Suicide Among Teenagers: Prevention Is Contagious

Just about everyone in the USA either knew a teenager who committed suicide or knows family and friends of a teen who ended his or her own life. Once a relatively rare event in the United States, teen suicides increased as the American lifestyle changed to become more insular, more hectic, less engaged with friends and neighbors, more competitive on the job and at school, and more preoccupied with social media and TV. 

Suicide rates among American teens fell off sharply between 1990 and 2006, the number of teens reporting that the had considered suicide falling off by over half, but increased slightly in 2011. And suicidal thoughts and suicide attempts are both shockingly common. The Centers for Disease Control and Prevention 2011 National Youth Risk Behavior Survey found that:

• Twenty-eight percent of teens had felt so sad or hopeless in the past year, for 30 days or more, so that they stopped participation in their usual activities.
• Sixteen percent of American teens had seriously considered suicide in the last year.
• Thirteen percent of American teens had made plans to commit suicide in the last year.
• Eight percent of American teens had attempted to suicide in the last year.
• Girls were more likely to attempt suicide than boys.
• Boys were more likely to complete suicide than girls. Boys tend to use methods that are more immediately lethal.
• About 8 in 100,000 teens actually die as the result of suicide in any given year.
• For 15- to 19-year-olds, suicide is the third most common cause of death.
• Teens who live on Indian reservations attempt suicide at about twice the national average rate.
• Gay, lesbian, bisexual, and transgendered teens attempt suicide at about twice the national average rate.
• Being bullied is clearly associated with teen suicide. Sixteen percent of teens surveyed that they had been electronically bullied in the previous twelve months.
• Teens who smoke are more likely to commit suicide.
• Teens who started drinking before the age of 15 are more likely to commit suicide.
• All forms of illegal drug use are associated with higher rates of suicide.

But what is the right approach to dealing with the issue of teen suicide? For many years, parents, teachers, counsellors, and mental health officials usually believed that it was a bad idea to discuss suicide of teens with surviving teens, and an especially bad idea to discuss the signs and symptoms that a suicide attempt might be imminent. The general idea was that teens copy each other's behavior, and learning of one teen's suicide might trigger a suicide or a suicide attempt in another vulnerable teenager.

Read More: 10% of Teenagers Self Harm

The newer approach is to try to break through codes of silence by treating teens as trusted adults who make responsible decisions and who seek appropriate help for their peers. High school counselors train both teachers and students to be "gatekeepers" for mental health assistance, using them to be their eyes and ears to identify students who can receive timely health. These interventions lower teen suicide rates. But there is always the problem of how to handle a death by suicide after the fact.

When Death Becomes Bigger Than Life

The problem with memorializing the deaths of classmates who have taken their own lives is, researchers say, that teens who know someone who has committed suicide are far more likely to think about committing suicide themselves. An article in the Canadian Medical Association Journal reported that12- to 13-year-olds who have been exposed to the suicide of a classmate think about suicide five times as often as those who have not suffered a similar loss, and that rates of "suicidal ideation" triple in 14- and 15-year-olds, and double in 16- to 17-year-olds. This contagion effect is stronger for teens who have lost a parent or suffered abuse, and memorials to the suicide victim can sometimes make the problem worse. An example of just how badly memorials can go wrong comes from Manasquan High School in Monmouth County, New Jersey.

The Tim Schenke Story

Tim Schenke was a top student, who had a scholarship in hand at the beginning of his senior. He was also a star soccer player and well liked by his peers. Tim had gotten into trouble with alcohol and drugs, however, and he had confided in his mother that he wanted to die. One day in the spring of 2008 Tim stepped out in front of a train and was killed instantly.

Students at Manasquan High School placed flowers, T-shirts, poems, and candles both at the school and at the tracks where Tim died. Over the next four months, two more teens at Tim's high school stepped out in front of a train, and school and police officials decided the problem might be that Tim's death had been overly idealized. Perhaps the next two young men had thought, "If I kill myself by stepping in front of a train, at least I'll get flowers and poems," so the police made a new policy of keeping memorials at the railroad tracks to a minimum and watching the area for distressed youth.

So how can parents and schools encourage memorials for fallen friends without causing the contagion of suicidal thought?

Read More: How to deal with teen depression

Safer Memorials for Suicide

Some schools that have lost students to suicide have begun encouraging online memorials, and service memorials, rather than memorials at the school or at the site of the death. Online memorials do not create a physical place where suicides can "cluster," or where teens can expect special attention if they die.

And over 250 schools in Canada and the United States have established clubs sponsored by the organization Source of Strength, which organizes teens from across schools--not just teens who do well in class or on the playing field--to serve as peer counselors for depressed students who might otherwise fall through the cracks. These kids are expected not to stick to a code of silence, that is, to seek out help when it appears a classmate needs it, getting help for potential suicides rather than making suicide into something glamorous or attractive. These teens receive training so they will know how to handle the "heavy stuff," in ways that encourage their peers to feel comfortable receiving help.

What Else Can be Done?

Addressing this critical public health concern requires collaboration and active involvement from parents, educators, healthcare professionals, community leaders, and policymakers.

One of the fundamental aspects of preventing teen suicide is raising awareness about mental health issues and suicide. Schools and communities can implement mental health education programs to destigmatize mental health problems and encourage open conversations. By fostering an environment of understanding and support, teens may feel more comfortable seeking help for their emotional struggles without fear of judgment.

Early identification of mental health issues is crucial in preventing suicide. Schools can play a vital role in this regard by providing access to mental health screenings and counseling services. Trained gatekeepers, such as teachers and school staff, can recognize warning signs of distress, such as changes in behavior, withdrawal from social activities, or sudden academic decline. These gatekeepers can then intervene and connect at-risk teens with appropriate mental health resources.

Creating safe and nurturing environments is also vital in preventing teen suicide. At home, parents can foster open communication and emotional support, ensuring that their teens feel heard and valued. In schools, implementing bullying prevention programs can reduce instances of victimization, which is a significant risk factor for suicidal ideation. Community programs and youth organizations can also offer opportunities for positive social interactions and engagement, fostering a sense of belonging and purpose.

Limiting access to lethal means is another essential component of prevention. Studies have shown that restricting access to firearms, medications, and other potentially harmful items can help reduce suicide rates, particularly for impulsive suicide attempts. This highlights the significance of responsible gun ownership and secure storage practices.

Promoting resilience and coping skills in teens can help them navigate life's challenges more effectively. Providing opportunities for emotional expression, stress management, and conflict resolution can equip teens with healthy coping mechanisms. Teaching emotional intelligence and problem-solving skills can also empower them to navigate difficult situations constructively.

Suicide prevention efforts must also consider the influence of media. Irresponsible media reporting of suicides can lead to "suicide contagion," where suicidal behaviors are glamorized or imitated. Implementing media guidelines that prioritize responsible reporting and avoid sensationalizing suicides is essential in mitigating these harmful effects.

Furthermore, public policies play a vital role in supporting suicide prevention efforts. Adequate funding for mental health services, both in schools and healthcare settings, is critical to ensure that teens have access to appropriate care when needed. Comprehensive suicide prevention strategies should be integrated into broader public health initiatives to maximize their impact.