Adolescent suicide.

Abstract

In the introduction to this report our committee, with its focus on adolescent development, expressed its concern that adolescent suicidal behavior represented a grave crisis in the adolescent, a crisis not only in the development of the adolescent but one that endangers the existence of the adolescent. The possibility of a fatal outcome is abhorrent to us as physicians and psychiatrists, as it is to all those entrusted with the care and development of our fellow human beings. Consequently, we explored the ways in which developmental and other forces lead to adolescent suicide and the measures that can be taken to prevent it. We first considered the historical and cross-cultural aspects of suicidal behaviors. Societal and cultural stresses arise from parental attitudes, beliefs, expectations, and childrearing practices that evolve from the social and economic needs in each culture. If unbalanced by growth-sustaining supports, they may compromise or constrict the existential adaptive ability of the developing adolescent and place the adolescent at risk for suicide. Research into vulnerability in adolescence has revealed gender, ethnic, and geographic differences in the dimension of the problem and has indicated the social, psychological, and biological conditions that increase the likelihood that adolescents will resort to suicidal behaviors. Research is still needed to distinguish those adolescents who commit suicide from those adolescents with similar conditions who do not. Research has only begun to explore the ways in which the interaction of specific individual dynamics, precipitating events, and personal characteristics result in an adolescent's attempt of suicide. We discussed the strengths that adolescents acquire, but we emphasized the weaknesses that ensue as adolescents are faced with the impact of the thrust of their own biological, psychological, and social development with the forces inherent in their cultures. Adolescents progress through this period in their lives with varying and varied attempts to master, or cope with, the inevitable change in their existential status. Some try but fail and some fail to try, with resulting despair that can lead those adolescents to believe that suicide is the only choice they have to end their suffering. We described how psychodynamics can influence motivation, relationships, and behaviors, and how these may contribute to an outcome of suicide. Existing psychopathological conditions contribute. These include anxiety, dysthymia, posttraumatic stress disorders, acute reactive disorders, major affective disorders, severe conduct disorders, and psychotic disorders. We considered the possible lethal interplay between psychodynamic and psychopathological factors. This led to the crux of this report, a full discussion of prevention and treatment. The first and most important aspect of suicide prevention is early recognition of the adolescent at risk. It is of high priority to detect and treat those psychiatric disorders accompanied by greatest suicidal risk; depression, conduct disorders, substance abuse disorders, borderline conditions, and schizoaffective disorders. With all adolescents, threats of suicide must be taken seriously. There should be an immediate, complete psychiatric workup preferably before specific treatment begins. If crisis intervention must precede diagnostic study, the workup should not be delayed longer than necessary. Education of health care professionals, educators, families, and peers about warning signs can emphasize early intervention and thereby enable a skilled psychiatrist to assess suicidal thoughts, plans, means, and previous attempts, past and current life stresses, and available family and environmental support. All of this information will lead to a decision regarding hospitalization and treatment for the adolescent.(ABSTRACT TRUNCATED)