Survey Identifies 'Final Straw' Stressors That May Be Associated With Teen Suicide

Acne and academic pressure can compound other factors for at-risk youth.
Dominic Lipinski/PA Wire

Anxieties such as acne and academic pressure could contribute to suicidal feelings in young people, suggests a new study of suicide cases among young people in the United Kingdom.

While such factors should not be considered direct causes of suicide, researchers said they might act as so-called "final straw" factors when combined with other issues such as long-term family problems, mental illness, bereavement and bullying. The research, which analyzes descriptive reports on the circumstances surrounding suicides of people under 20, is part of a research program in the U.K. called the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.

“Many of these factors are common in young people in general and on their own cannot be used to predict suicide risk,” said the authors of the study, which was published last week in The Lancet Psychiatry. However, they added that recognizing certain issues in adolescents may help families and doctors better identify those at risk of harming themselves.

Previous research has indicated that suicide risk factors in adults include depression, social isolation, and alcohol and drug misuse. In the new study, researchers from the University of Manchester aimed to identify other potential risk factors that may be specific to younger populations.

They looked at national data relating to suicide cases of people under 20 that occurred between January 2014 and April 2015. During that period, 145 suicides and probable suicides in this age group were reported. The researchers obtained data for 130 of the cases and analyzed common patterns preceding the deaths.

More than one-third (36 percent) of the 130 young people had a health condition, most commonly acne and asthma. The acne cases were severe enough that they required medical attention and may have been linked to social isolation, the researchers noted.

About one-quarter (27 percent) were experiencing school pressure and anxiety. “Academic pressures, especially related to exams, were common, although often unrecognized at the time, and four deaths occurred on the day of an exam or the day after,” the researchers wrote.

Twenty-two percent of the individuals had been bullied, the report found. In many cases, the bullying had happened in the past. However, some individuals had been bullied within three months of their death.

The report also found that 28 percent of the young people had recently experienced a loss of a family member or friend. About one-third had family problems, 15 percent had experienced child abuse or neglect, and 26 percent had shown excessive drinking.

Risk factors for young people in the United States are similar, said David Miller, the president of the American Association of Suicidology and a psychologist at the State University of New York at Albany.

Suicide is the second leading cause of death (after accidents) among teenagers and young adults between the ages of 15 and 24 in the U.S., causing more than 5,000 deaths per year, according to 2014 data from Centers for Disease Control and Prevention.

Deaths from suicide are only part of the picture. A 2013 survey of U.S. students in grades 9 through 12 found that 17 percent had seriously considered suicide; 14 percent said they had recently made a suicide plan; and 8 percent said they had attempted suicide in the 12 months preceding the survey. About 3 percent of students had made a suicide attempt that resulted in an injury, poisoning or overdose requiring medical attention.

The U.K. investigation found more than half (54 percent) of the 130 young people had harmed themselves, some of them in the week before death. More than one-quarter had expressed suicidal ideas or intent, many of them on the day they died, and 12 percent of the people had searched online for suicide methods.

“These young people who died by suicide were experiencing suicidal thoughts prior to their suicides and communicated this fact to others, whether it be family, friends, or health professionals,” Miller said. “This clearly demonstrates that a large number of these students were asking for help, and they may not have received it. All such communications should be treated very seriously and compassionately.”

Some of the young people in the U.K. study had been diagnosed with mental disorders, most commonly depression and bipolar disorder. But 61 percent of the individuals had no diagnosis of any mental disorder, and 43 percent had not been in contact with a health agency or related service.

“I see that in most cases the people who died by suicide had no formal diagnosis of a mental health problem, but that is not the same thing as saying that they did not have a mental health problem, which perhaps went undiagnosed,” Miller said. “Many people, including young people, feel stigmatized for admitting to a mental health problem, and this may prevent them from getting the help they need.”

Most suicides occurred during the late teens: 18- and 19-year-olds accounted for 79 of the cases, while 66 were connected to people younger than 18.

Many things could explain why suicide is more common in older adolescents than in younger teens and children, Miller said.

“Suicide is complex and a number of factors — genetic, environmental, and cognitive among them — likely account for it," he said. "These include higher rates of depression and hopelessness among adolescents as compared to younger children, as well as other factor such as easier access than children to lethal means."

Being aware of possible risk factors, including the "final straw" stressors such as exam pressures and relationship problems, can be important in preventing suicides, according to the report’s authors.

“Although the overall risk is low, services and families should recognize the serious potential risk for some children and young people who are bereaved or under exam pressure, witnessing domestic abuse or using drugs, or who could be facing risk online or have themselves experienced a suicide,” they wrote.

If you — or someone you know — need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.

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