What parents and teachers should know about suicide in adolescents

Dr. Shahul Ameen, M.D. :

(From previous issue)

School based suicide prevention programs include both curricula components to teach students about these warning signs and what to do, as well as non-curricula components such as peer groups, hot lines, intervention services and parent training. Prevention includes education efforts to alert students and the community to the problem of teen suicidal behavior. Intervention with a suicidal student is aimed at protecting and helping the student who is currently in distress. Postvention occurs after there has been a suicide in the school community. It attempts to help those affected by the recent suicide. In all cases it is a good idea to have a clear plan in place in advance. It should involve staff members and administration. There should be clear protocols and clear lines of communication. Careful planning can make interventions more organized, and effective.
The goals of school based suicide prevention programs are to:
* Increase awareness
* Promote identification of students at high risk of suicide and suicide attempts
* Provide knowledge about the behavioral characteristics (“warning signs”) of teens at risk for suicide.
* Provide information to students, teachers and parents on the availability of mental health resources
* Enhance the coping abilities of teenagers
Education: Education may be done in a health class, by the school counselor or outside speakers. Education should address the factors that make individuals more vulnerable to suicidal thoughts. Education regarding the ill effects of drug and alcohol abuse would be useful. PTA meetings can be used to educate parents about depression and suicidal behavior. Parents should be educated about the risk of unsecured firearms in the home. Outside mental health professionals can discuss their programs so that students can see that these individuals are approachable. Education on the following topics will be useful:
Warning signs of suicide:
* Preoccupation with death and dying
* Signs of depression
* Taking excessive risks
* Increased drug use
* The verbalizing of suicide threats
* The giving away of prized personal possessions
* The collection and discussion of information on suicide methods
* The expression of hopelessness, helplessness, and anger at oneself or the world
* Themes of death or depression evident in conversation, written expressions, reading selections, or artwork
* The scratching or marking of the body, or other self-destructive acts
* Acute personality changes, unusual withdrawal, aggressiveness, or moodiness
* Sudden dramatic decline or improvement in academic performance, chronic truancy or tardiness, or running away
* Physical symptoms such as eating disturbances, sleeplessness or excessive sleeping, chronic headaches or stomachaches, menstrual irregularities, apathetic appearance
Sudden changes in behavior that are significant, last for a long time, and are apparent in all or most areas of his or her life (pervasive) are more specific than presence of isolated signs. However, it should be noted that many completed suicides had only a few of the conditions listed above, and that all indications of suicidality need to be taken seriously in a one person to another person situation.
Signs of depression in teens:
* Sad, anxious or “empty” mood
* Declining school performance
* Loss of pleasure/interest in social and sports activities
* Sleeping too much or too little
* Changes in weight or appetite
Features of self harm that suggest high suicidal intent:
* Conducted in isolation
* Timed so that intervention is unlikely (for example, after parents have gone to work)
* Precautions to avoid discovery
* Preparations made in anticipation of death (for example, leaving indication of how belongings to be distributed)
* Adolescent told other people beforehand about thoughts of suicide
* The act had been considered for hours or days beforehand
* Suicide note or message
* Adolescent did not alert others during or after the act
What can be done to help someone who may be suicidal?:
1. Take it seriously.
Myth: “The people who talk about it don’t do it.” Studies have found that more than 75% of all completed suicides did things in the few weeks or months prior to their deaths to indicate to others that they were in deep despair. Anyone expressing suicidal feelings needs immediate attention.
Myth: “Anyone who tries to kill himself has got to be crazy.” Perhaps 10% of all suicidal people are psychotic or have delusional beliefs about reality. Most suicidal people suffer from the recognized mental illness of depression; but many depressed people adequately manage their daily affairs. The absence of “craziness” does not mean the absence of suicide risk.

 (To be continued)