Youth Suicides in Canada and elsewhere

Youth Suicide report - Canadian Task Force on Preventive Health Care

Prevention of Suicide

Prepared by Jane E. McNamee, MA, Research Associate, Department of Psychiatry, Chedoke McMaster Hospitals and David R. Offord, MD, FRCPC, Professor of Psychiatry, McMaster University, Hamilton, Ontario

Objective

To make recommendations regarding routine evaluation of suicide risk in individuals from high-risk groups, and interventions to prevent suicide in these individuals. This updates a 1990 report.

Burden of Suffering
Suicide has accounted for about 2% of annual deaths in Canada since the late 1970s. Eighty percent of all suicides reported in 1991 involved men. The male:female ratio for suicide risk was 3.8:1. In both males and females, the greatest increase between 1960 and 1991 occurred in the 15-to-19-year age group, with a four-and-a-half-fold increase for males, and a three-fold increase for females.

Read the report: Canadian Task Force on Preventive Care 2003

The Canadian Mental Health Association / L'Association Canadienne Pour La Sant Mentale

Reflections on Youth Suicide

Adolescence is a time of dramatic change. The journey from child to adult can be complex and challenging. Young people often feel tremendous pressure to succeed at school, at home and in social groups. At the same time, they may lack the life experience that lets them know that difficult situations will not last forever. Mental health problems commonly associated with adults, such as depression, also affect young people. Any one of these factors, or a combination, may become such a source of pain that they seek relief in suicide. Suicide is the second leading cause of death among young people after motor vehicle accidents. Yet people are often reluctant to discuss it. This is partly due to the stigma, guilt or shame that surrounds suicide. People are often uncomfortable discussing it. Unfortunately, this tradition of silence perpetuates harmful myths and attitudes. It can also prevent people from talking openly about the pain they feel or the help they need.

Communication is the first essential step in assisting youths at risk of suicide. Learning the facts about suicide can help build a parent's confidence in discussing a difficult subject.

SOME MYTHS ABOUT SUICIDE

Myth: Young people rarely think about suicide.
Reality: Teens and suicide are more closely linked than adults might expect. In a survey of 15,000 grade 7 to 12 students in British Columbia, 34% knew of someone who had attempted or died by suicide; 16% had seriously considered suicide; 14% had made a suicide plan; 7% had made an attempt and 2% had required medical attention due to an attempt.

Myth: Talking about suicide will give a young person the idea, or permission, to consider suicide as a solution to their problems.
Reality: Talking calmly about suicide, without showing fear or making judgments, can bring relief to someone who is feeling terribly isolated. A willingness to listen shows sincere concern; encouraging someone to speak about their suicidal feelings can reduce the risk of an attempt.

Myth: Suicide is sudden and unpredictable.
Reality: Suicide is most often a process, not an event. Eight out of ten people who die by suicide gave some, or even many, indications of their intentions.

Myth: Suicidal youth are only seeking attention or trying to manipulate others.
Reality: Efforts to manipulate or grab attention are always a cause for concern. It is difficult to determine if a youth is at risk of suicide All suicide threats must be taken seriously.

Myth: Suicidal people are determined to die.
Reality: Suicidal youth are in pain. They don't necessarily want to die; they want their pain to end. If their ability to cope is stretched to the limit, or if problems occur together with a mental illness, it can seem that death is the only way to make the pain stop.

Myth: A suicidal person will always be at risk.

Reality: Most people feel suicidal at some time in their lives. The overwhelming desire to escape from pain can be relieved when the problem or pressure is relieved. Learning effective coping techniques to deal with stressful situations can help.

WHO IS AT RISK

In Canada, suicide is the second highest cause of death for youth aged 10-24. Each year, on average, 294 youths die from suicide. Many more attempt suicide. Aboriginal teens and gay and lesbian teens may be at particularly high risk, depending on the community they live in and their own self esteem.

Suicide is a complex process. The cause can seldom be attributed to one single factor, such as the death by suicide of a rock star or family break-up. It may be a routine event or an overwhelming one that overloads a vulnerable youth's coping mechanisms. As well, new research suggests that there may be a genetic link to suicide. A family history of suicidal behaviour should be taken into account, if for no other reason than the young person may have been affected by this behaviour in the past.

Suicidal youth rarely make a direct plea for help. But most will exhibit warning signs. Here are some of these signs:

• Sudden change in behaviour (positive or negative)
• Apathy, withdrawal, change in eating patterns
• Unusual preoccupation with death or dying
• Giving away valued personal possessions
• Signs of depression; moodiness, hopelessness
• One or more previous suicide attempts
• Recent attempt or death by suicide by a friend or a family member

TALKING ABOUT TEEN SUICIDE

Warning signs are an invitation to communicate. A direct, straightforward response is most effective. Ask your child if he or she is contemplating suicide; no matter what you hear, try not to be judgmental, shocked or angry. Do not communicate your personal attitudes about suicide; instead, offer support and reassurance that suicidal feelings do not last forever. Seek the assistance of a trained professional as soon as possible.

Your child's school may have protocols to follow in the case of a suicide attempt or death by suicide. It is important that the suicide is not romanticised or glamourised. Instead, teachers are encouraged to discuss with students the characteristics and events that can lead to suicide, and to explore with them all the other options that exist. But school should not be the only source of help. For parents, an attempted suicide or death by suicide in their child's circle of friends presents an opportunity to explore their child's stress levels and methods of coping. Dramatic statements emphasising the parent's horror and fear "of suicide are best avoided. It is more effective to express a willingness to talk and to be supportive, no matter what may be happening in the child's life Canadian Mental Health Association - Youths and Suicide Pamphlet PDF

• Epidemiology of Teen Suicide
• Ten Tips for Working With Suicidal Teen
• Anxiety, Panic, AgitationB But Not Suicide IdeationB Tied To Suicide Risk(2 copies)
• YOUTH NET - Intr. Info. Package for Professionals
• YOUTH NET - Info. Package for Professionals
• YOUTH NET - Introduction Information Handout for Youth
• Getting a Youth Net Started in your Community
• YOUTH NET- Youth Handout
• The Relationship Between Posttraumatic Stress Symptomatology and Suicidal Behavior in School-Based Adolescents.
• Resilience and Vulnerability among Preschool Children: Family Functioning, Temperament,  and Behavior Problems
• The Resilient Child
• Suicide in Children, Adolescents and Seniors: Key Findings and Policy Implications
• Teen Suicide: A Tragic Puzzle
• Big. Bad. Bully.
• Resilience and Coping in Children at Risk
• Family Risk Factors for Child and Adolescent Suicidal Behavior
• Suicide Prevention
• Children not immune to deadly depression: Doctors now know even the very young can be suicidal
• The Homosexuality Factor In Youth Suicide Problems
• What to do if someone you know becomes Suicidal
• Why Talk to your Students about Depression?
• What to do if a Friend has Depression: a Guide for Students
• Depression can strike anyone
• Questions most frequently asked after hearing presentations on depression & suicide awareness conducted by sa\ve=s speakers bureau
• Facts for Families : Teen Suicide
• My Best Friend Committed Suicide
• Suicide in Young People
• Youth Suicide - An Overview
• Youth Profile
• Legacy of the Yellow Mustang
• Current Issues in Dealing with Suicide Prevention in Schools: Perspectives from some Countries.
• Project SOAR: A Training Program to increase School Counselors= Knowledge and Confidence regarding Suicide Prevention and Intervention.
• Suicide Prevention: A Classroom Presentation to Adolescents.
• Developing a Comprehensive School Suicide Prevention Program.
• Preliminary Effects of Brief School-Based Prevention Approaches for reducing Youth Suicide - Risk Behaviors, Depression, and Drug Involvement.
• Evaluation of Indicated Suicide Risk Prevention Approaches for Potential High School Dropouts.
• Risks to Students= Lives: Setting Priorities.
• Adolescent Suicide Prevention: School Psychologists' Acceptability of School Based Programs.
• Are Teachers of Children and Young Adolescents Responsive to Suicide Prevention Training Modules? Yes
• Youth Suicide Prevention A Framework for British Columbia 1998.
• Kant reed or spl gud, knt wanta liv: Youth, Learning Disabilities and Suicide.
• The growing problem of youth suicide.

Youth Suicide in the United States

Explaining the Rise in Youth Suicide (Harvard University discussion paper) PDF by David M. Cutler, Edward L. Glaeser, and Karen E. Norberg of Harvard Institute of Economic Research, Discussion Paper Number 1917, March 2001. - An interesting paper

Abstract:
Suicide rates among youths aged 15-24 have tripled in the past half-century, even as rates for adults and the elderly have declined. And for every youth suicide completion, there are nearly 400 suicide attempts. This paper examines the dynamics of youth suicide attempts and completions, and reaches three conclusions. First, we suggest that many suicide attempts by youths can be viewed as a strategic action on the part of the youth to resolve conflicts within oneself or with others. Youths have little direct economic or familial power, and in such a situation, self-injury can be used to signal distress or to encourage a response by others. Second, we present evidence for contagion effects. Youths who have a friend or family members who attempts or commits suicide are more likely to attempt or commit suicide themselves. Finally, we show that to the extent we can explain the rise in youth suicide over time, the most important explanatory variable is the increased share of youths living in homes with a divorced parent. The divorce rate is more important for suicides than either the share of children living with step-parents or the share of female-headed households.  View Explaining the Rise in Youth Suicide (Harvard University discussion paper) PDF

Children from single-mothers households (compared to children of two parent households) are five times more likely to commit suicide.

Youth Suicide in the U.K.

Rates are highest among young men

The London Times, UK, by STEWART TENDLER, November 09, 2004

SUICIDES accounted for 13 per cent of the 27,100 inquest verdicts in England and Wales last year, with 2,511 men killing themselves compared with 744 women.

The highest ever suicide numbers occurred around 1931, at the start of the Depression, when rates for the older age groups were higher than those of the youngest groups. However, since the end of the 1950s there has been a marked increase in suicide death rates in people aged 15 to 24 and a sharp decline in those over 44.

Last year's total figures were the second lowest since 1988, and since the 1990s the number has always remained below 4,000. Young men are the most likely to kill themselves, according to figures from the Office for National Statistics. Young women aged 15-44 had the lowest suicide rate between 1979 and 2001.

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'Mood' enzyme linked to suicide

BBC, UK, July 5, 2004

Protein kinase C activity was lower in teens who committed suicide. The activity of a brain enzyme thought to affect mood may be reduced in teens who commit suicide, according to US researchers.

Dr Ghanshyam Pandey and colleagues at the University of Illinois at Chicago examined the brains of 34 teenagers who had died - 17 by suicide.

Protein kinase C (PKC) activity levels were much lower in the suicide victims' brains.

The findings are reported in Archives of General Psychiatry.

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Reasons Why Young Men Commit Suicide

By John von Radowitz, Science Correspondent, PA News, September 28, 2003

Broken marriages, living a single life and lack of income are the three factors chiefly to blame for a surge in suicides among young men, a new study has shown.

Suicide rates in England and Wales have doubled for men under 45 since 1950, but declined among women and older age groups of both sexes.

Researchers trying to discover why found that between 1950 and 1998 there were worsening trends for many suicide risk factors.

These included marital break up, birth and marriage declines, unemployment and substance abuse.

But those most associated with young men aged 25 to 34 were divorce, fewer marriages, and increases in income inequality.

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Study: Young white men face higher suicide risk

Legal issues and relationship problems were main reasons for those taking their lives.

The Indianapolis Star, Staff Report, November 23, 2002

White men younger than 65 are most likely to commit suicide in Indianapolis, often because of relationship or legal problems, according to a new study that examined four years of data in Marion County.

Health officials said Friday they hoped the findings would help them develop ways to prevent suicide, which they termed an epidemic in Indiana.

"We wanted to get a better idea of educational or intervention services to focus on," said Lori Lovett, director of the Indiana Suicide Prevention Coalition.

The coalition was formed last year after the U.S. surgeon general released a national strategy for suicide prevention and encouraged states to develop plans. Indiana's plan is expected to be completed within a year, Lovett said, and would focus on increasing funding and raising awareness of suicide prevention.

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Invisible Suicides

The Ottawa Citizen, by Jeffrey Asher, May 16, 2002

StatsCan recently reported on a 10% increase in suicides. But StatsCan persists in ignoring the group of Canadians at greatest risk for suicide, as do the media and professional reports. Suicide is a microcosm for those most under stress and most at risk of unresolved crisis in society. Suicides may logically be categorized as 100% citizens of Canada, and then as 79% male. The most critical measure of depression - suicide - is counted overwhelmingly in male corpses. For over 23 years widespread media and professional attention concentrated on 12,500 AIDS deaths, compared to little concern with 92,000 suicides.

Every three hours in Canada, another male kills himself. In the 1990s, at least 800 females ended their lives along with 3200 males. From 1960 to 1980 male suicides in the 20 - 24 age group increased by over 200%. After age 70, women's suicide rates decline gradually, but men's rates, already five times higher, rise another 50%. This startling male suicide data should have raised alarms decades ago among researchers and journalists across Canada. The absence of widespread prevention campaigns to save lives from more than 4000 suicides every year seems incomprehensible.

Health Canada's "Suicide 1995" report Health Canada refers to suicides in mostly gender-neutral terms. Special sections were devoted to "High Risk Groups": aboriginal communities, gay men and lesbians, and persons in custody. Combined, they receive 6.5% of the report, but are less than 1% of suicides. Throughout the report, females receive 34% of the report text, and constitute 21% of all suicides. Males receive 11% of the text, and are 79% of all suicides. The media follow Health Canada's lead, and their few articles on suicide describe suicide victims in terms of geography, age and ethnicity, but rarely as four males for each female.

A shortened life span and high suicide rates are understood world-wide as indicators of neglect of mental and physical health and destructive social stresses. Decades of media, legal and government campaigns have humiliated and demonized men. Those men are not strangers. They are your grandfathers, fathers, uncles, sons, lovers, co-workers, and friends. In old-age homes across the country, women outnumber men over five to one. Ask those widows about the early deaths of the men they loved.

Men are still defined by their incomes. A man is expected to preserve his wife and children from the insecurity and deprivations caused by poverty. The media and social scientists have yet to examine the burdens on men of an unpredictable economy. Husbands and fathers blame themselves for low income, job loss, bankruptcy, and family poverty. If he cannot provide adequately for his family, a man loses the central definition and meaning for his life.

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Suicide study surprises
Males in their mid-forties most likely to take their lives, Ontario group finds

The Globe and Mail. By DAWN WALTON, November 29, 2001 Print Edition, Page A10

Middle-aged men in Ontario are more likely to kill themselves than die in car crashes or succumb to other injuries, a national health agency reported yesterday.

The non-profit Canadian Institute for Health Information found that 1,012 people killed themselves in that province in 1998-99, but the vast majority of them -- 79 per cent -- were men with an average age of 44.

"The common perception is that suicide is something that affects teens and young men more than anything," said Greg Webster, the institute's manager of clinical registries. "We did find it surprising that for middle-aged men [aged 35 to 64], it was the leading cause of injury-related death."

Mr. Webster speculated that the Ontario findings would likely apply across the country. But because each province and the federal government gather data independently, it's not clear whether suicide would be the leading cause of injury-related death for men in mid-life across the country.

The institute, which has offices in Ottawa, Toronto and Vancouver, is now working with medical examiners across the country and Statistics Canada to design a nationwide survey.

According to Statscan data for 1997, the highest rates of suicide -- about 25 per 100,000 people -- was among men aged 20 to 64.

That compared with the highest suicide rate for women -- 7.6 per 100,000 people -- among those aged 45 to 64, according to Statscan. According to the institute's data for Ontario, suicide is not the leading cause of injury-related death for women in any age group.

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Health boards publish suicide study

Radio Telefs ireann (RT) is the Irish Public Service Broadcasting Organisation, November 22, 2001

A new national study on suicide has identified a need to improve men's skills in dealing with emotional problems and life crises. The study, commissioned by the country's health boards, found that mental health disorders, especially depression, are the highest risk factors for suicide. It said that young men, in particular, need help to improve their skills in dealing with emotional problems.

This latest study investigated the circumstances surrounding over 800 suicides which occurred in 1997 and 1998. In recent years, suicide has become the principal cause of death in men aged between 15 and 34 years, surpassing the number of deaths from road traffic accidents.

Data from coroners, Garda reports, doctors and families was used to detail the circumstances, five times more men died from suicide than women, and 40% of the deaths were men aged 30 or under.

The report said that the strong protective effect of marriage, as found in other studies, was confirmed in this research. Single, separated, divorced or widowed people had higher rates of suicide.

Depression remains the highest risk factor for suicide, almost a third of those treated as in-patients for mental illness died within three months of discharge. The research also found that relationship problems were the most common recent significant event prior to death.

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Children not immune to deadly depression
Doctors now know even the very young can be suicidal

The Ottawa Citizen, Sharon Kirkey, Tuesday June 13, 2000

Children don't get depressed. That used to be the thinking. Years ago, child psychiatrists never thought to even ask about suicidal thoughts or behaviour in children, because "depression" was an adult word.

Today, doctors are seeing depressed children as young as three.

"They show it in strange ways," says Dr. Philip Cheifetz, a child psychiatrist and assistant professor of psychiatry at the University of Ottawa. "They show it in their anger, in their feistiness and sulkiness," he says, in irritability and a lack of interest in the world around them.

On Friday, Marc Allaire found his son dead in a small wooden cabin near the family's Buckingham home. Philip, who would have been 12 years old today, had hanged himself.

Lately, Philip had been plagued by a series of bad marks and risked failing the school year, Mr. Allaire said. "It became a big part of conversations."

Always a perfectionist, Mr. Allaire said, his son could not do things halfway.

"It was everything or nothing at all," he said. "He would get discouraged pretty easily. I guess he wanted to send a message that he could no longer deal with things."

Not only is it well recognized in psychiatry today that depression can strike in childhood, "we know that some little children will report -- if you ask them -- suicidal ideas," Dr. Cheifetz says.

Not three-year-olds, he stressed. But "there are kids of 10 and 11 who, because of various reasons, either because they've heard about (suicide), or they know about a suicide in their family, will say, 'Yes, I've thought about death. I've thought about killing myself.' "

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Quebec men more likely to commit suicide than women

Rate is especially high among baby boomers, statistics reveal

The National Post, The Gazette, Montreal, Lynn Moore, Monday, February 15, 1999

Women in Quebec talk more about it, but when it comes to doing it -- committing suicide -- it's men who actually do the deed. It's a gender gap that needs explaining, say suicide prevention experts who point to statistics that show 80% of Quebec suicides are male.

"The high rate of male suicide is becoming a pressing public heath issue," Louise Levesque, head of the Association Quebecoise de suicidologie, said yesterday during a press conference to launch Suicide Prevention Week.

Of the 1,351 Quebecers who committed suicide in 1997, 1,071 were male and 280 were female, said Pierre Morin, Quebec's chief coroner, citing the most recent figures available.

Especially alarming is the high suicide rate among male "baby boomers," Mr. Morin said. Almost 2,000 men, aged 35 to 50, committed suicide during the last five years for which statistics are available, he said.

According to Statistics Canada, Quebec has the highest rate of suicide of any province and that is nothing to be proud of, said Gilles Baril, Quebec's junior health minister.

"We have to get to the point where suicide is not seen as an acceptable solution to end a person's suffering," Mr. Baril said.

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