Adverse Trauma with Suicide Ideation among youth
INTRODUCTION AND OVERVIEW
Today, one of the leading causes of death among young people is suicide. Suicide attempts have been identified as a significant predictor of suicide deaths. Compared to fatal suicide attempts, nonfatal ones are 50-80 times more prevalent. In 2015, close to half a million Americans were taken to the emergency room after they attempted to commit suicide. In many ways, suicide has proven to have far-reaching impacts as it affects friends and family members of individuals who attempt or die by it. The world health organization estimates that every year, about 800,000 people commit suicide worldwide.
There are several reasons that warrant concern of suicidal thoughts and behaviours among youths as compared to other age groups. First, there has been a drastic increase in the number of suicide among people in their adolescence and early adulthood. Secondly, suicide has been franked the greatest cause of death among young people in comparison to older people. During adolescence and childhood, suicide is said to be the second leading cause of death. On the other hand, among adults, it is ranked the tenth cause of death. Thirdly, suicide warrants concern among youths because most adults who have attempted or considered committing suicide, first did it while they were still youths. Lastly, suicide deaths can easily be preventable among youths. By understanding why suicide emerges during the youth stage, it would offer a chance to intervene on this problem early in life stages. Don't use plagiarised sources.Get your custom essay just from $11/page
This paper does a review of the current state of works of literature on behaviours and thoughts of suicide among youths. Behaviors and thoughts of suicide include; attempting to commit suicide, suicide deaths, and suicidal ideation. The paper starts by taking a look at the history and background of this problem, the various theories that can help explain the challenges, literature reviews, and the policies that are in place to tackle the issue. The paper concludes by summarizing the essential findings of the research and how these findings contribute to social practice and knowledge.
BACKGROUND
In the study of suicide ideation among youths, it is crucial to determine the likely pathways that lead to the development of suicidal behaviours and thoughts among these young people. In other words, one has to understand factors that make youths think about suicide and possibly take action on those suicidal thoughts. To effectively do this, there is a need to examine the biological, environmental and psychological factors that might lead one to have suicidal behaviors and thoughts.
ENVIRONMENTAL FACTORS
While trying to understand the environmental or ecological factors that make youth have suicidal thoughts, it is also crucial to understand that there are several types of these environmental factors. The most substantial evidence of environmental factors highlights childhood bullying and maltreatment. Around media and peer influence, there are mixed evidences on suicide clusters. Similar to these environmental factors, there are also some promising yet tentative pieces of evidence inline to the timing of maltreatment in a person’s life, influences through the internet, and some other forms of peer victimization that are nontraditional. These environmental factors are discussed below.
Maltreatment during childhood
Several pieces of evidence suggesting that different kinds of childhood maltreatment like emotional, sexual, and physical abuse can predict a person’s future suicide attempt and suicidal ideation when they get to the youth stage. Prospective twin and cohort studies demonstrate the significant impact of sexual abuse on suicidal death and suicide attempts among young adults and adolescents. These impacts are not dependent on contextual factors like the characteristic of a child and parent and the qualities of a family environment. Emotional abuse to a person has also said to increase the chances of suicidal ideation in adolescents and older children controlling for covariates like depressive symptoms, history of suicidal ideation, and controlling physical and sexual abuse.
More recent researches have shifted to give more focus on identifying the characteristics of maltreatment, which are related to suicidal behaviors and thoughts. One thing that has been noticed is that there has been mixed finding in relation to the sensitive periods when maltreatment is exposure. While some findings underscore these exposures during early childhood and preschool years, other findings highlight the impact these exposures have when one is at mid-adolescence. In addition to that, there are also some reporting without any associations at all. A good number of these associations are likely to be dependent on the type of maltreatment or sex.
Bullying
Bullying has been highlighted as being a powerful risk factor for suicidal behaviors and suicidal thoughts among young people. Bullying consists of both intentionally disturbing and harmful behaviors that are repeated. These behaviors in the process have been noticed to invoke some power differential. Results from longitudinal studies indicate that coercion, social exclusion and physical/verbal abuse by peers during early adolescence and childhood stage have an impact on a person’s later suicide attempt, ideation, and death. Such association significantly holds up when controlling psychiatric symptoms such as; depression and are robust for the impact of peer victimization among female adolescents. One major consideration is the chronicity of victimization since long durations of exposure tend to increase the chances of suicidal attempts and suicidal ideation. The most important thing to note is that any manner of bullying increases the chances of subsequent suicidal behaviors and thoughts.
Medical and peer influence
The other consideration is determining if suicide incidences have happened in an environment. Numerous pieces of evidence have been used to demonstrate the time-space clustering of suicides. These point clusters, according to some studies, are not as common among older populations as compared to adolescents. However, the occurrence of the point cluster is greatly accepted by the field. There still remains some interpretations that explain exactly how these clusters emerge and why they emerge. The longitudinal studies have been effective in demonstrating how having a friend who committed or attempted to commit suicide, could predict one’s future suicide attempt while in the adolescence stage. Other explanations include social integration, assortative relating, and complicated bereavement.
PSYCHOLOGICAL FACTORS
When it comes to psychological factors, there are various correlates of suicidal behaviors and thoughts that should be put into consideration. These factors can be organized based on social, affective and cognitive processes. Moreover, these factors are also measured through physiology, self-report and behavior. In regards to the current review, cognitive processes relate to some select information-processing biases and psychological factors. Affective processes involve psychological factors that pertain to negative affect and are emotionally valance. The social processes, on the other hand, pertain to psychological processes that are oriented towards each other, and they include engagement in interpersonal relationships and observed degree.
Affective processes
The available evidence that supports negative affect process range from moderate to strong based on aspects of negative effect examined. The substantial pieces of evidence have given support to low self-esteem and worthlessness as major risk factors for suicidal behaviors and suicidal thoughts among young people. The self-reported low self-esteem, worthlessness and behavioural measures are said to predict an individual’s future suicidal attempt ad suicidal ideation controlling other symptoms of baseline suicidal behaviors, suicidal thoughts and depression. Some other aspects, such as hopelessness, could play a significant role in helping predict the occurrence of suicidal behaviors and suicidal thoughts. Many longitudinal studies that involve youths prove that hopelessness might be a more distal risk factor since never predict suicidal attempts or ideation controlling for baseline factors of depression and suicide attempts. This, however, is in contrast with findings that are more promising among youths.
Cognitive processes
THEORIES
THE INTERPERSONAL PSYCHOLOGICAL THEORY
This theory proposes that it is not possible for a person to die by suicide unless that person has the desire and ability to die by suicide. To best understand this theory, it is essential first to understand what desires for suicide are and its constituent parts. Other than that, it is also important to tell what can die by suicide and how it develops. The theory asserts that when a person simultaneously holds different psychological states in his/her mind for a prolonged period of time, then he/she is likely to develop a desire to die. The theory perceives these psychological states both as a sense of social alienation as well as being burdensome.
In consideration of suicide capabilities, the theory finds self-preservation as a powerful tool that very few people can overcome through force of will. According to the theory, the few who would have developed fearlessness of death, pain, and/or injury would have got it through a process of continuous experience of painful and provocative events. Such experiences mostly include self-injury and other experiences like physical fights and accidental injuries. One influence from this theory is that it gives hope hence making it promising since it has a growing empirical base that supports it. The theory suggests that it is possible for clinicians to be cognizant of their patients’ stages of burdensomeness, acquired ability, and belongingness. This knowledge can help clinicians to assess the risk of suicide.
THE STRAIN THEORY OF SUICIDE
The strain theory of suicide presumes that suicide is often brought about through some forms of psychological strains. It is, however, important to understand that a strain is not necessarily stress, or pressure. While stress and pressure are a single variable phenomenon, strain, on the other hand, would develop when there are at least two variables or two pressures. Although strain pulls are similar to the formation of cognitive dissonance, they are, however, more detrimental and serious compared to the cognitive dissonance. Unlike cognitive dissonance, strain pushes or pulls a person in many directions hence making him/her feel pain, frustrated, angry and/or upset. Strain, just like cognitive dissonance, is a psychological frustration that a person needs to find a solution to. Strain is, therefore, stronger and more serious as it can quickly turn into a mental disorder. When strain is not resolved, an individual may consider suicide as an ultimate solution.
This theory may influence thinking in that it enables one to understand that suicide is a personal method people use to solve their problems. By knowing this, it becomes possible to intervene and alleviate the problems. One way to go this is by sensitizing other methods of problem solving that are socially desirable. Suicide is a personal decision to terminate one’s own life. Inescapable or painful psychological strains might force a person to make these personal choices. To reduce suicide among youths, it is, therefore, vital to try and find out what might be causing strain in their lives. Once these are done, there is a need to eliminate the cause of such strains.
DURKHEIM’S THEORY
As proposed by Durkheim in 1951, the rates of suicide are related to the integration degree of a specific social structure such as the political system, family, and the church. In addition to that, rates of suicide are also related to the degree of regulation imposed within a particular social system. The two types of suicides predicted by the level of social integration within a society are altruistic and egoistic suicide. The egoistic type of suicide happens when the level of integration is low among social institutions. This can be demonstrated through a lack of common traditions, views, values, and beliefs among individual members of society. People would often assert themselves from social groupings and losing the social meaning of life. Doing this creates intolerable burdens on individuals. Altruistic suicide occurs when an individual decides to end his/her life based on the conditions created by the society.
According to Durkheim, the degree of social regulations is a major predictor of fatalistic and altruistic suicide. When social regulations are low, ‘anomie’ may result in social changes place a person in new circumstances. In these new circumstances, the old moral rules would no longer apply. An individual desire and passion would not be subject to social restraint and hence means it might outpace a person’s resource and causing frustrations. When social regulations are high, it would eventually lead to ‘fatalism.’ Though not verified strongly in Durheim’s research, Fatalistic suicides occur when there are inflexible social constraints, particularly so when individual desires are stifled. Lastly, based on Durkheim’s theories, Anonic suicide happens when a person sacrifices his/her life for the goals of society.
SOCIAL LEARNING THEORY
This theory has greatly been posited as an explanatory model explaining adolescent suicide thought and behavior. The theory proposes that when other family members commit suicide, youths hence learn suicide to be the right way to address problems affect one’s life or the right way to gain social attention. This theory influences one’s thinking by enabling one to understand that when responding to suicidal behaviors of youths, sometimes people tend to reinforce this style of coping. This, therefore, means that rather than the youth learning adaptive coping styles, they, however, learn pathological strategies.
LITERATURE REVIEW
Suicide thoughts and behaviors among youths have become a topic of concern, and this has greatly been reflected in the increase of literature works that have assessed suicide over the past years. While deaths caused by other factors have decreased over the years, the rate of suicide still remains very high. This hence shows the importance of having suicidal thoughts and also highlights the need to develop and improve suicide prevention mechanisms.
ONSET AND COURSE
Prior to the age of 10, suicidal ideation is not quite common. However, its prevalence increases tremendously between the ages of 12 and 17. Even after hospitalization, most youths are likely to continue experiencing suicide ideation. Youths experiencing suicidal ideation have a high likelihood of attempt suicide when they are in their 30s. As NOCK et al., 2013 puts it, about one-third of teenagers experiencing suicide ideation go-ahead to commit suicide. Frequent suicidal ideations that are also chronic and serious are said to be associated with suicide attempts. Compared to suicide ideation, suicide attempt has a later age of onset. Before the age of 12, suicide attempts are not common, and their prevalence tends to increase from the time one is in early to mid/late adolescence. Suicide attempts that happen after adolescences are often reattempts. Although suicidal attempts at young ages are not frequent, there are still records of suicides happening at young ages of even 5-8 years old. By the age of 15-19, suicide deaths are more common.
DEMOGRAPHIC PATTERNS
In the course, presentation and prevalence of suicidal behaviors and thoughts, there are several demographic patterns. The most distinguished demographic characteristics are inclusive of race, sex and age.
Race
In the United States, most findings reveal an excessively high rate of suicide among Indigenous youth compared to other races. This patter, however, is not only observed in America but throughout the world and ranges from Aboriginal, American Indian, and Alaska Native youths in both Canada and the US. The pattern is also observed among indigenous youths in New Zealand and Australia, to the Nandeva and Guarani Kaiowa communities of Brazil. The most common risk factor cited include poverty, loss of culture, and accessibility to lethal means. Regarding other racial minorities, most findings show that these groups are most specific and nuanced to religion, time and type of suicide outcome. In the United States, for instance, Black Non-Hispanic youths experience suicidal ideation at the least rate compared to adolescents from other racial groups. Despite this, however, Blacks in America have recently depicted an increasing suicide attempt. There is also less death rate among Black adolescents compared to Black children. Another major consideration is the local environment and interactions made with minority status. For instance, Swedish youths have a high risk of committing suicide when they had foreign-born parents and resided in regions that consider them minority. Contrary to this, living in regions of Sweden where the greatest population have foreign born-parents reduced chances of an adolescent committing suicide. A similar interaction between environment and demographic characteristics have been observed in other nations such as the United States and England.
Sex
A well-established paradox is presented by sex, whereby adolescent girls have a higher chance of experiencing suicide attempts and ideation compared to boys. However, teenage boys have a higher likelihood of dying by suicide compared to girls. Until the ages of about 11 to 12,s there is no pronounced sex difference in either severity or prevalence. Although most findings show some slight difference in the ages of suicide onset, most of the patterns, however, differ across the levels of clinical severity. In regards to an individual’s transition adolescence to early adulthood, there are mixed finding with some reporting persistent group differences and others more tempered sex differences. Sex variation in suicide death among adolescents imitate those that are in adults in that when comparing girls and young women, boys and men die by suicide at a higher rate.
Age
in consideration of age, older youths are at a high chance of committing suicide compared to younger adolescents. Across most nations, the suicide rates of the older youths are about ten times greater than young adolescents. This trend among older youths is a result of the great prevalence of psychopathologies, like suicide intent and substance abuse. There also exists a notable age pattern in the way methods are used. For instance, suffocation/hanging is much more common among children, unlike in adolescents. Also, adolescents tend to use sharp objects more often compared to adults. Unlike adults, both children and adolescents who commit suicide are less likely to have made prior suicide attempts or to have been intoxicated.
INTERVENTIONS
It is essential to try and determine the best way to reduce suicide among adolescents. It is also crucial to find the best prevention strategy and psychological intervention that can be applied to help reduce suicide among children and adolescents. Here, the random control trials are drawn to help outline the efficacy of psychotherapeutic approaches that are meant to treat as well as to prevent suicidal behaviors and thoughts among young people.
PSYCHOLOGICAL TREATMENT
Generally, psychological treatments that have strong preliminary support that reduce suicidal behavior and thoughts among adolescents put more emphasis on skill enhancement, behavior change, and strengthening of interpersonal bonds. One format of psychological treatment is:
Family and individual therapy
A combination of both family and individual therapy has been efficacious in the treatment of suicide among adolescents. For example, the Integrated Cognitive Behavior Therapy (I-CBT) that combines both family and individual CBT as a training component. Similar to I-CBT, attachment-based Family Therapy (ABFT) helps in the enhancement of quality of the attachment bonds through interpersonal approach to family and individual therapy. ABFT also helps to enhance parental skills training. The early evidence of RCT suggests positive short term and immediate post-intervention effects for ABFT as well as for I-CBT compared with an active control condition. Youths getting a six month I-CBT have had less suicidal attempts. ABFT was found superior at minimizing suicidal ideation. Such finds are in no doubt quite promising since the intervention effects are often maintained after treatment was delivered. The findings are, however, limited because of the low rates of treatment completion during the control condition.
Interventions during high-risk periods
One important part of suicide treatment efforts that have gained empirical support is the interventions that were implemented from the acute care setting or emergency department. Some interventions already evaluated are inclusive of components addressing skills training, crisis management, and parent-youth psychoeducation. Initial evidence speaks of acceptability as well as the utility of safety planning as a stand-alone intervention to assist patients known the effective coping strategies for suicidal crises. Moreover, multiple emergency department interventions have come to be noted to be more superior to routine care to improve outpatient treatment compliance.
Technologically based intervention
More recent studies identify affective and cognitive markers of increased suicide behavior risk. Such studies might serve as new treatment targets. Previous studies have proved that individuals who either suicidal or nonsuicidal self-injuries have a positive implicit that is associated with the concept of self-injury, death, or suicide. Following up on this research, investigators have used evaluative conditioning procedures that are delivered through games such as smartphone app to create an aversion to self-injury/suicide/death. The results found by these investigators are quite promising, although still at a preliminary stage. There is a need to do more research to continue testing the efficacy that these approaches have as a novel mode of treatment.
PREVENTION
putting into consideration the rapid increase in prevalence of suicidal behaviors and thoughts among youths, it is essential to develop prevention strategies. Some of the most effective and common prevention strategies we have today include, selective prevention strategies, indicated prevention intervention and universal programs.
Selective prevention strategies
There are certain programs whose main aim is to pre-empt the development of the most common risk factors for mental health outcomes, including suicidal behaviors. Such programs accomplish this by teaching the most adaptive skills like self-regulation, enhancing social support, and problem solving. Despite there not being any supportive evidence for the efficacy of such interventions, there are, however, some preliminary findings for resilience programs and family-based risk prevention. Some interventions have targeted the source of stress and conflict in families with the aim of preventing substance abuse. Externalizing and internalizing disorders have been evaluated for the impact that they present on suicidal behaviors and thoughts.
Indicated prevention intervention
Strategies like hotlines, which are indicated preventive, respond to the most immediate needs of a suicidal person during a crisis. Crisis support services like school postvention address the need surrounding community after an event that is suicide related. For reducing risks of commit suicide, a gap exists in formal evidence for the efficacy of school postvention.
Universal programs
Most suicide prevention programs have more focus on screening and school-wide education about suicide symptoms and signs. Universal programs have proved to have some of the strongest pieces of evidence for the ability to minimize suicidal behavior among youths in European nations. The individual schools that were assigned to the program showed a great reduction in suicidal attempts and ideation.
Recommendations
There is a need to have more studies that would provide adequate details about the operationalizing of suicidal behaviors and thoughts. For future studies, they should specify if the standard suicide measure was used. If a standard measure was not used, then a clear operational definition should be given. This definition should determine the severity, method, and presence of suicidal thoughts. The suicidal thoughts ought to be measured by the use of multi-item assessments in order to prevent false conclusions and misclassification.
POLICIES
Among adolescents, most of those who commit suicide have shown to have a psychiatric disorder. In addition to that, most of these youths have also shown symptoms that can be identified through screening. Most providers of primary care do not often screen these young people for mental health challenges. Most teachers have also proved to lack adequate time or training that can help identify mental/emotional issues and refer their students for the right intervention. A number of policies are important and help understand suicide attempts and behavior among youths. An example of such a policy is to ensure that teachers at school get sufficient training and are adequately funded in order to help recognize signs of suicidal ideation, depression, and self-injury. Implementation of such a policy will help connect students with the right services. The other policy involves ensuring discrimination is eliminated. Discrimination can cause an adolescent to experience mental health challenges and hence bring about suicidal thoughts and behaviors.
CONCLUSION
Adolescent suicide is quite a major public health concern not only in the United States but throughout the world. It is essential to ensure suicide among youths is prevented. For this to be successful, adolescent suicide prevention should never be restricted, but actions ought to be taken at various levels of society. With environmental, biological, psychological, cultural, and social factors involved, suicide is certainly a complex phenomenon. The general finding is that less than half of youth suicides have got psychiatric care. Suicidal rates have been reduced significantly through physician education on how to restrict access to lethal. Literature on adolescent suicide have made great advances in treatment, prevention, etiological mechanisms, and epidemiology. Currently, the field has developed a firm cross national knowledge in regards to the epidemiology of suicidal behaviors, and suicidal thoughts. Despite the great improvements, there still remain huge gaps that need attention. Acceptance of the gaps represent an important first step to prompt a promising and innovative direction for any work that would be done in the future.
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