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Friday, January 28, 2011

Why do teens commit suicide?

A new book by Thomas Joiner of Florida State University, Myths about suicide, is probably the best, recent book about this topic. It has current information and it's geared towards dispelling myths about suicide - some myths are less important, like "not everyone who commits suicide leaves a note," or that animals do not commit suicide, and myths that can be harmful: that someone who is intent on committing suicide cannot be stopped, or worse, that suicide is "typically" a cry for help.

What I find most important are the three primary risk factors for predicting suicide:
1) learned fearlessness of the act of suicide
2) perceived burdensomeness
3) low belongingness

The combination of factors on one weekend night can lead
to a suicide act with no warning, such as an intoxicated teen male
whose girlfriend breaks up with him. Single care accidents are
often a suicide act.
I mentioned in the last post that social alienation is a primary risk factor - that would be what Joiner calls, "low belongingness." Learned fearlessness is an interesting risk factor because it shows that people who think about suicide more frequently will start to be desensitized to the act of suicide. So, someone may start out thinking about how to commit suicide, then move to having fantasies about committing suicide, then actually do "dry runs" of suicide. Dry runs were identified as a serious risk factor in the 1990s and according to Joiner, they seem to fall into a process of desensitizing oneself to the act of suicide. This is why suicide threats or attempts should not be viewed as a cry for help, but as part of a process towards increased suicidality.

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Joiner's research has lead him to write that suicide is something that most people who commit suicide have thought about for quite some time - what appears to be an impulsive act, was probably contemplated for a long time.

There certainly are people who commit suicide "impulsively" but it is highly unlikely that they did not consider the act and how they would do it, for a lengthy period of time. What's important about this information is that it require parents, teachers, therapists, physicians and others to be aware that suicidal thinking alone can over time lead to suicidal action and that the goal should be to eliminate suicidal thinking altogether - not just eliminate the intent, but the thoughts, too.

Also, it suggests that intervention should occur very early in the process. For example, if a child is having thoughts that they would be better off dead, then parents shouldn't wait for those thoughts to become "more serious" before getting help. Thinking about suicide is a distorted form of problem solving.

The relationship between these three factors (social isolation, perceived burdensomeness, and learned fearlessness) are important. Risk factors interact to produce an outcome. For example, social isolation may lead to thoughts of worthlessness, which may lead to suicidal thoughts, which may then lead to increased fearlessness. If the social isolation is unresolved, then over time, the suicidal thinking may become worse - but not for everyone. Some people are more affected by social isolation than others. Some people cope with it differently, for example, they just don't think about suicide, or they have protective factors, a religious belief, which could prevent continued suicidal thinking.

Another important myth is that "children do not commit suicide." I bring this one up because children ages 8-12, are one of the fastest growing suicide rates. Why this is happening is not clear, but, it is. However, the rate for that age group is still very low. But, it does indicate that intervention should occur much earlier than in the past.

Joiner writes that suicide contagion is a myth. However, I disagree. Statistical methods apparently show a weak correlation between media reports and increased suicides, but this is one factor that where the application of statistical methods is sketchy or maybe spurious. The case study in Micronesia is too much of a coincidence to write off the relationship between media reports and increased suicides. Since suicide occurs over the course of time, it's too difficult to know how and when media reports might impact someone's suicidal thinking. So, I stick to my position that the media should be very careful about how and when they report suicides.

UPDATE (05-02-2014):
This study indicates a correlation between newspaper coverage and "suicide clusters."
http://www.usatoday.com/story/news/nation/2014/05/01/newspaper-suicide-clusters/8573239/

Children who make comments about suicide in any manner should probably be seen by a mental health professional immediately.

Mental Health Advice Disclaimer
The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

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