Suicide Ideation in at Risk Youth and Adolescents

Suicide ideation and attempts are a part of a continuum of suicidal behaviors, and are among the strongest predictors of death by suicide in youth and adolescents (Fraser, 2015). The rates of suicide have increased over the last 70 years. In the 1950's through the 1960's, rates were as low as 5.2 percent for every 100,000 people (Fraser, 2015). These rates however, steadily increased from the 1970's and 1980's until the turn of the century (Fraser, 2015).

People that are younger with a mental health diagnosis are more likely to report suicide ideation. In order to be a part of the suicide solution, one must first identify the leading problems. There a number of reasons that youth and adolescents may exhibit suicidal behavior including, poverty, race, gender, sexual orientation, bullying, and in and out of home placement, which all put a child in an at-risk environment.

This paper will discuss suicide and suicide ideation among at risk youth and contending variables that lead to suicide such as single parent households, race, gender, sexual orientation, in and out of home placement such as a guardian/caregiver that is not a parent, a guardian/caregiver that is a blood relative, foster parents and adoptive parents, multiple forms of bullying, and suicide motivation.

Gender and Race

It has been classified as the second leading cause of death in people aged between 10 and 29 years (Gontijo, 2016). However, young men are far more likely to die as a result (Campbell, 2006). All youth are affected in some way by suicide, however there are normally behavioral differences in suicide attempts between men and women. For men aged 15–24, there were 9 deaths per 100,000 in 1974, 10 deaths per 100,000 in 1984 and 16 deaths per 100,000 in 2000 (Campbell, 2006).

Around 19,000 young people attempt suicide every year, and 700 are successful in their attempt (Campbell, 2006). Over the years suicide ideation, attempted suicide, and death by suicide have risen among youth and adolescents. Every day, five young people under the age of 20 commit suicide and every 6 hours a young person commits suicide.

When it comes to suicide attempts, and choosing means to commit suicide, males are found more likely to choose more violent ways to commit suicide such as firearms or hanging (K?µlves, 2017), whereas females tend to use digestive measures to commit suicide such as pills, poison, and so on(McWhirter, 2017). The most frequent suicide methods in this study were categorized into seven groups: hanging, poisoning by drugs, poisoning by pesticides, firearms, jumping from height, and moving objects with hanging being more prevalent in ages 10-14 years (K?µlves, 2017).

Results showed that out of 1,668 eighth and 10th grade students, 617 students placed in the medium and high suicidal ideation group (Albers, 1994). When the results were narrowed down by grade level the results also showed that eighth grade students were found more likely to state having suicide ideation than 10th grade students.

The suicide rate among adolescents age 13 through 16 however, has more than tripled since 2007 from 1.6 to 3.2 deaths per 100,000 population (Holland, 2017). According to the Center for Disease Control, almost 40 percent of high school students reported seriously considering suicide, and carrying out suicide ideation.

Race also plays a part in suicide and suicide ideation. In the same study results showed that between 2003 – 2014 78.8 percent of whites committed suicide between the ages of 11-15, which was the highest out of African American, Asian, and other races that were studied (Holland, 2017).

Studies have shown a positive correlation between adolescent race/gender and suicide. According to a study done in a rural area in Montana on adolescents, whom were given a survey to complete based on six categories. The Youth Risk Behavior Survey (YRBS) monitored health behaviors such as unintentional injury and violence, tobacco use, alcohol and other drugs, sexual behaviors, physical activity, and dietary behaviors. Questions were answered yes (meaning 1 or more times) and no (meaning 0 times) (Manzo, 2015).

The survey found that suicide ideation, attempts was vastly higher in White males compared to the other three groups that were studied. Those groups included, American Indian boys, American Indian girls, and White girls (Manzo, 2015). Common feelings that were associated with the adolescent suicide ideation were sadness and hopelessness. The adolescents in this study also reported involvement with sexual intercourse before the age of 13, smoking cigarettes and marijuana, and using diet pills, fasting, and purging to lose weight (Manzo, 2015).

The unhealthy weight control was more of a contributing factor among the female adolescents than the male (Manzo, 2015). Therefore, White females had more suicide ideation and behavior predictors than any other group that was observed in this study (Manzo, 2015). Along with the characteristics mentioned above, White females also dealt with lack of personal safety at school, partner victimization, and weapon carrying (Manzo, 2015). Based on a study conducted by Brian Munstanski in 2012 on suicide attempts, Black/African Americans were the largest percentage of the sample at 56.1 percent. Out of 248 youth, 113 were male and 124 were female ages 16-20 with 18 years of age being the mean age of the sample (Munstanski, 2013).

In 2017 Dr. Rheeda Walker completed a study on the correlation of being African American and suicide ideation. Participants were recruited from rural, suburban, and metropolitan communities and one midwestern state to participate in this study (Walker, 2017). Participants were asked a series of questions based on life events such as death/illness in their family or of a close friend, parental divorce, break up with boyfriend/girlfriend, trouble in school or have a close friend move away in the last 12 months (Walker, 2017). Total scores ranged from 0 to 47 where higher numbers indicated more stressful events (Walker, 2017). Results in this study showed that racial discrimination was severely related to extremely higher levels of depression, anxiety, and death ideation (Walker, 2017).

According to the Center for disease control (CDC), since 2010, suicide rates for African American youth have increased dramatically. Whereas in recent years African American adolescents have had significantly lower suicide rates compared to European American adolescents (Walker, 2017).

Sexual Orientation

The LGBTQ community are at a greater risk of suicide ideation and attempts (Munstanski, 2013). Suicide attempts among LGBTQ youth are relatively higher when the youth first come to terms of their sexual orientation to themselves and to the people around them (Munstanski, 2013). Although LGB youth have not been found to be over represented in deaths by suicide, there have been at least 16 studies done on Lesbian, Gay, and Bisexual youth that have reported high rates of suicide attempts ranging from 20 to 53 percent (Munstanski, 2013).

During the duration of this study data was collected twice; once when the participants were recruited, and again after a 12 month follow up with over 91% retention. Participants included male and female adolescents between the ages of 16-20, 47.7% were male, 52.3 % were female, male to female transgender being 5.5 % and female to male transgender being 3.4 percent, gay/lesbian 61.6 %, bisexual 28.7 percent, questioning 9.7%. The results of this study showed that the transgender youth reported having a lifetime of suicide attempt history 52.4% of the time, females reported having a lifetime of suicide attempt history 33.6% of the time, and males reported having a lifetime of suicide attempt history 25% of the time (Munstanski, 2013). Depressive symptoms such as Mood Depressive Disorder (MDD), impulsivity, hopelessness, conduct disorder, and LGBTQ victimization increased the odds of a lifetime suicide attempt by 17 percent and each unit increase in hopelessness more than doubled the odds (Munstanski, 2013).

In and Out of Home Placement

Suicide ideation goes much further when talking about mental health issues and juvenile justice system. One theory suggests that there are three jointly operating conditions that must be fulfilled in order for individuals to be considered high risk for committing suicide which include, failed belongingness, perceived burdensomeness and a habituation to fear and pain involving self-injury (Kretschmar, 2011). Furthermore, even youth and adolescents that have a strong desire to complete suicide, will not be able to do so until all three stages are interconnected (Kretschmar, 2011).

Loneliness and burdensomeness are two huge factors of suicide and suicide ideation among youth and adolescents (Kretschmar, 2011). Loneliness usually begins in childhood, thus adding on difficult circumstances, such as a parental divorce, may further place a negative impact on the child (Kretschmar, 2011). When there is a family disconnect, children may often times project blame onto themselves, and take on feelings of loneliness and worthlessness (Kretschmar, 2011). Additionally, research shows that children who do in fact place blame on themselves develop a higher risk for maladjustment, shame, depression, and anxiety (Kretschmar, 2011).

Youth in the welfare system are exposed to an array of aversive events that increase their risk of emotional and behavioral problems. According to Heather Anderson's research based on her study conducted in 2011, there is no correlation between gender, age, and ethnicity when it comes to suicide ideation (Anderson, 2011). However, there is a significant association between the type of out of home placement and suicide ideation (Anderson, 2011). Youth that were living in a group home were 7.25 times more likely to report suicide ideation compared to youth living in kinship care (Anderson, 2011).

Male youth in the above study were significantly more likely than girls to have clinically significant depressive symptoms at baseline (Anderson, 2011). Among youth in an out of home placement, those youth that were placed in a group home setting were 4.6 times more likely to report suicide ideation than youth placed in kinship care (Anderson, 2011). Results further showed that youth in an out of home placement that had clinically depressive symptoms also reported suicide ideation (Anderson, 2011).

In order to gain a better understanding of the role of displacement regarding suicide ideation and behavior, Kretschmar and Flannery 2011 went a step further and examined youth with mental health issues in the juvenile justice system. In order to comprehend how influential displacement is they investigated three factors, (a) youth reported suicide, (b) self-harm ideation, and, (c) and the caregiver reports for suicide attempts who either were or were not involved in an out of home placement 12 months prior to placement into this program (Kretschmar, 2011). Results on Youth Reported Ideation showed several significant factors of youth's confirmation of suicide ideation (Kretschmar, 2011). Thus, a 1-point increase in total victimization score increased the odds of youth-reported suicide ideation by 8.7% (Kretschmar, 2011). A significant interaction between gender, and mood disorder occurred in this section of the study. For youth without a mood disorder, girls had 402% greater chance of reporting suicide ideation that boys (Kretschmar, 2011).

Additional results of the study mentioned above reported that youth who had not been in an out of home placement within the last 12 months of participating in this study were drastically more likely to report suicide ideation than youth who had been in an out of home placement. The youth that were placed in the program that were a part of the juvenile justice system, and had been placed in an out of home placement were found less likely to report suicide ideation. Displacement was found to be related to lower levels of youth reported suicide ideation (Kretschmar, 2011).

Kretschmar's 2011 study also showed that being a girl and being in an out of home placement was extremely positively correlated with having an Axis I mood disorder. As a result, girls with mood disorders were at an elevated risk for suicidal behaviors (Kretschmar, 2011). The results in Kretschmar's 2011 self-harm ideation further indicated that girls with greater total victimization scores were more likely to report self-harm ideation. There was no significant correlation for out of home placement status.

Suicide Motivation

According to the Center of Disease Control, bullying victimization is a major public health problem in the United States affecting youth from elementary to high school. Bullying is a specific subset of hostile aggression in which there is an imbalance of power with a more powerful person or group attacking a less powerful one (Kodish, 2016). One third of adolescent's report involvement in bullying, and 10 percent of the youth report being victims of bullying (Kodish, 2016).

Most studies that examine the relationship between bullying and suicide risk fail to distinguish between types of bullying, which include verbal harassment, cyber bullying, and physical aggression which are all related to increased suicide risk (Kodish, 2016). Technology has afforded young people a new, and particularly insidious, method of bullying (Litwiller, 2013). Victimization from bullying has been proven to correlate with low self-esteem, anxiety, and depression (Litwiller, 2013). It has been reported in recent studies that between 20-35% of adolescents have stated being involved in bullying as either a bully, victim, or both (Litwiller, 2013).

A study was conducted by Tamar Kodish in 2016 to measure the correlation between suicide risk and attempt. The results of this study showed that bullying was more strongly linked to suicide with patients who had reported more depressive symptoms (Kodish, 2016). Cyber bullying was found to have a positive correlation with suicide in adolescents and mental health issues such as depression and anxiety (Hay, 2009).

The economy also adds to suicide and suicide ideation. Poverty is the greatest problem facing single African American mothers and their children (Kim, 2005). Adolescents who lived in neighborhoods with weak social networks reported higher levels of hopelessness, even after controlling for SES and depression (Perez-Smith, 2002).

Intentional self-harm amongst adolescents has been studied significantly since the early 1960's (Hawton, 2012). Types of self-harm include but is not limited to burning, cutting jumping from heights, poisoning, and self-battery (Kolves, 2017). A significant amount of research has proven that self-harm, suicide and suicide ideation are link closely with depression, anxiety, and low self-esteem (Anderson, 2011). Every year at least 15% of youth and adolescents in the United States commit to or contemplate acts of self-harm and suicide ideation. Factors related to these actions are poverty, race, gender, sexual orientation, and bullying. In order to find yourself contributing to the solution of suicide in youth and adolescents you must gain a better understanding of the problem. Educate yourself, students, children, and youth around you.

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