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Awaiting a Social Awakening: The Alarming Issue of Teenage Suicide

Submitted by on April 7, 2016 – 7:20 PM

Teen-Suicide-Photo-by-Issa-via-FlickerAlong with all the other organs of the body, the human brain too undergoes many changes during the teenage. In the latest five years, specialists, using new progressions, have found that youth’s brains are far less developed than it was considered to be (Herman, 2005). These changes in the brain distinguish them from the mature adults. According to McKenzie (2007), dopamine levels are at peak during the teenage, which leads them to risk taking behaviors. This could be the reason why suicide is the third leading cause of death among teenagers age 15-24.

 

According to Gvion and Apter, (2015) Suicide is characterized as a demonstration of deliberately ending one’s own life. It covers all from suicidal ideations i.e. planning for suicide to suicidal behavior, i.e. attempting a suicide. Teenage suicide, therefore, refers to suicide committed by a teenage age 15 to 18.

 

Pakistan is an Islamic country and Islam strictly prohibits self-harm and suicide yet many newspaper headlines and news channels in Pakistan have reported teenage suicide in the past few years. Khan (2007) says in Pakistan many of the suicide cases do not appear in annual mortality statistics of the country, hence are not correctly reported to world health organization (WHO). According to Ebrahim (2012), in 2002, the World Health Organization evaluated that more than 15,000 suicides were committed in Pakistan.

 

Reading all this stuff, grabbed my attention towards this issue and I often wonder what could lead these young people to such behaviors. What could we do as an individual, as a health care worker and as a community to reduce the increasing rates of suicide in our country? And what interventions have already been taken by our government to reduce these statistics?

 

Dr. Musa Murad Khan, chairman of the psychiatry department at Aga Khan University, talks to Daily Dawn (2012): “If they don’t have the right balance of opportunities, resources and hope, they can get ‘bored’ and feel hopeless”. During my last winter clinical, I encountered a boy aged 15 who was brought to the emergency after ingesting too many pills at once. The father said that in the morning he had scolded his son due to failing in his school exams. He further added that the boy was often bullied by his teachers and harassed by the classmates. History revealed that his uncle had also committed suicide due to loss in his business and his elder sister had also attempted suicide by cutting her wrist after she broke up with her boyfriend.

 

Causes and risk factors of teenage suicide:

There are several factors associated with suicidal behaviors in teenagers. These factors could be classified as biological, psychological and behavioral factors.
Biological factors:

Research suggests decreased levels of CSF 5-hydroxyindoleacetic acid (5HIAA), a metabolite of serotonin leads to suicidal ideations in teenagers (Bridge, Goldstein & Brent, 2006). Neurobiological theory suggests that teenagers with low levels of 5-HIAA are found to use more violent methods for suicide like guns (Stuart &Laria, 2005). Other biological risk factors include gender and sexual orientation.

 

Plöderl et al (2013) describes that, even though girls are more prone to suicidal ideations and attempt, boys are more likely to die of suicidal acts. This may be because boys try out more dangerous methods than the girls. Homosexuals and bisexuals are assumed to be at an increased risk of suicidal behaviors due to rejection from their family and peers (MORRISON & L’HEUREUX, 2001).

 

Social and environmental factors:

Environment has a great influence on a person’s life. Often children who have attempted suicide said that their families are non-cooperative and highly conflicting (Bridge et al, 2006). Development theory suggests absence of important relationships, trouble in looking after connections, sexual issues, and issues with parents often result in suicidal behaviors (Fontaine, 2003). Suicide attempts often result after some stressful life events like loss of a loved one, e.g. parents or close family members, relationship break ups, parental divorce, physical or sexual abuse, and academic failure (Madge et al., 2011).

 

Other social and circumstantional factors may include a family history of suicide. A child who has witnessed suicide attempts within the family is at an increased risk of attempting it (Jackson, 2003) just as the child I observed. That is maybe because they consider suicide as the only solution to get rid of all problems.

 

Gould (2001) says media plays an important role in a teen’s life. It has an important contribution towards teenage suicide statistics. Media reporting of suicide also encourages children towards suicidal ideations. Suicidal planning and methods could easily be accessed on a few internet websites. TV dramas can also influence youths toward suicidal ideations.

 

Moreover, during adolescence, primary focus of attachment shifts from parents to the peers. Therefore, having poor social skill and low self-esteem could negatively influence these children. Feeling of rejection by the peers, social isolation and hopelessness are considered to be closely associated with suicidal ideations (Shah &Punjani, 2014).

 

Psychological factors:

Mental illnesses and psychological problems are reported to be an important risk factor of suicidal behaviors. Studies have shown that up to 90 to 95 percent suicide victims have been diagnosed with psychological problems (Shah &Punjani, 2014). Bridge, Goldstein & Brent (2006) have also reported mood disorders like bipolar disorder to be a risk factor of suicide. Other mental disorders including psychosis, anxiety, depression, antisocial behaviors, post-traumatic stress disorder and eating disorders are also considered to be associated with suicidal ideations. Among these depressions is reported to be most closely associated with suicide (Takahashi, 2001).

 

Suicidal impacts:

Suicide has devastating effects on an individual and the family. In spite of the fact that only 1 in 200 suicide attempts result in death, 33% result in severe injuries that require serious medical attention (Bearman& Moody, 2004). These injuries may include physical damages like broken bones and limbs, physical disabilities, head injuries and brain damages. Moreover, an individual could also have a feeling of guilt and depression towards their actions (Centers for Disease Control and Prevention, 2010).

 

Since every member is important, the surviving family would have a feeling of grief and loss of a loved one and aggression on their actions (Centers for Disease Control and Prevention, 2010). The family would also have a feeling of guilt for being unable to help that individual. Besides the suicide survivors are also stigmatized by the society as it is not yet an acceptable act (Jackson, 2003). I think this could also give suicidal ideations to other children in the society.

 

Besides, Gould, et al. (2004) says that suicide also negatively impacts the victim’s peers. Peers may also adopt some maladaptive behaviors to cope with the loss. According to Feigelman and Gorman, (2008) children who have experienced loss of their friends are reported to end up with many mental health problems like loss and grief, depression and PTSD.

 

Measures taken by Pakistani government to prevent teenage suicide

As Pakistani laws are made according to Islamic tenets, suicide and deliberate self-harm (DSH) are considered as illegal acts in the country. People who make such attempts would either be imprisoned or charged a penalty for their acts. Few hospitals of the country are designated as medico-legal centers (MLCs) which deal in such cases (khan, 2007).

 

Every year on 10th September, International Association for Suicide Prevention (IASP), celebrates “World Suicide Prevention Day” and plan various activities all throughout the world. In the past four years, normal exercises have been held to avoid DSH and suicide attempts in Pakistan. In 2009, the first National Seminar on Suicide Prevention was organized in Karachi. The primary point was to highlight the truth that DSH and suicides are expanding in Pakistan (Shahid, 2013).

 

Recommendations

Since teenage suicide is a major public health problem in Pakistan and also worldwide, it is important to pay attention to such issue. CARE framework can help resolve this issue (McAllister & Walsh, 2003). Control (C) indicates keeping up client’s security. As self-destructive ideations are unpredictable, it can play a vital role to guarantee the client’s well-being, and encourage him to vent-out his feelings. Awareness (A) indicates increasing knowledge about the reasons which raise self-destructive acts; along these lines, empowerment to reflect and admit those reasons. Resilience (R) indicates thinking so as to change self-destructive ideations into survival pictures hopefully and investigating concealed possibilities. Engagement (E) connotes adapting new adapting aptitudes that reduce self-destructive feelings and help to oversee issues (McAllister & Walsh, 2003).

 

According to AMERICAN ACADEMY OF PEDIATRICS, (2000) to prevent their young ones from taking such actions parents should be supportive and encourage their children during difficulties and in decision making. They should trust their children and should talk to their children about matters like suicide in a non-judgmental manner. Things that could help children harm themselves, e.g. guns and drugs, should be kept away from children. Schools can also help to decrease teenage suicide through providing a supportive environment to the students. Moreover, I think teachers should also talk about topics like positive coping strategies and stress management skills to the students.

 

As a health care provider, we can teach coping strategies to our clients and could also organize programs to provide awareness in the community regarding this suicide and other mental health issues which can lead to suicide. We should not be judgmental to the clients who attempt suicide. Instead we should help these patients to ventilate their feelings to help them cope positively with their problems. We can also counsel their parents and can guide them about suicide. We should also recommend psychotherapies like cognitive behavior therapy and dialectical behavior therapy to these patients for their better management.

 

Since the media has a great influence on today’s generation, it should not provide a fake image of ‘suicide as the easiest solution to all problems’. Rather, it should discourage suicide by providing all its negative impacts to the viewers.

 

Shahid (2013) suggests that the government of Pakistan should make some community based institutions like SNEHA working in India and Sumithrayo Befrienders that is working in Sri Lanka which could help these teenagers against these suicidal ideations. Moreover, in my opinion due to the criminalization of suicidal acts, individuals do not report suicidal attempts. This guards them against taking interventions for the problem. The new Mental Health Ordinance, 2001 that annul the Lunacy Act of 1912 has been a stage forward and accommodates a psychiatric appraisal of survivors of suicide endeavors.

 

Section 49 of the Ordinance relates to suicide and DSH and states a man who endeavors suicide might be surveyed by a sanction specialist and if observed to be experiencing a mental issue should be dealt with properly under the procurement of this Ordinance (Khan, 2007).

 

In conclusion, teenage suicide is an alarming issue on the rise globally and it is mainly due to poor coping mechanism of an individual. This act not only affects the individual, but influences the entire family and society. Keen attention should be given to resolve this issue. CARE framework and other individual, family and community based interventions and psychotherapies could help reduce its burden to a great extent.

 

References:
AMERICAN ACADEMY OF PEDIATRICS,. (2000). Suicide and Suicide Attempts in Adolescents. PEDIATRICS, 105(4).
Bearman, P., & Moody, J. (2004). Suicide and Friendships Among American Adolescents. American Journal Of Public Health, 94(1).
Bridge, J., Goldstein, T., & Brent, D. (2006). Adolescent suicide and suicidal behavior. J Child Psychol&Psychiat, 47(3-4), 372-394. doi:10.1111/j.1469-7610.2006.01615.x
Centers for Disease Control and Prevention,. (2010). Understanding Suicide. Retrieved 21 August 2015, from http://www.cdc.gov/ViolencePrevention/Suicide-FactSheet
Ebrahim, Z. (2012). The alarming rise of teenage suicides in Pakistan. DAILY DAWN. Retrieved from http://www.dawn.com/news/724902/the-alarming-rise-of-teenage-suicides-in-pakistan
Feigelman, W., & Gorman, B. (2008). Assessing the Effects of Peer Suicide on Youth Suicide. Suicide And Life-Threatening Behavior, 38(2), 181-194. doi:10.1521/suli.2008.38.2.181
Fontaine, L. K. (2003). Mental health nursing.(5th ed.). New jersey: Prentice Hall. P. 601
Gould, M.S. (2001). Suicide and the media. In H. Hendin, & J.J. Mann (Eds.), The clinical science of suicide prevention (pp. 200-224). New York: Annals of the New York Academy of Sciences.
Gould, M.S., Drew, V., Kleinman, M., Lucas, C. Thomas, J.G. & Chung, M. (2004) Teenagers’
attitudes about coping strategies and help-seeking for suicidality. Journal of the American
Academy of Child and Adolescent Psychiatry. 43, 1124-1133.
Gvion, Y. and Apter, A. (2015). Suicide and Suicidal Behavior. Public Health Reviews, 34(2).
Herrman, J. (2005). The teen brain as a work in progress. Pediatric Nursing, 31, 144–148
Jackson, J. (2003). A Handbook for Survivors of Suicide. Washington D.C: American Association of Suicidology.
Khan, M. (2007). Suicide Prevention in Pakistan: an impossible challenge?. J Pak Med Association, 57(10).
Madge, N., Hawton, K., McMahon, E., Corcoran, P., De Leo, D., & de Wilde, E. et al. (2011). Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study. European Child & Adolescent Psychiatry, 20(10), 499-508. doi:10.1007/s00787-011-0210-4
McAllister, M., & Walsh, K. (2003). CARE: a framework for mental health practice. Journal Of
Psychiatric And Mental Health Nursing, 10(1), 39–48.
McKenzie, M. (2007). why do teens make such bad decisions?. EMORY MEDICINE. Retrieved from http://www.whsc.emory.edu/_pubs/em/2007winter/pdfs/TEENSLowres.pdf
MORRISON, L., & L’HEUREUX, J. (2001). Suicide and gay/lesbian/bisexual youth: implications for clinicians. Journal Of Adolescence, 24(1), 39-49. doi:10.1006/jado.2000.0361
Plöderl, M., Wagenmakers, E., Tremblay, P., Ramsay, R., Kralovec, K., Fartacek, C. and Fartacek, R. (2013). Suicide Risk and Sexual Orientation: A Critical Review. Arch Sex Behav, 42(5), pp.715-727.
Shah, M., &Punjani, N. (2014). Suicide in Teenagers and Its Related Determinants in Developing Countries. International Journal Of Science And Research (IJSR), 3(6).
Shahid, M. (2013). Deliberate Self Harm Prevention in Pakistan. Journal Of The College Of Physicians And Surgeons Pakistan, 23(2).
Stuart, G.W. &Laraia, M.T. (2005).  Principles and practice of psychiatric nursing (8th ed.).  St. Louis:  Mosbyp.393
Takahashi, Y. (2001). Depression and Suicide. Journal of the Japan Medical Association, 44(8).

 

 

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