Suicidal tendency in youth in relation to their gender

TABLE OF CONTENT

1. Abstract

2. Introduction

3. Review of literature

4. Significance of the Study

5. Objectives

6. Hypothesis

7. Methodology

8. Result and Discussion

9. Conclusion

10. Limitations

11. Suggestions

12. References

1. ABSTRACT

Abstract

The suicide rate among children and adolescents in the world has increased dramatically in recent years and has been accompanied by substantial changes in the leading methods of youth suicide, especially among young girls. Much work is currently underway to elucidate the relationships between psychopathology, substance use, child abuse, bullying, internet use, and youth suicidal behavior. Recent evidence also suggests sex- specific and moderating roles of gender in influencing risk for suicide and suicidal behavior.

Suicide is the third leading cause of death among adolescents in the world, accounting for 11% of all deaths to youth ages 12 to 19 between 1999 and 2006 (Minino 2010), and rates of attempting suicide and of suicidal ideation are higher than those of completed suicide. According to the Centers for Disease Control and Prevention (CDC; 2014), each year, 157,000 youth between the ages of 10 and 24 receive medical care at emergency departments for self-inflicted injuries. Data from the 2011 National Youth Risk Behavior Survey show that 16% of youth reported seriously considering suicide, 13% reported creating a plan, and 8% reported trying to take their own life in the 12 months preceding the survey (Crosby et al. 2011). The bulk of existing research on adolescent suicide focuses on psychological explanations and on individual-level risk factors for suicide, including mental health, substance use patterns, and exposure to traumatic life events, such as sexual abuse (e.g., Cash and Bridge 2009; Epstein and Spirito 2010; Hansen and Lang 2011; Molina and Duarte 2006). This work is critical because it identifies individuals who may be at the greatest risk of suicide and provides clear intervention strategies to address individuals’ unique paths to suicidal ideation. However, this approach obfuscates some of the larger (and harder-to-assess) social factors that may be at the root of suicide risk across populations. Social and cultural forces play an enormous role in suicide behaviors (Institute of Medicine 2002)—a perspective dating back to Emile Durkheim’s 1897 book Suicide: A Study in Sociology, which characterized the relatively stable rates of suicide within societies as a “social fact” and identified some of the social mechanisms that lead to higher or lower. Suicide is the third leading cause of death among adolescents in the world, accounting for 11% of all deaths to youth ages 12 to 19 between 1999 and 2006 (Minino 2010), and rates of attempting suicide and of suicidal ideation are higher than those of completed suicide. According to the Centers for Disease Control and Prevention (CDC; 2014), each year, 157,000 youth between the ages of 10 and 24 receive medical care at emergency departments for self-inflicted injuries. Data from the 2011 National Youth Risk Behavior Survey show that 16% of youth reported seriously considering suicide, 13% reported creating a plan, and 8% reported trying to take their own life in the 12 months preceding the survey (Crosby et al. 2011).

Keywords: suicide, adolescents, youth, risk factors, epidemiology, attempted suicide

2. INTRODUCTION

Introduction:

Suicide is the taking of one’s own life. It is a universal concept and happens all over the world. Ahrens, Linden, Zaske and Berzewski (2000) define suicidal behavior as ranging from feeling that life is not worth living to thoughts of suicide and suicidal acts. According to Durkheim (as cited in Williams, 1997) there are three types of suicide. In other words three categories, which reflect a breakdown in the relationship between the individual and society. Egoistic suicide incorporates the notion that an individual has no concern for their community and no interest in being involved in it. There is a lack of meaningful social interactions and therefore a low level of social integration, as exemplified in urban areas, as opposed to rural areas. Madu and Matla (2003) studied the prevalence of suicidal behaviors among secondary school adolescents in the Limpopo province and found that rates of attempted suicide were highest in urban areas. This fits with the above theory as urban areas and townships are known for low adherence to cultural and traditional values. This causes acculturation, which is the breakdown of family ties and an increase in social misconduct, leading to egoistic suicide. However, this study found no significant relationship between places of residence and plans to commit suicide or attempted suicide. In systems (families) 10 where the boundaries between the system and the surrounding community are impervious, the family becomes isolated from the social environment in which they exist (Barker, 1992). This has potentially negative effects on the adolescent, who is struggling to develop an independent autonomy. Altruistic suicide is when society has a strict hold over the individual, giving the person too little individualism. In this situation the family system has highly permeable boundaries, making the family and the individuals within the family highly susceptible to events and changes within their wider social environment (Barker, 1992). In both of the above-mentioned cases, the adolescent may have trouble disengaging from the family and developing an independent identity because of either too much or too little influence from the wider social environment. Durkheim defined Anomic suicide as a self-annihilation triggered by a person's inability to cope with sudden and unfavorable change in a social situation (Davison & Neale, 2001). Anomic suicide includes a situation where an individual is socially isolated from significant others. This may occur for reasons including changes in family structures and reduced employment opportunity. The individual does not benefit from societal normative restraints because they no longer participate in society. Although the above are sociological explanations for suicide, they correlate with the reasons and risk factors for suicidal behavior. The above explanations show how the boundaries between the family system and the wider social environment pose challenges to the adolescent living within the family, in terms of building a healthy autonomous identity and disengaging from the family, in order to become an independent individual. The challenges these adolescents face, within the above-11 mentioned scenarios, often result in feelings of hopelessness and helplessness, associated with depression, which in turn is associated with suicidal behavior, including suicide ideation. A study by Huff (1999) identified factors that related to adolescent stress and predicted suicide ideation in these individuals. These factors included depression, family disruption, poor grades and drug and alcohol abuse. These findings are consistent with theory that speaks about the individual being interconnected with their environment and it is a combination of many internal and external factors that bring about stress for the developing adolescent. Although the link between hopelessness, depression and suicide has been stressed above, it is important to be aware, that the common psychological assumption that depression causes suicide, is more complex than this one-to-one association. Zhang and Jin (1996) speak about a model that integrates individual characteristics (depression and attitudes toward suicide) and social structural characteristics (including gender and family cohesion). This model assumes that suicide ideation is an individual behavior that is influenced by social structure, both directly and indirectly through individual attitudes and behaviors. Suicide ideation is predicted simultaneously by the two characteristics mentioned above. A theoretical model such as this fits quite well with Durkheim’s explanations of suicide, involving the individual within a society or community. De Man, Labreche- Gauthier and Leduc (1991, as cited in De Man and Leduc, 1993) found that adolescents from controlling backgrounds reported low levels of self-esteem and high levels of stress, depression and anomie. In a later study by De Man and Leduc (1993) they found that suicide 12 ideation among adolescents was positively related to depression, negative stress, and drug and alcohol abuse and negatively related to self-esteem, satisfaction with social support and school absenteeism. It is evident that risk factors leading to suicide ideation and ultimately suicide, take the form of both individual and environmental factors. It is impossible to isolate one group of factors. The risk factors for suicide ideation among adolescents must rather be seen as interplay of many factors within different areas.

Suicide is the third leading cause of death among adolescents in the world, accounting for 11% of all deaths to youth ages 12 to 19 between 1999 and 2006 (Minino 2010), and rates of attempting suicide and of suicidal ideation are higher than those of completed suicide. According to the Centers for Disease Control and Prevention (CDC; 2014), each year, 157,000 youth between the ages of 10 and 24 receive medical care at emergency departments for self-inflicted injuries. Data from the 2011 National Youth Risk Behavior Survey show that 16% of youth reported seriously considering suicide, 13% reported creating a plan, and 8% reported trying to take their own life in the 12 months preceding the survey (Crosby et al. 2011). The bulk of existing research on adolescent suicide focuses on psychological explanations and on individual-level risk factors for suicide, including mental health, substance use patterns, and exposure to traumatic life events, such as sexual abuse (e.g., Cash and Bridge 2009; Epstein and Spirito 2010; Hansen and Lang 2011; Molina and Duarte 2006). This work is critical because it identifies individuals who may be at the greatest risk of suicide and provides clear intervention strategies to address individuals’ unique paths to suicidal ideation. However, this approach obfuscates some of the larger (and harder-to-assess) social factors that may be at the root of suicide risk across populations. Social and cultural forces play an enormous role in suicide behaviors (Institute of Medicine 2002)—a perspective dating back to Emile Durkheim’s 1897 book Suicide: A Study in Sociology, which characterized the relatively stable rates of suicide within societies as a “social fact” and identified some of the social mechanisms that lead to higher or lower.

Suicide rates across societies. In other words, it is important to recognize that suicide is not only an individual but a societal problem (Stack 2000; Wray, Colen, and Pescosolido 2011). A large body of sociological work has examined compositional and cultural factors unique to particular societies that may help to explain the social determinants of suicide, but few studies have examined how the gendered social context may enhance or suppress suicidal ideation among adolescents. We aim to build on previous work that documents the influence on suicide mortality of gender composition (Gunnell et al. 2003; Phillips 2013) and the gendered context as a form of social integration (Krull and Trovato 1994; Pampel 1998; Stockard and O’Brien 2002) and in particular on work that considers the impact of the gendered context as a form of social regulation that affects suicide (Aliverdinia and Pridemore 2009; Zhang 2010). In this paper, we use the National Longitudinal Study of Adolescent Health (Add Health) to develop a measure of gendered context that characterizes social differences in the regulating aspects of gender in different U.S. states. We compare this state- level measure to statelevel indicators of suicidal ideation among female and male youth and then examine the differential influence of that context on youth suicidal ideation at the individual level. We find that the most highly gendered states are also those that have the highest rates of suicidal ideation. This suggests a link between overregulation and suicidal ideation and potentially extends Durkheim’s thesis beyond enacted behavior to emotional states.

Attempted suicide refers to the failed attempt to take ones life. It is the intention of the individual to take their own life, but for whatever reason, the attempt fails. This differs from parasuicide, which is distress behavior (Pillay and Schlebusch, 1987). It is a cry for help. The individual intends to inflict self-harm upon themselves without fatal injuries. It has been found by, MacLeod, Pankhania, Lee and Mitchell (1997, as cited in O’Connor, Connery and Cheyne, 2000) that individuals who engage in deliberate self- harm irrespective of intention are impaired in their ability to generate positive future thoughts, when compared to controls drawn from either hospital or non-hospital settings. MacLeod (1992, as cited in Williams and Pollock, 1993) found that while both parasuicide and completed suicide are related to depressive experiences, they differ to the degree of anger expressed. Parasuicide is related to the experience of anger, whereas suicide is more related to giving up. Suicidal people are often poor at solving interpersonal problems. Hopelessness mediates the relationship between depression and suicidal intent within a parasuicide population. Hopelessness has also been found to predict repetition of parasuicide six months later. These results 13 indicate that it is a different population that would commit suicide to those that would commit a parasuicide.

The Suicidality/Depression Link

Psychological autopsy studies have shown a substantial link between clinical depression and suicide in adolescence with up to 60% of adolescent suicide victims having a depressive disorder at the time of death. Similarly, between 40-80% of adolescents meet diagnostic criteria for depression at the time of the attempt Depression is the main predictor of suicidal ideation . In clinically referred samples, up to 85% of patients with major depressive disorder (MDD) or dysthymia (i.e., chronic, but less severe depression) will have suicidal ideation, 32% will make a suicide attempt sometime during adolescence or young adulthood , 20% will make more than one attempt , and by young adulthood, 2.5% to 7% will commit suicide. The association of prior suicidal behavior and depression has been shown to increase the risk for a repeated suicide attempt and suicide.

Recent studies confirm prior research indicating that suicidal thoughts during adolescence significantly increase the adult risk of psychiatric problems, and are the gateway to attempted suicide, and suicide These findings suggest that ameliorating suicidal ideation in adolescence offers hope of reducing acute distress and changing the life course of affected individuals.

Fergusson et al. Examined the impact of recurrence of major depression in adolescence on outcomes at ages 21-25 years. Using data from a 25-year longitudinal study of a birth cohort of New Zealand, the authors found a dose-response relationship between the number of depressive episodes between 16-21 years of age and adverse adult outcomes, including suicidal ideation and attempted suicide, even after controlling for potential confounders. These findings suggest that early identification and treatment of major depression may reduce the risk of future suicidal behavior.

Alcohol and Drug Use

Substance abuse (alcohol/drug abuse) disorders contribute substantially to risk of suicide, especially in older adolescent male when co-occurring with mood disorder or disruptive disorders. Recently, Aseltine et al. examined the relationship between heavy episodic drinking (HED) and adolescent suicide attempts. They found that adolescents who were 13 years or younger and who participated in HED were at 2.6 times greater risk of reporting a suicide attempt as compared to those who did not participate in HED. For those youth who were 18 years and older, HED increased their suicide attempt risk by 1.2 times as compared to adolescents of this same age who did not participate in HED. Schilling and colleagues found that drinking while feeling down resulted in a threefold increase in the risk of self-reported suicide attempts.

Family Factors

Family factors, including parental psychopathology, family history of suicidal behavior, family discord, loss of a parent to death or divorce, poor quality of the parent-child relationship, and maltreatment, are associated with an increased risk of adolescent suicide and suicidal behavior.

Family Constellation

Increasing duration of exposure to a single-parent household before the age of 16 years was significantly associated with higher rates of anxiety disorder between the ages of 21-25 years. Duration of exposure, however, was not significantly associated with suicidal ideation or attempted suicide.

Family History of Suicide Attempt

There is strong and convergent evidence that suicidal behavior is familial, and perhaps, genetic, and that the liability to suicidal behavior is transmitted in families independently of psychiatric disorder. A recent prospective study of early-onset suicidal behavior found a higher relative risk (RR=4.4) of incident suicide attempts in offspring of parents with mood disorders who made suicide attempts, compared with offspring of parents with mood disorders who had not made attempts. Offspring mood disorder and impulsive aggression and parental history of sexual abuse were independent predictors of incident suicide attempts.

Sexual and Physical Abuse

Exposure to child sexual abuse and child physical abuse leads to a significant increase in the occurrence of a variety of poor mental health outcomes, including suicidal ideation and behavior, experienced between ages 16-25. The authors found that exposure to child sexual abuse had a more deleterious effect on mental health outcomes than exposure to only child physical abuse. In another study, approximately 50% and 33% of suicide attempts among women and men, respectively, were attributable to the experience of childhood adversity (physical abuse, sexual abuse, witnessed domestic violence), indicating that even a small reduction in these childhood experiences could have a dramatic effect on reducing the prevalence of suicide attempts in the general population.

When a child experiences both child abuse and parental divorce versus only parental divorce, there is a statistically significant increase in the likelihood of a suicide attempt later in life. This association, however, was attenuated after controlling for parental psychopathology.

Brezo et al. conducted a longitudinal cohort study to determine the relationship between childhood abuse and later suicide attempts. Non-abused children were less likely to have non-fatal suicide behaviors as compared to those who experienced abuse. Sexual abuse by an immediate family member, repeated sexual abuse incidents, and greater severity of abuse conferred an increased risk of suicide attempts.

Salzinger and colleagues followed two sets of urban school children over a period of 4 years (time 1: average age 10. 5 years, n=100 abused and 100 non-abused; time 2: average age 16.5 years, n=78 abused and 75 non- abused). They found that preadolescent physical abuse was an independent predictor of suicidal ideation and attempted suicide; only internalizing behaviors mediated the robust relationship between physical abuse and suicidal ideation.

Change of Residence

Adolescents aged 11-17 years who frequently moved during childhood were more likely to make suicide attempts during adolescence, and the more often they had moved, the more elevated their risk, even after controlling for potential confounders at birth and during upbringing. There was a dose- response relationship between number of moves and risk of attempted suicide: youth who had moved three to five times were 2.3 times as likely to have attempted suicide compared with those who had never changed residences, while those who had moved more than 10 times were 3.3 times as likely to attempt suicide, controlling for birth order, birthplace, and paternal and maternal factors. Controlling for additional child and parent factors attenuated these specific associations. Analyses of suicide completers revealed a similar association between change of residence and suicide.

Sexual Orientation

Youth who report same-sex sexual orientation are at greater risk than their peers to have attempted suicide, and this risk persists even after controlling for other suicide risk factors, including alcohol abuse, depression, family history of suicide attempts, and prior victimization. A recent study of family response to an adolescent “coming out process” reported that family rejection or negative family reaction to an adolescent who is gay, lesbian, or bisexual was associated with 8-fold greater likelihood of attempted suicide compared to adolescents who experienced minimal or no family rejection.

Bullying

Klomek and colleagues found that boys who were both bullies and victims of bullying had a higher likelihood of suicidal behavior as compared with those who did not exhibit bullying behaviors or who were only victims. For the girls, there was a different effect of bullying; girls who were victims of bullying were more likely to exhibit suicidal behaviors as compared to those who were neither bullies nor victims. Barker et al. examined the developmental trajectories of bullying and victimization during adolescence on delinquency and self-harm in late adolescence. For both boys and girls, those in the bully-victim trajectory showed significantly higher levels of self-harm than their same-sex counterparts in all of the other trajectories. The girls in the bully-victim trajectory had higher rates of self harm than their male counterparts.

Advances in technology have helped to create a new form of bullying: cyber bullying. Cyber-bullying can occur through emails, texting on cell phones, and posts on internet social sites (e.g., Facebook, MySpace, Twitter) and can be perpetrated by other adolescents or adults, as has been recently reported. At this time, research on cyber-bullying and suicide has not been published.

Rationale:

The rationale behind suicide, which is defined as the intentional taking of one's own life, can be as simple or as complex as life itself. The person who commits suicide may see his or her actions as some sort of solution to a severe physical or psychological dilemma. The Psychology of the suicide is rooted in depression. Therefore, the investigator must take into account the clinical considerations as well as the investigative facts.Oftentimes, a police investigator will find a note indicating that the victim had suffered psychological torment, or was severely depressed. The note might even suggest that he or she believed that suicide was the last resort. Many of the suicide notes I have seen over the years indicate the acute depression of persons who have taken their lives. Depression does not discriminate. It effects the young and old alike. According to Dr. Patrick Cachur of The Centers for Disease Control in Atlanta, Georgia, 30,906 persons committed suicide in 1990. The majority of the cases (approximately 6500) occurred in the age bracket of 25 to 34 years of age. There were 258 suicides among pre- teens ages 10 to 14 years old and there were 6 suicides of children between the ages of 5 and 9 years of age. Ms Sandy Smith, Public affairs Officer for The National Center for Health Statistics, Office of Data Processing recorded 29,760 suicides in 1992 placing suicide as the ninth leading cause of death. Homicide ranked number 10. There are more suicides occurring in the 1990's according to the experts and the rate of suicide among pre-teens and the elderly has significantly increased. Teenage suicides have been described as epidemic in proportion to their representation within society. Periodically, the nation's newspapers and television networks may cover this phenomenon by reporting a series of events including "Teenage Suicide”.

3. REVIEW OF LITERATURE

Review of Literature:

The study concluded that suicidal tendencies of the sample were above average in the present study. In this rapidly changing world and with the growing advancement in science and technology, massive use of social media, mobile phones and due to lack of mature understanding this problem emerged in the society vastly. Minor problems can also force to do something bad to oneself or suicide to rid out from that, instead of finding solution.

x Study -1: Youth Suicide Attempts in Germany

The study was done by Christian Tarchi and Erminia Colucci on March, 2013. Purpose of the study was the regions showing higher suicide rates for the general population are Sachsen, Sachsen-Anhalt and Thueringen for male; Sachsen-Anhalt, Bayern, Schleswig-Holstein for female (Weinacker et al, 2003; Wiesner, 2004). In Germany, young people with developmental crisis are the fourth group at highest suicidal risk, immediately after people with mental disorders, people with previous suicide attempts and old people isolated and/or affected by chronic illness (Wolfersdorf et al, 2002). Weinacker, Schmidtke and Loehr (2003) reported the highest rates of suicide attempts for the younger groups, especially for young female 15-30 years old. In 1998, 50 children (10-15 years old) and 294 adolescents within the 15-20 years range died by suicide; the attempted suicide rate was eight to ten times higher and attempted suicides were repeated in 25% of the cases (Kirkclady et al, 2004). Blüml (1996) reported that in Germany every day one child and three adolescents take their own life. Furthermore, 40 children and/or adolescents attempt suicide. In the same paper, Blüml showed how youth suicide concerns cities twice more than the rural areas, affecting especially Berlin and Frankfurt. Moreover, female attempt suicide three times more often than male, but male carry out suicide three times more often than female, mainly because they choose “harder means” (e.g. shooting or hanging themselves). Suicide rates seem to be influenced also by occupation: suicide risk is higher among students than among workers or trainees. In regard to the method, the WHO Multicentre’s studies showed that in 25% of the suicidal events recorded in Germany; more than one method was used. The most frequent combination of two methods was drug and alcohol and the most frequent combination of three methods was drug, alcohol and cutting (Michel et al, 2000). 23 YOUTH SUICIDE IN GERMANY World Cultural Psychiatry Research Review 2013, 8 (1): 21-28 Eight out of ten young persons who died by suicide have talked about their decision to someone: therefore Blüml (1996) stated that it is incorrect to think that people who talk about suicide will never do it. The author reported that 85% of people who attempted suicide will attempt it another time, mostly within 12 months; among these attempts, 10% will succeed. Only one young person every ten who suicide leaves a farewell- letter: therefore, it is extremely difficult to explore the reasons for their act.

Conclusion of the study is, the German government has given attention to the topic of youth suicide: the Bundesministerium fuer Bildung und Forschung (Federal Ministry of Education and Research) is carrying out some projects to prevent youth suicide. The most important agency for the prevention of suicide in Germany is the DGS (Note 4), which was founded in 1972 and since then has put efforts to better understand this phenomenon.

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