The D.A.N.G.E.R. of Adolescent Suicide

by Mark L. Pantle, Ph.D.

"Why did you try to kill yourself?"

Fifteen-year-old Michael sighed and shifted his glance to the floor. Without looking up, he replied in a sad voice, "I don't know. I just felt trapped, like I had no other choice. Things were just getting so bad that I felt like I was in a corner, you know, like in a room, and there wasn't anybody else around to help me."

The story is a familiar one to those who work with suicidal adolescents. Feeling helpless, hopeless, and alone, an adolescent may turn to suicide in a desperate attempt to resolve a problem for which no other solution seems available. Statistics on teen suicide indicate that increasing numbers of kids are engaging in self-destructive behavior as a means to solve their problems. Indeed, some reports speak of an "epidemic" of teen suicide.

Suicide is the third leading cause of death among adolescents behind accidents and homicide. Although a rate of more than 12 suicides per 100,000 people in the 15-to-24 age group may not seem high, the seriousness of the problem becomes clearer when one considers the ratio of suicide attempts to completed suicides. The ratio reported in various studies ranges from 100 to 1 up to 200 to 1.

The adolescent suicide rate has tripled over the past 30 years. Many researchers believe the increase in teen suicide is related to the changes in society that have occurred during the last three decades. The pressures and stresses that confront adults are felt by youngsters as well, but the teenager typically is less able to cope with such problems. The rising divorce rate seems to be a major factor in the increase in adolescent suicide; one study reports, "The presence of both parents throughout childhood helps to protect an adolescent from suicidal thoughts."

For years, researchers have attempted to identify signs and symptoms that could alert parents, teachers, and mental health professionals to the possibility that a teen is at risk for suicide. A variety of such indicators have been reported, but, unfortunately, they tend to be general and lead to many false alarms. In dealing with an adolescent's life, however, don't be too concerned about a false alarm.

Six signs often associated with suicide risk in an adolescent create the acronym "D.A.N.G.E.R."

D Depressed mood. Adolescents who attempt suicide very often are depressed. This seems to be especially true for girls, who in general tend to display depressive symptoms more obviously than do boys. Related to depression are despair and desperation, which serve to fuel suicidal impulses.

A Abuse of alcohol and drugs. The excessive use of alcohol and drugs seems to be correlated with adolescent suicidal behavior. Substance abuse can have a disinhibiting effect on a teenager, decreasing fears about self-destruction. Drugs also can provide a means to commit suicide. Alcohol and drug abuse sometimes represent a teen's attempt to self-medicate depression and dull negative thoughts and feelings.

N Negativity. Suicidal adolescents typically have pervasively negative and pessimistic thinking, feeling, and perception. Seeing little that is positive in themselves, their situation, or their future, teenagers can become convinced that suicide is the only means to escape the mire in which they feel hopelessly trapped.

G Giving away possessions. This is considered the equivalent of an adolescent "will." A kid who is contemplating suicide may offer his/her prized possessions to friends and siblings, not unlike the older adult who bequeaths belongings in a will. Depressed adolescents also may experience a loss of pleasure, and therefore, possessions that once seemed important lose their value.

E Estrangement. Most teens who engage in suicidal behavior feel isolated and alienated, and many become socially withdrawn. They frequently report feelings of distrust and even fear, and they tend to view others as rejecting and uncaring. This alienation also tends to perpetuate feelings of helplessness and hopelessness, as no social support is available to challenge the adolescent's pessimistic outlook and help him/her solve problems.

R Rebellious behavior. Many depressed adolescents (especially boys) do not appear obviously depressed. Instead, they seem irritable, oppositional, and moody. Their rebellion often represents a reaction to feelings of helplessness and hopelessness, but it may tend to contribute to their problems, as such behavior tends to alienate them from those who could provide help and support.

Many, perhaps even most, adolescents who are contemplating suicide will display at least some of these D.A.N.G.E.R. signs before making a suicide attempt. Some teens, however, may attempt suicide" out of the blue," with no warning to parents or peers. Depressed and otherwise psychologically distressed kids who are not imminently suicidal may show some of the D.A.N.G.E.R. signs as well. In fact, no research study has yet been able to reliably predict when, and if, troubled teens will try to kill themselves. Although the D.A.N.G.E.R. signs may not be a perfect index of suicidal potential, they do alert others to the possibility that an adolescent is experiencing psychological pain and turmoil, and they indicate the need for intervention by a mental health professional.

A concern that arises when an adolescent commits suicide is the possibility that a "contagion effect" will occur. The attention and sympathy that a teen suicide generates within a school and a community may lead other troubled kids to romanticize suicide. Such kids may perceive suicide as a means not only to solve their problems, but also to obtain the attention they desire. The more alienated and distressed a youngster is, the more likely she/he is to imitate a peer who has committed suicide. "Suicide pacts," in which two or more teens decide to kill themselves together, occur only rarely, but they receive a considerable amount of publicity. Such pacts typically are formed when very troubled adolescents share their distress with one another, thereby reinforcing each other's depression, negativity, and alienation. As a group, these kids decide that suicide is the only solution to their problems, and they encourage one another to follow through on the suicidal plan.

How can one help a suicidal adolescent? The initial focus of treatment usually is on crisis intervention. If suicidal behavior is a teen's desperate attempt to solve problems, then the first step in helping the teen is to identify his/her sources of distress and try to relieve them. According to Edwin Shneidman, a veteran suicidologist, "If you can reduce the pain just a little, the patient will want to live." Immediate and effective intervention is essential, as kids who do not receive help may experience increased feelings of hopelessness and helplessness and may make yet another suicide attempt. If attempts at crisis intervention do not reduce an adolescent's suicidal thoughts, feelings, and impulses, then psychiatric hospitalization may become necessary.

Often, teen suicide represents a desperate attempt to cope with longstanding problems, and-when this is the case-therapy beyond crisis intervention is indicated. Longer term psychotherapy will address problems of depression, negative self-image, deficient coping skills, and social isolation. Family therapy also is extremely important, as adolescent suicidal behavior has a powerful effect within the family system. Many mental health professionals believe that when dealing with a suicidal teenager, family therapy is at least as important as, and in some cases more important than, individual therapy. If the family refuses to become involved in therapy, the adolescent may perceive them as unconcerned about his/her problems, which can increase negative thoughts and feelings and increase the risk for another suicide attempt.

Although the treatment of adolescent suicidal behavior is conducted in the office of a professional, prevention occurs in the home and at school. If teens do not descend to the depths of depression and despair, then they are unlikely to attempt suicide. Three basic principles can guide family, teachers, and peers in helping prevent such a descent. These principles form the acronym "A.C.T."

A Awareness. By maintaining an awareness of the problems and pressures that beset a teenager, others can help insure that a situation does not worsen to the point that the teen feels helpless, hopeless, and desperate. Others should realize that problems often seem bigger to kids than to adults, and they therefore should be careful not to dismiss an adolescent's troubles as trivial. As discussed above, an awareness of the D.A.N.G.E.R. signs also is extremely important.

C Communication. This probably is the most important principle. Clear, effective communication between adolescents and their parents, teachers, and others is the key to maintaining awareness and providing the guidance and support they require. Without good communication, others can only guess what is happening within a teenager, and usually such guesses are wrong.

T Trust. An atmosphere of mutual trust facilitates communication and decreases the likelihood that an adolescent will feel alienated and helpless. Teens must perceive family and friends as reliable, stable, and trustworthy if they are to turn to them for help in times of trouble. Others also must be willing to trust the teenager, as trust allows her/him to develop the healthy independence necessary to cope with life's trials and tribulations.

Adolescent suicide is a serious problem, but is not one without hope. Family, friends, teachers, and others can A.C.T. to help prevent a teen's slide into the negative thinking and feeling that spawn suicidal impulses. And their awareness of the D.A.N.G.E.R. signs may prevent a suicide attempt. Competent professional mental health services are available in almost every community, and teens and their families should not be reluctant to seek the help and support that these services can provide.