Suicidal behavior in children and adolescents: risk factors and signs

In recent years, after more than a decade of stable recovery, there has been a decrease in the incidence of suicide among young people. The reasons for the previous rise and the present decline remain unclear. It is believed that in part this decline in recent years is associated with a more liberal approach to the use of antidepressants, although there is growing suspicion that individual antidepressants increase the risk of suicidal behavior. Nevertheless, suicide occupies the 2nd or 3rd place among the causes of death in the age group from 15 to 19 years and remains an important public health problem.

[1], [2], [3]

Risk factors for suicidal behavior in children and adolescents

Risk factors differ depending on age. More than half of the cases of suicidal behavior in adolescents develop from depressive disorders. Other predisposing factors are suicides among family members or close relatives, the death of someone from family members, substance abuse, and conduct disorder. More immediate provocative factors may be loss of self-esteem (for example, as a result of arguments of family members, degrading educational episode, pregnancy, failure at school); parting with a friend or friend; loss of familiar environment (school, neighbors, friends) due to moving. Other factors can be intense pressure from parents, demanding achievements and success, accompanied by a feeling that it does not meet expectations. Often the reason for suicide is an attempt to manipulate or punish someone, with the thought: "You will blame yourself after I die." The growth of suicides is observed after a widely reported suicide in the press (for example, a rock star) and in certain social groups (for example, a school, a student hostel), which indicates the power of suggestion. Early intervention to support youth in such circumstances can be effective.

Signs of suicidal behavior in children and adolescents

Almost every fourth teenager thinks about committing suicide. Among young children suicidal thoughts can appear in the event that they are victims of violence.

It is very important that you take all the signs of suicidal behavior seriously and, if they arise, immediately seek help from a doctor. If you yourself are a child or a teenager and you have a desire to commit suicide, talk about it immediately with parents, friends or a doctor.

Some problems in the life of a child or adolescent can only provoke thoughts of suicide, but some events can cause it.

The problems that suicidal thoughts can cause are:

• Depression or other mental illness, for example, bipolar disorder or schizophrenia.
• Parents who suffer from depression or alcohol or drug addiction.
• Attempts to commit suicide in the past.
• A friend, coeval, family member or idol who recently committed suicide.
• Violence in family.
• Sexual assault.

To problems that can provoke a suicide attempt, include:

• The presence in the house and access to weapons, pills or other means of suicide.
• Abuse of alcohol or drugs.
• Become an involuntary witness of committing suicide by a family member.
• Problems in school, for example, poor performance, bad behavior or frequent absenteeism lessons.
• Loss of one of the parents or close relative due to death or divorce.
• Stress caused by puberty, chronic diseases and sexually transmitted diseases.
• Closed and unwillingness to talk about their feelings with other people.
• Uncertainty associated with non-traditional sexual orientation (bisexuality or homosexuality).

The most common signs of suicidal behavior include:

• Expression of suicidal thoughts.
• An obsession with death in conversations, drawings or essays.
• Distribution of own things.
• Alienation from friends and relatives.
• Aggressive and rude behavior.

Other signs include:

• Leaving the house.
• Dangerous behavior, for example, careless driving or indiscriminate sexual relations.
• Indifference to own appearance.
• Change of personality (for example, an active child becomes too quiet).

Symptoms of depression that can lead to suicide include:

• Indifference to once-loved pursuits.
• Change the usual schedule of sleep and appetite.
• Difficulties in concentration and thinking.
• Complaints about a constant sense of boredom.
• Complaints about headaches, abdominal pains or fatigue for no apparent reason.
• Expression of own guilt; non-admission of praise in his address.

Correction of suicidal behavior in children and adolescents

Every attempt at suicide is a serious cause, requiring careful and appropriate intervention. As soon as the immediate threat to life disappears, a decision is made about the need for hospitalization. This decision depends on the balance between the degree of risk and the ability of the family to provide support. Hospitalization (even in an open ward in a therapeutic or pediatric ward with a separate observation post) is the most reliable form of short-term protection and is usually indicated for suspected depression, psychosis, or both.

The seriousness of the intention to commit suicide can be assessed by the degree of reasonableness (for example, writing a suicide note), the method used (firearms are more effective than tablets), the extent of self-harm, as well as the circumstances or immediate provoking factors associated with suicide attempts.

Medication can be indicated in any disorder underlying suicidal behavior (eg, depression, bipolar or impulsive disorder, psychosis), but can not prevent suicide. In fact, the use of antidepressants may increase the risk of suicide in some adolescents. It is necessary to carefully monitor the use of drugs and give them in quantities that are not sufficient for a lethal outcome with simultaneous administration of all tablets. An appeal to a psychiatrist is especially effective if there is continuity with a primary care physician. It is necessary to restore emotional balance in the family. The negative or unsupportive response of parents is a serious problem and may indicate the need for more intensive interventions, such as hospitalization. If the family shows love and care, the most likely outcome is a favorable outcome.

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Prevention of suicides in children and adolescents

Suicides are often preceded by behavioral changes (eg, depression, low self-esteem, sleep and appetite disorders, inability to concentrate, absenteeism, somatic complaints, suicidal thoughts), which often leads the child or adolescent to a doctor. Such statements as "I would like to never be born" or "I would like to fall asleep and never wake up" should be taken seriously as possible signs of the intention to commit suicide. Threats or attempts at suicide represent an important message about the degree of despair. Early detection of risk factors, named above, can help prevent suicide attempts. In response to these early signs, as well as when faced with a threat or attempted suicide, or with a fearful behavior shown active intervention. Patients should be asked directly about their feelings, failures, self-destructive experiences; such direct questions can reduce the risk of suicide. The doctor should not allow unreasonable calming, which can destroy the credibility of him and further reduce the patient's self-esteem.