Table of Contents
Background and Significance
Suicide is a major public health concern resulting in a growing number of premature deaths. In the United States alone, there were 8.6 million suicides between 1992 and 2016 (Drapeau et al., 2017). Despite efforts to minimize suicide as it gained public and clinical attention during its spike in the 21st century, rates have continued to increase by approximately 2% per year from 2006-2014 (Curtin et al., 2016). In the United States today, suicide is considered the tenth leading cause of mortality, accounting for more than 47,000 deaths in 2017 at a rate of 14 per 100,000 (Drapeau et al., 2017). There is a gross underestimation of the true prevalence of suicide as it often goes unrecognized due to misclassification of death reported to death registries and because suicide is not acknowledged or reported related to its sensitive nature and the stigma surrounding it (Bilsen, 2018).
Though data shows that the highest rates of suicide occur in late life, suicide is the second leading cause of death among youth ages 10-34 (NIMH, 2019). Youth in the United States also carry the highest burden of self-inflicted, non-fatal injuries that require medical attention which is among the strongest risk factors for suicide (Mercado et al., 2017). Suicide in youth presents a significant burden on health as it prematurely takes away so many young lives.
Suicide is defined as a fatality caused by self-injurious behavior with some evidence of intent to die, while a suicide attempt is defined as a self-injurious behavior that is non-fatal (Bilsen, 2018). Suicide attempts are 10-20 times more frequent than actual suicide (Bilsen, 2018) and those with a history of previous suicide attempts are more likely to have future attempts that eventually cause death (Goldston et al., 2009). Suicide attempts far exceed the number of suicide deaths with an increased incidence of future attempts, providing an essential opportunity for the implementation of suicide prevention strategies.
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Stakeholders
Family and loved ones of youth affected by suicide have been identified as individual level stakeholders in this public health issue. They are directly affected by the harm and deaths associated with youth suicide and they look towards health care professionals, mental health associations, and legislators to help build a framework for establishing suicide prevention for their children and future youth. Families and loved ones have an emotional investment in this issue which is the driving force behind their advocacy for finding solutions and bringing more public awareness about suicide. They will be some of the leading front-line advocates for the implementation of suicide prevention initiatives in their local communities and schools.
Schools would be stakeholders at the community level because they are a primary point of contact for a majority of youth and where suicide prevention interventions are likely to be implemented. School board members, school administrators, educators, and school health services staff would all be involved in this process and vested in such policies.
In 2013, the United States spent $93.5 billion in suicide and suicide attempt related costs (Shepard et al., 2016). This is a two-fold increase in the CDC’s estimate of $44.7 billion spent in 2010 and $33.3 billion dollars in 2000 (Corso et al., 2007). The upward trend in money spent nationally on suicide and suicide attempts should inform the country’s need to take action towards suicide prevention strategies. Research suggests that interventions such as access to adequate mental health care and suicide prevention strategies can reduce the number of subsequent suicide attempts that often follow previous non-fatal attempts (Shepard et al., 2016). The power of U.S. legislation and government to approve such policies will positively impact the lives of many youth and reduce the economic loss associated with suicide.
Social Determinants of Health
Risk factors for suicide have involved the dynamic and complex interplay between biological, psychological and social factors. Adolescence become vulnerable to mental health problems as it is during this time that they begin to establish their identity, develop self-esteem, further their independence and responsibility, build new intimate relationships, in conjunction with ongoing physical and psychological changes. This period of transition coupled with being confronted with high expectations from family and peers, can induce stress, a sense of loss of control, insecurity and helplessness (Patton et al., 2016) adding to their vulnerability for suicide.
When assessing suicide in youth, identifying at least one psychiatric disorder is extremely important as this increases their risk by 90%, and previous suicide attempts increasing future risk by 25-33% (Bilsen, 2016). History of physical or sexual abuse, alcohol and drug use, and interpersonal conflict or loss have also demonstrated increased suicide risk (Shain, 2016). A review of several studies has shown that an increased risk of suicide has been predicated through the various impacts of bullying in adolescents and that victimization can lead to anxiety, depression and suicide (Arseneault et al., 2010, Klomeck et al., 2010, Copeland et al., 2013). More specifically, youth identifying as LGBTQ are three times more at risk for depression and suicide related to victimization and discrimination (Gnan et al., 2019).
From 2010 onwards, a study reported on youth that spent longer periods of time on social media and electronic devices have a higher incidence of depression and suicidal ideation (Twenge et al., 2018) and are at greater risk of imitating suicidal behaviors seen through media exposure and peer suicides (Gould et al., 2003). Barriers to mental health seeking behaviors in youth can be attributed to societal and self-stigmatizing attitudes towards suicide, reliance on self to solve problems, confidentiality and trust, lack of mental health services, and lack of accessibility i.e. time, cost, transport (Gulliver et al., 2010). Exo-system factors including stigma and lack of mental health services in addition to adolescent’s unique vulnerabilities at the micro and meso-system levels, significantly increases their risk. Understanding these factors will be important in identifying effective suicide prevention strategies.
