CONTENTS

INTRODUCTION BACKGROUND SCOPE OF THE PROBLEM RISK FACTORS CASE STUDIES OF YOUTH SUICIDE CONCLUSIONS AND RECOMMENDATIONS REFERENCES

INTRODUCTION
Youth suicide is the third leading cause of death among adolescents nationwide. Although the actual occurrence is relatively low compared with other serious concerns that children and adolescents face, given the high impact and severe implications of youth suicide, it is a problem that society cannot ignore. Suicide affects not only the individual, but also the childs family, peers, school and community. The phenomena of youth suicide must be further understood and work must be done to identify children and adolescents at risk and prevent future occurrences. Every completed suicide is a potentially preventable death. In order to understand the phenomena of youth suicide, it is important to first examine the interacting systems of which children and families are a part. The adolescent suicide project was designed to mobilize existing resources, and increase awareness and collaboration among key professional groups, state agencies and community organizations. This report highlights the critical relationships and interdependencies among professionals and communities that are necessary to respectfully and effectively intervene with those vulnerable children and presents findings

from the increasing body of clinical and research literature indicating that adolescent suicide is not random, uncontrollable or inevitable. A range of biological, psychosocial and educational factors may contribute to an individuals inclination to consider suicide. It is most often stable family structures, capable community networks and competent professional support that can best nurture children and youth, and keep them safe. Promising areas for intervention lie in the identification and strengthening of protective factors that keep the majority of children and youth from resorting to suicide or violence. Every organization that has contact with adolescentsfamilies, schools, communities, healthcare providers, policymakers, and mediamust help build upon resilience by providing the support and intervention necessary to contribute to an adolescents sense of safety, dignity and preference for healthy alternatives.

BACKGROUND

Adolescence is a time of dramatic change. The journey from child to adult can be complex and challenging. Young people often feel tremendous pressure to succeed at school, at home and in social groups. At the same time, they may lack the life experience that lets them know that difficult

situations will not last forever. Mental health problems commonly associated with adults, such as depression, also affect young people. Any one of these factors, or a combination, may become such a source of pain that they seek relief in suicide. Suicide is the second leading cause of death among young people after motor vehicle accidents. Yet people are often reluctant to discuss it. This is partly due to the stigma, guilt or shame that surrounds suicide. People are often uncomfortable discussing it. Unfortunately, this tradition of silence perpetuates harmful myths and attitudes. It can also prevent people from talking openly about the pain they feel or the help they need. Suicide can appear to be an impulsive act. But it's a complicated process, and a person may think about it for some time before taking action. It's estimated that 8 out of 10 people who attempt suicide or die by suicide hinted about or made some mention of their plans. Often, those warning signs are directed at a friend. Recognizing the warning signs is one thing; knowing what to do with that information is another. Suicide was a taboo subject for a very long time. Even talking about it is still difficult for most people. But being able to talk about suicide can help save a life. Learning about suicide is the first step in the communication process. Suicide is about escape. Someone who thinks seriously about suicide is experiencing pain that is so crushing, they feel that only death will stop it.

RISK FACTORS
REASONS BEHIND SUICIDE
Unlike adults, youth do not have the ability to think about life and life events in terms of the broader perspective or "big picture". They tend to believe that all of the unhappiness they are feeling and experiencing will go on forever. Everything that is happening to them is in the "here and now" and they can't begin to think that there might be a brighter future just around the corner. They often don't believe that anyone can help them, and they feel helpless and hopeless within their situation. They believe that they can either choose to live with the pain, or end it by ending their life. Unfortunately their ultimate decision could be fatal.

Suicide is a permanent solution to a temporary problem.

The reasons for suicide are deep and long standing. The teen that attempted suicide right after his girlfriend broke up with him or the teen that contemplated suicide after losing her job probably had a history of low selfworth that was magnified by the upsetting event.

What is so stressful about being a youth ?

Trouble at home Change in family dynamics (i.e. new baby, older sister moves back home, Grandmother moves in) Balancing relationships with divorced or separated parents Change of schools Difficulties at school Bullied at school Relationship breakup Social struggles Balancing school, work, social life, and family relationships Facing an environment that encourages drugs, alcohol, and sex The natural separation from parents

Dating Learning to accept themselves with or without talents and abilities Getting good grades for college/university Getting a part-time job Choosing a college/university Choosing a career

RISK FACOTRS
While there is no stereotypical "suicidal type" the following risk factors may increase the risk of suicide among youth.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Diagnosis of depression or other psychiatric disorder Chronic or terminal illness Previous suicide attempt Family history of suicide Recent suicide of family member, friend, classmate History of sexual, physical, or verbal abuse History of self injury Engaged in risky or self-destructive behaviour (i.e. smoking, dangerous driving, substance abuse, unprotected sexual activity) Perfectionist Low self-image, low self-esteem Gay or lesbian youth - confusion around sexual orientation Social isolation or neglect from family A traumatic or recent loss (includes divorce)

PSYCHIATRIC ISSUES
The strongest and most consistent risk factor for suicidal behavior is mental illness (Gould, Greenberg, Velting & Shaffer, 2003). This

relationship is consistently observed in studies of clinical populations, in large community studies examining risk factors for suicidal thoughts and behaviors in the general population (such as the National Comorbidity Study and the YRBS), and in studies using psychological autopsy techniques (i.e., in which parents or caregivers, close friends and school personnel are interviewed after a death by suicide to assess the mental status and family dynamics of the youth in question) (Brent, et al., 1999; Goldsmith, 2001; Rao, Weissman, Martin & Hammond, 1993; Shaffer, 1988; Shaffer, Gould, Fisher, et al., 1996).

The majority of young people who have thought about or acted upon their suicidal inclinations have at least one psychiatric illness (Brent & Kolko, 1990), and the symptoms of the mental illness are most frequently present at least a year or more prior to the death of those who ultimately kill themselves (Shaffer et al., 1996). Researchers investigating cases in which youth have attempted and completed suicide report that between 76%-92% meet clinical criteria for mental illness (Andrews & Lewinsohn, 1992; Brent et al., 1999; Gould et al., 1998; Mazza & Reynolds, 2001). Gould and her colleagues (1998) found that 47.6% of suicide attempters had at least one additional/comorbid psychiatric diagnosis. Other researchers have found comorbidity rates as high as 70%-81% among completers (Mazza &

Reynolds, 2001). Thus, children and adolescents who attempt suicide are likely to have other presenting psychiatric issues and concerns.

SOCIAL FACTORS
In recent years, a number of risk factors for adolescent suicide have been identified, many of them related to family context and family processes (Beautrais, Joyce & Mulder, 1996; Fergusson, Woodward, & Horwood, 2000; Johnson, Cohen, Gould, Kasen, Brown, & Brook, 2002; King, Schwab-Stone, Flisher, Greenwald, Kramer, Goodman, et al., 2001). Higher rates of suicide attempts have been found among adolescents from single-parent families than those from two-parent families (Andrews & Lewinsohn, 1992; Velez & Cohen, 1988), and high levels of family conflict have been observed in families of youth who have both attempted and completed suicide (Joffe, Offard & Boyle, 1988; Wagner, 1997).

Adolescents who had run away from home were found to have been almost three times more likely to have suicidal thoughts or behaviors than youths who had not (Gould et al., 1998; Molnar, Shade, Kral, Booth, & Walters, 1998). Recent studies have also found that a lifetime history of physical and sexual abuse increases the risk of suicide for both genders (Brent, Braugher, Bridge, Chen & Chiapetta, 1999; Garofalo, Wolf, Wissow, Woods, & Goodman, 1999; Goldsmith, 2001; Mann, Waternaux, Haas, & Malone, 1999; Molnar, et al., 1998), and youth who have experienced traumatic loss are five times more likely than their peers to report suicidal ideation (Prigerson, et al., 1999). For boys, stressors related to frequent legal or disciplinary problems were associated with suicide risk (Brent et al., 1999). Access to firearms may be a greater risk to boys as well, as they are six

times more likely than girls to use firearms to kill themselves (ODonnell, 1995).

OTHER MENTAL AND BEHAVIOR DISORDERS

Other mental health problems are also related to suicidal thoughts and behaviors. Several studies have found anxiety disorders to be associated with increased suicide attempts. A diagnosis of posttraumatic stress disorder also appears to increase risk of both suicidal ideation and attempts, particularly when combined with a diagnosis of major depression. In addition, panic attacks and aggression are significantly associated with both suicidal ideation and attempts, particularly when panic attacks are secondary to depression (Gould et al., 1998; Pilowsky, Wu & Anthony, 1999). SEXUAL ORIENTATION There has been ongoing debate about sexual orientation and its relationship to youth suicide (Hershberger & DAugelli, 1995, Russell, 2003; Savin-Williams, 1994). The National Longitudinal Study of Adolescent Health, the only national data source in the United States that includes sexual minority status for adolescents, indicated that homosexual and bisexual youth of both sexes were at greater risk for suicidal thoughts and attempts than their heterosexual peers (Russell, 2003). In particular, boys with same-sex relationship partners and girls with partners of both sexes were more likely than exclusively heterosexual youth.

DEPRESSION
The most frequent psychiatric diagnosis among youth with suicidal thoughts and behaviors is depression (Kelly, Cornelius & Lynch, 2002). Major depression is an illness lasting more than one month with symptoms that may include depressed or irritable mood, loss of energy, decreasing concentration, sleep disruption, a sense of hopelessness, and thoughts of death and suicide. Depression is a fairly common psychiatric diagnosis among adolescents with frequency rates similar to those found in adults. Data from the National Comorbidity Study reveal that 15.3% of 15 to 19-year-olds have a lifetime history of major depression, and 9.9% have a lifetime history of minor depression (Kessler & Walters, 1998). The Youth Risk Behavior Survey data

indicate that almost a third of high school students (28.3%) reported having felt sadand hopeless enough almost every day for two weeks during the past year that they stopped doing some usual activities (Grunbaum, et al., 2002). Among community samples, major depression was found almost twice as often in girls (21.3%) as in boys (9.5%) (Kessler & Walters, 1998; see also Lewinsohn, Rhode, Seeley, Klein, & Gottlieb,2000). However, among those who have attempted suicide, the rate of major depression may actually be higher among boys (64.5%) than among girls (55.6%) (Andrews & Lewinsohn, 1992). Research indicates that depression is a consistent risk factor for suicidal ideation and attempts across race/ethnic categories (Ialongo, et. al, 2002; Negron, Piacenti, Graae, Davies, & Shaffer, 1997; Olvera, 2001; Rao et al., 1993). Bipolar disorder may pose additional risks for suicidal behavior.

TEEN SUICIDE - FAILURE IN EXAMS

In India, every year around the months of June/July the results of the board examinations are out; i.e. (the 10th and 12th grade). These exams are very important as their marks are counted for admissions in a good college. Even points of difference in the percentage can cause a lot of difference.

During these months we hear various cases of students committing suicide if they fail in the exams or do badly. Some commit suicide even before the results are declared, because they are sure they will fail or will just clear the exams. This is a horrible situation. Why should one end his life just

because he has failed in board exams? And it is even more ridiculous to end one's life even before the results are out, assuming he will fail in the exam.

1. The existing educational system:

There are various loopholes in today's educational system in India. The syllabus is strictly written. One has to know the textbooks very well and if possible understand the content or otherwise just learn the answers with out understanding it. This is because there is a lot of stress on theory and not in practical. In short, students lose interest in their studies, as it is very boring, monotonous and tedious. The purpose of the educational system is not specified. In spite of spending lots of money for a good education and finishing the graduation still many students don't get a job. At the end of the day aren't you studying for standing up on your own feet, so that you can earn your living? Then why does one not get a job after finishing one's education?

2. Pressure of Parents and Teachers:

a. There is a lot of pressure on the students from the teachers and parents. The student is very tense with all these pressures. To some extent it is the teacher's and parent's right to guide and advise the child. But they SHOULD not force the child to do something which he does not like. They should be aware of their child's capacity and not expect too much from their child. It should be in the limits of the child's capacity. b. They should not compare their child with anyone else's child or even his/her sibling. No one is the same. Everyone is unique. So the parents and teachers have no right to compare their child.

3. Pressure of the society:

a. Today there is lot of pressure of the society on the parents. Sometimes parents feel a big blow is given to their self-esteem if their child fails or gets very bad marks in these crucial exams. So they emotionally torture their child which, is also one of the reasons why the child may commit suicide.

b. There are fights between friends or peers over who is more intelligent than the other. This also causes emotional stress and frustration on the child.

4. Competition:
As we all know, competition is increased tremendously. Lots of pressure is on the student to prove his/her worth in the world.

5. Loss of self-confidence:
a. Sometimes students lose their self-confidence. This is if they are constantly failing or because they only hear criticism from their teachers and parents. Due to this they feel that they are hopeless and cannot do anything in life. b. Another reason can be the thought that their parents don't force their children to study or don't expect anything from them. Still the child wants to be perfect and keeps forcing himself to study.

ABUSE
Youth known to state child welfare and juvenile justice systems commonly present with multiple social, biological and psychological factors that place them at the highest risk for suicide. The very factors that bring these youth to the attention of child welfare and juvenile justice authoritiesabuse, neglect and disorders in conductalso make them extraordinarily vulnerable to suicidal thoughts and behaviors. Their early life histories are frequently marked by maltreatment and trauma as well as failure to form meaningful attachments to stable caregivers. A recent retrospective study of more than 17,000 adults tested the relationship between adverse childhood experiences (ACE) defined as emotional abuse, physicalabuse, sexual abuse, parental mental illness, substance abuse, incarceration, domestic violence, and separation or divorce, and lifetime attempted suicide. An individuals ACE score - a cumulative tabulation of these experiences -correlated with suicide attempts at P<.001, such that the likelihood of an individual attempting suicide increased as his or her ACE score increased. For every increase in theACE score, the risk of suicide increased by 60%. The authors concluded that approximately twothirds of suicide attempts are attributable to the cumulative effects of the

adverse childhood experiences identified in this study (Dube, Anda, Felitti, Chapman, Williamson, & Giles, 2001).

SCOPE OF THE PROBLEM

Youth Suicide is a worldwide mental health crisis. According to the World Health Organization (WHO, 2000), approximately one million people die each year by their own hand. Globally, suicide rates have increased by approximately 60% in both developing and industrialized nations in the last 45 years. In the United States, there were approximately 30,000 deaths attributed to suicide annually between 1996 to 1999, making suicide the ninth most frequent cause of death overall (Peters & Murphy, 1998). A recent survey indicated that one in 14 adults (7%) have known someone who committed suicide within the previous year (Crosby & Sacks, 2002). However, focusing on the number of completed suicides masks the extent of this mental health crisis. Using various data sources, the American Association of Suicidology (1999) estimated that there are 25 attempts for every completed suicide in the nation, suggesting that there are upwards of 750,000 suicide attempts in the United States annually. Trends in suicide rates among children and youth are even more alarming. In the United States, the Centers for Disease Control reports that suicide among adolescents ages 15 to 19 years tripled between 1952 and 1995 (CDC, 2002). Recent trends among younger adolescents are of particular concern. Between 1980 and 1997, the rate of suicide among 15 to 19-yearolds increased by 11%, but more than doubled among 10 to 14-year-olds. This translates to the sobering statistic that on average a young person in the nation kills him or herself every two hours (Peters & Murphy, 1998).

SUICIDE RATES BY GENDER AND ETHNICITY

Rates of suicide among adolescents in the United States vary greatly by both gender and race/ethnicity. In 1998, suicide was the third leading cause of death for males 19 years old and younger in the United States, but the sixth for females in the same age range (CDC, 1998). Girls had a lower suicide rate than boys across all race/ethnic groups. According to national statistics, the lowest risk group is African American girls, representing approximately 2% of total fatalities, compared with a high of 10% of all deaths for Native American and Alaska Native young women. European American male

adolescents are at the highest risk for suicide which accounts for 11.3% of all deaths for male youth in this ethnic group. Suicide ranks as the third most frequent cause of death for African American adolescent males, accounting for approximately 4% of all deaths in this racial group. Although these rates remain low relative to Whites, the rate of suicide among African American males has increased dramatically of late, suggesting that prevention and intervention initiatives should strategically target this segment of the population in addition to other high-risk gender and ethnic groups (Ialongo et al., 2002; Shaffer, Gould & Hicks, 1994). The rate of suicide among Indians and Alaska Natives reached an alarming peak in the 1970s, and, although rates of death by suicide have declined from these levels, they have remained significantly higher than all races in the United States throughout the past two decades (DeBruyn, Wilkins, Setterburns & Nelson, 1997). In 1998, suicide accounted for 16.7% of all deaths among Native American and Alaska Native young men, making it the second leading cause of death for young Native males (Patel, R. N., Wallace, L. J. D. & Paulozzi, L., 2005).

Conclusion :
Teen suicide is the third leading cause of death among teens, but teen suicide can often be prevented. If you know the warning signs of adolescent suicide you might save a life. So after recognizing the following symptoms one can take measures and the suicide rates can be widely reduced.

Feelings of emptiness, hopelessness, restlessness, or irritability Changes in appetite, mood, or sleep patterns Trouble concentrating at school or work Withdrawal or loss of energy Headaches, backaches, stomachaches, or joint pain Alternating between depression and mania, or excessive energy Drug or alcohol use

If a teen is being treated for a mental illness such as depression, schizophrenia, or bipolar disorder, he or she needs to stick with his or her treatment. So teens can be given antidepressants , and proper medical and mental treatment will reduce the cause of the teen suicide.