren said during

the briefing.

Clear connection 

A second report, published in the American Journal of Psychiatry, makes a

clear connection between the warnings and the suicide rate.

Robert Gibbons of the University of Illinois at Chicago found that youth

antidepressant prescriptions fell 22 percent among children aged 0 to 19 in

both the United States and the Netherlands after the warnings were issued.

In the Netherlands, the youth suicide rate rose 49 percent between 2003 and

2005. Youth suicide rates in the United States rose 14 percent between 2003

and 2004.

The CDC said its report looked at a slightly older population, starting with

children at age 10 because that is the age when suicide becomes a leading

cause of death.

More education is needed, some specialists said, so that teachers, parents and

others can quickly spot troubled teens.

"It underscores the need for more evaluation methods for school personnel and

pediatricians to be able to better identify at-risk youth," said Dr. Alec Miller,

director of the adolescent depression and suicide program at Montefiore

Medical Center in New York. "They are out there, and everyone needs to be

better trained in identification."

He said people who commit suicide tend to have a psychiatric condition, even if

it has not been formally diagnosed.

Arias said warning signs include mental illness, alcohol and drug use, family

dysfunction and relationship problems.

"For some, talking about suicide is awkward," she said. "Our goal is to stop

suicides, and to do that we need everyone's willingness to talk about it."

***The incidence of suicide among the youth has been increasing over the years. There is such hopelessness among youngsters who should have so much to look forward to. These tragic cases reflect an ominous trend. Once thought to be confined to older people, suicide is now claiming more and more youngsters.

Because of the religious stigma attached to the suicide, too many cases go unreported and when young people kill themselves, families often say they were accidents. Teenagers these days are impulsive and don’t think before taking a decision to end their lives. What’s behind the tragic figures? Most answers are speculative, but psychiatrists note that there are multiple reasons for the increasing suicide rates among the youth. Some of the reasons are listed below:

• Loneliness: Youth’s most stressful problem seems to be loneliness. With the growing number of nuclear families, more and more children are physically or emotionally isolated at an early age by parents who are so wrapped up in their own careers that they cannot give the vital nurturance a child needs. Today’s youngsters find it difficult to turn to their parents when they have a problem because of their parent’s busy schedule. Even in joint families, children particularly teenagers, often enter a phase when they feel they cannot talk to their parents or other relatives because they will not be understood. Suicides are rare when children feel loved, wanted and understood by their family members.

• Examination blues: Most experts agree that another important reason for the rise in teen suicides is educational stress. Not only do the kids these days have to cope with a vast syllabus, they’re under pressure from parents, friends and also themselves to do well. Teen suicide rates always go up both before crucial board exams, and when the results are announced.

• Love affairs that create problems: To compensate for poor family life, teenagers often fall in love. And when this attachment turns sour, they see no future for themselves. Suicides also occur when parents oppose their children’s marriage plans. Suicide takes place when a person sees no relief from his various problems except death. They feel their parents, especially their mothers are overly critical and don’t care much for them; they suffer from depression; and they find their studies difficult.  Finally, they cannot take it for long and kill themselves.

• Warning signs: Whatever the reason for suicide, potential warning signs can be seen. Studies show that at least three quarters of those who commit suicide, state or show their intensions. Youngsters often mask their real feelings in bad behavior like running away from home, delinquency, promiscuity, truancy, tardiness, bullying other youths or being accident prone. So the experts say that parents should differentiate between adolescent tantrums and abnormal behavior. Parents and friends should watch for boredom, restlessness, fatigue, concentration problems and most importantly, inexplicable change in behavior, such as withdrawal, lack of appetite, sleeplessness, general sadness and ignoring things that usually bring pleasure. Verbal threats should always be taken seriously. It is simply not true that those who talk about suicide won’t do it. They are the cries of the assistance. Most of those prone to suicide usually have low self-esteem and consider them worthless.

• How to offer help: In an emergency, virtually anyone can offer a suicidal youngster emotional support like friends, teachers, siblings, parents, employers. Professional help should be sought immediately, either through your family doctor or psychiatrist. There are also about a dozen distress or suicide prevention centers in India, and if there’s one in your town, it’s worth getting help from it. But a lot depends on ordinary people; it doesn’t take an expert to make a suicidal youngster feel loved and wanted.

The relationship between parent and child is crucial. By regularly expressing your love and concern, you make your child feel less lonely and so, less likely to take that final, irrevocable step.

Suicide rates among youths aged 15-24 have tripled in the past half-century, even as rates for adults and the elderly have declined. And for every youth suicide completion, there are nearly 400 suicide attempts. This paper examines the dynamics of youth suicide attempts and completions, and reaches three conclusions. First, we suggest that many suicide attempts by youths can be viewed as a strategic action on the part of the youth to resolve conflicts within oneself or with others. Youths have little direct economic or familial power, and in such a situation, self-injury can be used to signal distress or to encourage a response by others. Second, we present evidence for contagion effects. Youths who have a friend or family member who attempts or commits suicide are more likely to attempt or commit suicide themselves. Finally, we show that to the extent we can explain the rise in youth suicide over time, the most important explanatory variable is the increased share of youths living in homes with a divorced parent. The divorce rate is more important for suicides than either the share of children living with step-parents or the share of female-headed households.

Rediff.com  » News » South India: World's suicide capital

South India: World's suicide capital 

Out of every three cases of suicide reported every 15 minutes in India [Images ], one is committed by a youth in the age group of 15 to 29.

In the Union Territory of Pondicherry, every month at least 15 youths between the ages of 15 and 25 commit suicide.

In 2002, there were 10,982 suicides in Tamil Nadu, 11,300 in Kerala [ Images], 10,934 in Karnataka [ Images ], and 9,433 in Andhra Pradesh.

In 2003, the largest number of farmers -- around 175 -- committed suicide in Andhra Pradesh. Kerala, the country's first fully literate state, has the highest number of suicides. Some 32 people

commit suicide in Kerala every day.

These statistics are startling. Southern India is the country's information technology hub. The southern

region is competing with northern India to become the country's economic powerhouse.

But south India has another distinction, one that it would rather not have: the region accounts for the

world's largest number of suicides by young people, according toThe Lancet, the respected British

medical journal.

Some 50,000 people in the four states of Kerala, Karnataka, Tamil Nadu and Andhra Pradesh and the

Union Territory of Pondicherry kill themselves every year. This statistic becomes even more alarming

when you consider that the total number of suicide cases recorded in the whole of India in 2002 was

154,000.

The Lancet has published an authoritative study on suicides in southern India in its April edition. The

study says the suicide rates among young men and women in southern India are the highest in the world.

The study conducted by the Vellore-based Christian Medical College on teenagers in Tamil Nadu,

especially in the Vellore region, found that the average suicide rate for women is as high as 148 per

100,000, and 58 per 100,000 for men.

Worldwide, this rate is 14.5 per 100,000. Also, in the West, men are three times more likely to commit

suicide than women.

"This is just the tip of the iceberg," says Dr S K Vijayachandran, nodal officer for Kerala's district mental

health programme. "It is not youngsters alone. More people in the southern states belonging to every

walk of life are killing themselves than in other regions in India."

For instance, the suicide rate in Kerala was about 32 per 100,000 persons in 2002, thrice the rate in India

as a whole. "This is a huge problem," Dr Vijayachandran says, "which requires urgent intervention."

Experts like him put forward various reasons for the dismal state of mental health among people in the

South. Some of these reasons, which mental health experts term 'acute stress factors,' include:

Family conflicts, domestic violence, academic failures, and unfulfilled romantic ideals.

Voracious appetite for high-end consumer goods spurred by moneylenders and hire-purchase schemes.

The wide gap between people's aspirations and actual capabilities. The disintegration of traditional social support mechanisms as was prevalent in joint families. Emergence of a trend towards nuclear families, alcohol abuse, financial instability and family

dysfunction. A growing population of the aged. Failure of crops, huge debt burdens, growing costs of cultivation, and shrinking yield.

Two years ago, the National Crime Records Bureau noted that out of every three cases of suicide

reported every 15 minutes in the country, one involves a youth in the age group of 15 to 29. 'Youth and

middle-aged (30 to 44 years) are the prime groups taking recourse to the path of suicide. Of the total

suicide victims, around 37.6 per cent are youths in the age group of 15 to 29 years,' the Bureau said in a

report.

Interestingly, Uttar Pradesh [ Images ] and Bihar, which have much higher populations and far lower

levels of literacy, report fewer suicides. In 2002, Uttar Pradesh and Bihar accounted for 4.8 percent and

1.7 percent, respectively, of the total number of suicides in the country.

But not everyone is convinced by these figures. "In northern Indian states, there is low level of registration

of suicide deaths in police stations," says Sunder Rajan, a retired Tamil Nadu police officer. "Therefore,

no figures about suicides in the country can be relied upon for any scientific analysis of the problem."

On its part, the National Crime Records Bureau has one main reason for the increasing suicide rate in the

country: 'Family problems.'

Psychologist Mathew Kurien of the Southern Medical Centre, Bangalore, agrees. "In this modern age," Dr

Kurien says, "children are not brought up peacefully. They are under pressure to deliver at school; they

are under pressure to appear for competitive examinations. After they reach puberty, no one in the family

gives them any advice about the meaning of life."

Dr Kurien's argument is borne out by the fact that every year, when the results of secondary and

intermediate school examinations are announced, counselling centres across the country are flooded with

distress calls from students. "I get hundreds of calls from students who are contemplating suicide

because they could not achieve the good scores expected by their parents," says Elizabeth Vadakkekara,

co-ordinator at Thrani, a counselling centre in Thiruvananthapuram.

Vadakkekara says the only way to make India, especially the southern region, less suicide prone is "to

make life easy." Of course, that is easier said than done

Explaining The Rise In Youth Suicide

The following is a summary of "Explaining the Rise in Youth Suicide", by David M. Cutler, Edward Glaeser, Karen Norberg.

This article is the best we have found for comparing suicide theories to what the data actually says. It is essential reading because the US data is richer than in many other countries, permitting more insights that may also have applicability outside of the USA.

A key characteristic of the US data is that suicide rates amongst US youths aged 15-24 has tripled in the past half-century, even as rates for adults and the elderly have declined. At 13/100,000 suicide is the 3rd leading cause of death, after accidents (which may include some suicides) and homicide. And for every youth suicide completion, there are nearly 400 suicide attempts. Other observations on US data are:

Suicide and homicide are positively correlated. Girls attempt suicide more than boys, but boys complete it more than girls. Suicide clearly decreases with age after adolescence (one reason why The Anika Foundation has chosen to

focus on adolescent depression). Blacks attempt and complete fewer suicides than whites. Rural states have higher suicide rates. Completed suicides are overwhelmingly accomplished with guns in the US. etc.

Some of the theories of youth suicide the authors explore are:

1. 'Rational' youth suicide: for example, because of chronic depression. Youths make the judgement that their suffering is such that the unhappiness of life is valued much less than death.

2. Strategic behaviour on the part of youths. Youths have little direct economic or familial power. In such situations, self-injury can be used by youths to signal distress, or to encourage a response by others. Attempts to punish altruistic parents or other adults are a key part of this.

3. Instrumentality (e.g. the ready availability of guns etc), combined with impulsive behaviour.4. Contagion theories based on imitative behaviour (as in Durkheim's early views).

The authors look at these theories, each of which have various sub hypotheses and subtleties, from three quite different data sets: first, that on attempted suicides, using survey information from the AddHealth data; second, since surveys are not possible for completed suicides, they use national versus county data variations in suicides and related explanatory data; and third, they look at changes over time using detailed state data.

But Remember;

First, the overriding data-versus-theory issue that should always be kept in mind is this: whatever your theory of youth suicide is, it must be consistent with explaining why it's rate of incidence is rising so strongly over time. A puzzle indeed.

Second, all analysis will be plagued by problems of endogeneity: what is really causing what? And are there missing variables and hypotheses that need to be thought about?

 

The Suicide Attempt Data

With regard to suicide attempts, using the AddHealth data permits medically screened as well as total suicide attempts to be compared to matched data concerning:

demographics (female, black, Asian, native American, urban); age characteristics (from 12 to 18 years); employment and income (including mother's participation in the work force); family structure (mother's presence, father's presence, never knew father, knew father but he is no longer

there, stepfather); interaction with parents (relationship with mother, father and non-resident father); sexual activity (intercourse, rape); delinquency (including violent behaviour, or violence against the person); drug and alcohol problems; participation (in clubs, sports, TV watching hours); contagion (eg friend attempted suicide, friend completed suicide, relative attempted, relative completed); and whether the person suffered from depression (score used).

The regression results for suicide attempts are similar for the medically screened and total samples. The results for total attempts, where all of the explanatory variables are included together, show the following relative importance (statistical significance at the 96% level).

1st(by far the most significant), the depression score

2nd drug use

3rd friend attempted suicide

4th raped

5th delinquency

6th violent behaviour

7th relative attempted suicide

8th friend died by suicide

9th alcohol problems

10tha poor relationship with a non-resident father

11th being 14 years of age

12th being female

(The other variables mentioned earlier, but not included in these 12, were only marginally significant or not significant at all.)

If the key depression score is used as the dependent variable, then of the variables studied, the highest correlated factors (in order of importance) were: the delinquency score; being female; being Asian; having a friend who suicided; having been raped; having been hurt in violence; a poor relationship with the mother; a poor relationship with a resident father; alcohol problems; the family being on welfare; drug problems; a relative who attempted suicide; low family income; being 13 years of age; low participation in clubs/societies; father not home in the evening; being native American; being black; mother not home in evening; stepfather in the home (surprisingly negatively correlated with depression-good news for step dads); and being an urban dweller.

 

Suicide Completion Data Across Countries

The authors note that the motivations for suicide completions are very different to attempted suicide, (most people who complete actually do intend to die). However, the above interview-based data is not available for completions. So the authors use detailed county data across the USA, looking for explanations of variations in county suicide completions versus the national rate.

The explanatory variables are: urbanicity (large urban, small urban, farm, population greater than 1m); demographics (black, native American, Asian); economic (median income); social characteristics (% divorced females, female employment rate, share of step children, share of female head of families); and gun ownership (shared owning generally, and shared gun ownership for hunting purposes, i.e. rural/farm).

The most important explanatory variable by far is the increased share of youths living in homes with a divorced parent.  Next came being native American. Then there was access to shared guns for hunting (which, when added to the regression, knocked out the otherwise powerful factor of living on a farm, low income, and guns shared more

generally). If the rise in the divorce rate over time were simply superimposed on their correlations, then mechanically this would explain 2/3 of the rise in youth suicide over time.

 

Changes in State Suicide Completions Over Time

But when it came to running the regressions for data that actually includes changes over time, based on state suicide data and statistics, then the divorce rate actually dropped out. The clearest explanatory variables were: the rise in female participation in the labour market, and the change in family median income (higher is better). Female participation rising and low family income is probably highly correlated with divorce.

This aspect of the research opens the door for economic hardship and more general social stressors to enter. Divorce, rising female participation, and suicide might be related to a third set of factors, such as increasing economic hardship (e.g. through widening income disparity and competition for jobs that pay), that cause social stress to rise, put pressure on marriages, necessitate higher female participation, etc.

 

Our Comments On The Suicide Theories That Follow

First, we agree with the authors that there is some support for the theory that many suicide attempts by youths (as very distinct from completions) can be viewed as a strategic action to resolve conflicts within oneself (delinquency, drug use, sexual activity, rape, alcohol, victimisation), or to punish others (the non-resident father variable, and the poor relationship with mothers, via the depression channel of influence).  Being female also seems to be highly correlated with the strategic attempts at suicide, as opposed to completions (where males dominate).

Second, we agree with the authors that there is clear evidence for contagion effects. Youths who have a friend or family member who attempts or commits suicide are more likely to attempt or commit suicide themselves. There is individual-level evidence of contagion in the US AddHealth data, and clear statistical evidence of non-random clustering in the country-level vital statistics (e.g. across counties including urban and remote regions). Contagion may involve the direct influence of one teen's suicidal behaviour on another, or it may involve more indirect social and cultural processes. But in either case these "neighbourhood effect" may multiply the effects of events (a negative) and government policies (potentially positively).

Third, the instrumentality/impulsiveness theory is not that well supported in this study. Allowing for guns used for hunting knocked out general gun ownership. Guns have always been widely available for hunting in rural areas, but it is gun ownership in urban areas that has grown over time during the Post-War period. (Remember, suicide theories must explain why there has been a rise in the youth suicide rate over time.) In any case, there are many countries with less gun ownership that have higher suicide rates than does the US. There are widely available substitutes to guns everywhere.

Fourth, the authors make little comment themselves on the "rational" suicide theory: that for a person completing suicide (where little pretence and strategic posturing is involved) the benefit of living was judged to be worth less than the benefit of dying. Yet when we look at the single most powerful findings in the 3 sets of data, they are as follows:

the depression score was most highly significant for suicide attempts; the divorce rate was most significant for county deviations in suicide rates; when it came to looking at time variation itself, the rise in female participation had the most explanatory

power for state data, and median income was the only other significant variable at the 96% level.

For future research, then, it will be interesting to explore the interaction there may between people with a predisposition to suicide, i.e. where clinical depression is present, and the pressures on families that arise from increasingly competitive economic environments. It may well be that increasing female participation in the workforce, divorce, delinquency, drug and alcohol abuse, etc, are themselves endogenous to the dynamics that drive the rising youth suicide rate. The median income variable found in the state data suicide time variation is also interesting in this context. For example, youths may feel rising stress from the more competitive school environment. Rising income disparities put more onus of doing well in school: i.e. to be winners in the process rather than the losers. Depressed students cope less well as the pressures increase over time.

The interaction between these sorts of pressures and the presence of clinical depression may be a cocktail that is increasingly lethal over time.

The Surgeon General's Call To ActionTo Prevent Suicide, 1999

At a Glance: Suicide Among the Young

For young people 15-24 years old, suicide is the third leading cause of death, behind unintentional injury and homicide. In 1996, more teenagers and young adults died of suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza, and chronic lung disease combined.

Americans under the age of 25 accounted for 35% of the population, and 15% of all suicide deaths in 1996. The rate among children aged 10-14 was 1.6/100,000, the rate for children aged 15-19 was 9.7 per 100,000, and the rate for young people aged 20-24 was 14.5/100,000.

Important risk factors for attempted suicide in youth are depression, alcohol or other drug use disorder, and aggressive or disruptive behaviors.

Over the last several decades, the suicide rate in young people has increased dramatically. From 1952-1996, the incidence of suicide among adolescents and young adults nearly tripled, although there has been a general decline in youth suicides since 1994. From 1980-1996, the rate of suicide among persons aged 15-19 years increased by 14% and among persons aged 10-14 years by 100%. For African-American males aged 15-19, the rate increased 105%.

Among persons aged 15-19 years, firearm-related suicides accounted for 63% of the increase in the overall rate of suicide from 1980-1996.

The risk for suicide among young people is greatest among young white males; however, from 1980 through 1996, suicide rates increased most rapidly among young black males.

Males under the age of 25 are much more likely to commit suicide than their female counterparts. The 1996 gender ratio for people aged 15-19 was 5:1 (males to females), while among those aged 20-24 it was 7:1.

Although suicide among young children is a rare event, the dramatic increase in the rate among 10-to-14-year-olds underscores the urgent need for intensifying efforts to prevent suicide among persons in this age group.

It has been widely reported that gay and lesbian youth are two to three times more likely to commit suicide than other youth and that 30 percent of all attempted or completed youth suicides are related to issues of sexual identity. There are no empirical data on completed suicides to support such assertions, but there is growing concern about an association between suicide risk and bisexuality or homosexuality for youth, particularly males. Increased attention has been focused on the need for empirically based and culturally competent research on the topic of gay, lesbian and bisexual suicide.

In a survey of students in 151 high schools around the country, the 1997 Youth Risk Behavior Surveillance System found that Hispanic students (10.7%) were significantly more likely than white students (6.3%) to have reported a suicide attempt. Among Hispanic students, females (14.9%) were more than twice as likely as males (7.2%) to have reported a suicide attempt. But Hispanic male students (7.2%) were significantly more likely than white male students (3.2%) to report this behavior.

Youth Suicide

By David N. Miller, Ph.D. Associatie Professor of School Psychology at the University at Albany,

SUNY

Youth suicidal behavior is a significant and world-wide public health problem. According to the World Health

Organization (WHO), suicide is the second-leading cause of death among young people ages 10-24 in the

world. In the U.S., although death rates of children and adolescents have decreased substantially during the

last several decades as a result of continuing medical advances, the youth suicide rate has remained

persistently high. Despite some encouraging declines in the rate of youth suicide in recent years, the rate of

youth suicide is still approximately 300% higher than it was in the 1950s, and there are indications it will

increase further in the future. On average, approximately five children and adolescents between the ages of

10 and 19 die by suicide every day in the U.S.

Unfortunately, youth suicide is only one aspect of the broader domain of youth suicidal behavior. For

example, it has been estimated that for every youth who dies by suicide, 100 to 200 young people will make

a suicide attempt, and thousands more will engage in serious thoughts about suicide (i.e., suicidal ideation)

or in suicide-related communication (i.e., threats or plans). According to the most recent (2009) data

available from the national Youth Risk Behavior Survey, during the previous 12-month period, 6.3 percent of

youth self-reported having attempted suicide one or more times, 1.9 percent reported having made a suicide

attempt that resulted in the need for medical intervention, 10.9 percent reported having made a plan for a

suicide attempts, and 13.8 percent reported having seriously considered attempting suicide.

There are a variety of demographic factors that affect the prevalence of youth suicide. Among the larger

ethnic groups in the U.S., European Americans have the highest rate of youth suicide, followed by African

American youth and Latinos. Proportionally, however, Native American youth have the highest rate of youth

suicide. In regards to gender, research has consistently found a strong but paradoxical relationship between

gender and youth suicidal behavior. Specifically, although adolescent females report much higher rates of

suicidal ideation than adolescent males, and females attempt suicide at rates two to three times the rate of

males, adolescent males die by suicide at a rate five times more often than females. In regards to age, the

probability of suicide increases for both males and females as children grow older and reach adolescence.

For example, adolescents who are 15 years of age or older are at much higher risk than pre-adolescents

ages 10 to 14, who are at much higher risk for suicide than children under 10, where suicide is an extremely

rare occurrence.

As with adults, youth suicide rates are highest in the Western states and Alaska and lowest in the

Northeastern states. It has been suggested that the proportionally larger suicide rates in Western states may

be due to their greater physical isolation, decreased opportunities for social interaction, fewer mental health

facilities, and greater prevalence of guns is comparison to other areas of the country. In regards to sexual

orientation, there is increasing evidence that gay, lesbian, and bisexual youth may be at higher risk for

suicidal behavior than heterosexual youth, particularly in regards to suicidal ideation and suicide attempts.

Incidents involving gay and lesbian youth who were victims of bullying and later died by suicide has recently

received significant media attention.

There are many myths and misconceptions in regards to youth suicide. Perhaps the most dangerous of these

myths is that talking about suicide with children and adolescents may increase the probability that suicide

that will occur, because it will “put ideas in their heads.” Despite fears to the contrary, there is no evidence

for this belief. In fact, research suggests that children and adolescents have better outcomes when they are

provided with the opportunity to openly and candidly discuss suicide with trusted adults. Other prominent

myths or misconceptions associated with youth suicide include:

Parents/caregivers are aware of their child’s suicidal behavior

Youth who attempt suicide usually receive medical attention or some other kind of treatment for it

Most children or adolescents who die by suicide leave suicide notes

Youth who are suicidal are impulsive, often dying by suicide “on a whim”

Youth suicide is caused primarily by family and social stress

Youth who talk about suicide are not “serious” about it and are “only looking for attention”

Youth who are suicidal are “crazy,” “insane,” or “out of their mind”

Youth suicide follows a lunar cycle and is more frequent during a full moon

Once a child or adolescent decides to die by suicide there is little or nothing that can be done to prevent

it

There are a variety of risk factors for youth suicide, as well as protective factors that may decrease suicide

risk. Risk factors are characteristics and other variables established through research that distinguish those

who engage in suicidal behavior from those who do not. Risk factors do not establish a cause for suicidal

behavior; they only describe an association to it. Protective factors are characteristics or variables associated

with youth who do not engage in suicidal behavior. Some established risk and protective factors are listed

below.

Risk factors:

mental health problems, particularly the presence of depression

previous suicide attempts

substance abuse

presence of firearms in youth’s household

nonsuicidal self-injury

exposure to a friend’s or family member’s suicidal behavior

low self-esteem

hopelessness

Protective factors:

family connectedness

school connectedness

reduced access to firearms

safe schools

academic achievement

self-esteem