Chapter 75 Suicide
PATHOPHYSIOLOGY
Suicide is the third leading cause of death among youth in the United States. Risk of suicide is the most frequent reason for inpatient psychiatric hospitalizations of adolescents. Suicidal behaviors represent a continuum ranging from the completed act to suicide attempts and self-inflicted injury. Suicidal ideations are recurrent thoughts of death and of killing oneself. Suicidal ideations do not necessarily include a plan or intention to kill oneself but may be a precursor to suicidal behavior. A carefully formulated suicide plan is an indicator that the youth has serious intentions of carrying out his or her plan.
Contributing factors to youth suicide are complex and fall within the following areas: psychiatric illnesses, family problems, major life changes, and demographics. Mood disorders, especially untreated depression and substance abuse, place the youth in considerable jeopardy. Family history of emotional problems, multiple family moves, problematic parent-child relationships, sexual abuse, emotional neglect, parental divorce, and family violence are risk factors for suicide. Significant recent life changes such as loss of a parent, end of a romantic relationship, and a recent move are also associated with suicidal behaviors. Demographic risk factors include being a member of a single-parent family or in a noncustodial living arrangement, being male, and being in one’s late teens. Ready access to firearms in the home is positively associated with suicide attempts.
Suicide clusters have been identified among adolescents who imitate their peers in committing suicide. Three or more suicides or attempts occurring within 3 months within a specific geographic area constitute a suicide cluster. During adolescence the sense that death is final may not be entirely grasped. The youth may fantasize about being at his or her own funeral and observing other’s reactions to his or her death. Suicide methods used by adolescents include poisoning, hanging, jumping from a high place, jumping out of a car, inhaling carbon monoxide fumes, drowning, and overdosing from medications. Use of a firearm is the most common method used to commit suicide in the United States, by adults as well as youth. Females use less violent methods of suicide than males. Males are 4 times more likely to die from suicide attempts than females.
INCIDENCE
1. Depression with functional impairment occurs in 2% to 10% of children and adolescents who complete suicide.
2. Mood disorders account for most suicide attempts.
3. Suicide is the third leading cause of death in 15- to 19-year-olds and the fourth leading cause in 10- to 14-year-olds.
4. American Indians and Alaska Natives have the highest suicide rate in the 15- to 24-year age-group.
5. For every suicide among high school students, there are approximately 350 unsuccessful suicide attempts.
6. Suicide rates in the United States are highest in the spring and lowest in the winter.
7. Adolescent suicide risk increases sevenfold with maternal suicide attempts and fivefold with marital discord.
8. Use of firearms is the method most often employed in completed suicides among those 10 to 14 years old, followed by hanging and drug overdose.
9. Use of firearms, hanging, and drug overdose are the methods used most often by 15- to 24-year-olds who complete suicide.
