Suicide Prevention in the Adolescent Population in the US - Case Study Example

Contents 2 Introduction 3 1 Problem ment 4 2 Literature Review 5 2 Who is an adolescent? 7 2.2 Who amongst the adolescents are more prone to committing suicides, in US context? 10 3 Contextual framework for suicidal prevention in US 17 References 18 Abstract Suicide is a major public health issue that is affecting the lives and families of many thousands of people all over the world, and especially worrying are the numbers of adolescents comprising mainly of school going children that are committing suicide all over the world. In US ‘adolescent suicides’ figure amongst the top 3 three reasons for teenager deaths, with fear from the experts that the numbers many increase with time. Thus we find that there is a great need for suicide prevention programs in American schools, to raise awareness amongst the students and their parents, both. In US, we find that as a first, New Jersey educators are mandated to incorporate suicide prevention programs within their curriculum. Here the N.J.S.A. 18A: 6-111 mandates that, suicide prevention programs (owing to its relation with the health and well being of students in New Jersey) be incorporated into the New Jersey Core Curriculum Content Standards, yet we find that the problem remains persistent and pervasive. In the context of this persistent problem, my article will explore the adolescent mindset through various theories that leads them to the take their own lives; the various causative factors that lead to suicidal ideations; like, previous suicide attempts, a history of mental disorders that cause acute depression, family history of child abuse, impulsive and aggressive tendencies, cultural and religious beliefs (stigma), substance abuse, and bullying. My aim is to develop an educational tool for educators, parents and students, in order to increase awareness, recognition and prevention of suicides in the teen years. Suicide prevention in the adolescent population in US 1 Introduction “To be normal during the adolescen! period is by itself abnormal" (Freud, 1958, 267). In the last few decades there has been remarkable progress in the field of medical diagnoses and available treatment for the various physical and mental disorders. This progress has undoubtedly led to marked improvement in the quality of lives for many people suffering from various illnesses worldwide. Despite improved medical and other facilities to increase the life quality, suicide still remains a major preventable public health crisis, both worldwide and in USA. In 2002, an estimated 877,000 lives were lost worldwide due to suicide (Mann et al., JAMA 2005, p. 2064-2074). Recent figures from the National Institute of Mental Health (NIMH) tell us that in 2007 suicide was found to be the “tenth leading cause of death in the U.S., accounting for 34,598 deaths”(NIMH, Suicide in the U.S.: Statistics and Prevention, 2010) and it also states that with each successful suicide, there are simultaneously almost 11 other failed attempts. Suicidal behavior arises from complex psychological conditions, and the associated risk factors may vary according to age, gender, and ethnicity, and often these patterns may also vary over time. Another very disturbing trend emerges from a close study of the US suicidal figures as given by Centers for Disease Control and Prevention (CDC). It was seen that in 2007 suicide was the third leading cause for adolescent deaths, which covers the age group 15 years- 24 years, and accounts for almost 4400 deaths each year. It has also been noted that amongst the adolescents, the age group 20 -24 years is at the maximum risk zone, showing almost 12.7 deaths for every 100,000 adolescents, belonging to this age group, with males showing a higher death rate (84%) than females (16%) (CDC, Suicide Prevention, 2009). Global adolescent suicide statistics also have also reached quite alarming proportions where we find that “Of 4 million worldwide suicide attempts each year, at least 90,000 adolescents (up to age 19) successfully complete, with one success­ful suicide in every 5 minutes” (Greydanus & Shek, 2009, 144). The above given figures on adolescence suicide shows the seriousness of the entire situation, while also highlighting the fact that there is somewhere something going wrong in our social systems, that is affecting our youth, prompting them to take their lives. It is time that we take a closer look into this issue that is fast turning into a major US social problem, and find out ways to tackle this rising social threat. 1.1 Problem statement Rise in the number of Teenage suicides is a social problem that is fast becoming a cause for persistent worry, for both the government and the parents. Various reasons have been cited as factors for this high percentage of teenage suicides that we see in USA. Some of the important factors that give rise to suicidal tendencies arise from family, peer, or social pressures; which may negatively affect a teenager, pushing the latter into a state of severe mental depression. Another important factor is the major physical, psychological, and biological changes that occur during this transitory phase of growth, as one move from childhood and enter the realms of adulthood. During these formative years when one is neither a child nor an adult, he goes through mental turmoil, while adjusting to the new mind and body. It is imperative that during these years when is learning to adjust to his new world the child is given enough love, and care by his parents and the society, in general. My article will examine the complexities of the adolescent mind, and will study the various scholarly concepts/notions that explain the psychology behind the so called typical ‘teenage’ behavior, while exploring other relationships that lead to self harming ideations; in order to comprehend the reason behind teenage suicides. This article will also look at the various social theories that will help me as an educator to find an answer to the question: what are the ways in which we can hope to work towards reversing this rising trend of suicide, amongst the American adolescents? 2 Literature Review “The paradox of adolescence is that it can be at once a time of storm and stress and a time of exuberant growth”  (Arnett, 1999, 317-326). Introduction: To successfully deal with adolescents and to work towards preventing them from committing suicide, it is necessary that we first understand the adolescents and their mental makeup. An adolescent psychology is extremely complex, and undergoes emotional upheavals more than any other age group, as it adjusts to the rapidly changing mind and body, and the newly discovered sexuality. Traditionally society has never laid much stress on the transitory phase of adolescence, and signs of puberty were generally marked as one’s passing from childhood, directly to adulthood. However, recently this age group has been given much importance by the psychologists and sociologists, owing to the large number of social problems arising in association with the teenagers, and according to some scholars the importance attached to this age group is an invention of the nineteenth century. As Kett (2003) remarked “adolescence…essentially a conception of behavior imposed on youth, rather than an empirical assessment of the way in which young people actually behaved. The architects of adolescence used biology and psychology…to justify the promotion among young people of norms of behavior that were freighted with middle class values” (cited in Liechty, 2003, 36). However, most of the modern day psychologists lay importance on these developmental years in a person’s life; and advocates proper upbringing that is filled with love and care, so that the adolescent is able to balance the ‘storm and the stress’ that goes on within his mind and body. It is true that not all teenagers have psychological problems; on the other hand it has also been observed that it is the adolescents that demonstrate more of this “storm and stress” than any other age groups. As WHO tells us “Adolescents – young people between the ages of 10 and 19 years – are often thought of as a healthy group. Nevertheless, many adolescents do die prematurely due to accidents, suicide, violence, pregnancy related complications and other illnesses that are either preventable or treatable. Many more suffer chronic ill-health and disability. In addition, many serious diseases in adulthood have their roots in adolescence. For example, tobacco use, sexually transmitted infections including HIV, poor eating and exercise habits, lead to illness or premature death later in life”(WHO, Adolescent Health, 2010). Thus one can say that adolescence under proper guidance and adequate love can be a period of joyful growing up that transforms a child and metamorphoses him into an adult; on the other hand this same period can be equally stressful and dangerous if not handled properly. 2.1 Who is an adolescent? The word adolescent derived from the Latin word, ‘adolescere’, refers to the period of growing or developing when one is neither a child nor an adult. “Adolescence has fascinated developmental scholars because the transition into adolescence involves biological, psychological, and social changes” (Grabber & Brooks-Gunn, 1996, 768-776). WHO defines adolescence as a period of remarkable growth and development as is seen in a person, belonging to the age group of 10 to 20 years. Adolescence can be broadly divided into 3 age groups. The age groups between 10 to 14 years is referred as early adolescence group; the age groups between 15 to 18 years is known as the middle adolescence group; while the late adolescence group consists of the age group 19 years and above, till 24 years, and this group shows full adult characteristics. This period that marks the social, mental and physical changes and transcends the move from childhood to adulthood, shows certain transformations that are quite easily discerned like the physical and biological attributes; however, it is the psychological changes that occur within the mind of a teenager, which for most parts goes completely unnoticed by the society. Adolescence can be characterized by 3 distinct phases: Gradual onset of puberty marked by the development of the secondary sexual characteristics that attain completion after developing into the sexual and reproductive organs, as seen in an adult. This phase is also marked by the development towards well formed mental processes, as are seen in the adults, and there is also the strong urge to form a sense of ‘self identity. This phase is referred to as “stage of identity” by Erikson, and as Nishikawa further construes, “Erikson believed that adolescents seek to find a definition of self (i.e., identity), and question their goals, attitudes, beliefs, and place in society. If the adolescents can resolve these questions of sense of self, they will develop an identity. However, if they fail to achieve this, they will develop a sense of identity confusion” (Nishikawa, 2009, 13). This phase is also marked by the gradual independence of the child from his caregiver or parents, when the adolescent starts becoming partially free, in a socio-economic sense. However, in their urge to fast gaining independence, the adolescents often fail to understand that at this stage parental guidance is more necessary to help them become responsible individuals. Here often the adolescents turn into a collision course with their parents, thus turning this stage into, as Branje, van Doorn, Van der Valk, & Meeus (2009) tells us “a period of engaging in conflict with their parents” (cited in Nishikawa, 2009). Here we will closely examine some of the developmental theories that deal with adolescence, namely Piaget’s theory of cognitive development and Erikson’s theory that will help us to comprehend the nature of adolescence mindset. Piaget’s theory of cognitive development: Piaget classifies four different stages in the cognitive development of an individual; in which the third stage that is known as the concrete operational stage covers the early adolescence stage, while the fourth stage that is the formal operation stage covers the late adolescence phase which culminates into adulthood. In the concrete operational stage, intelligence is shown through the logical handling of various symbols related to concrete objects. At this stage the ‘operation mental power’ develops where one is able to control his mental actions and if necessary also reverse it. The egocentric nature, perceived in childhood, according to Piaget, disappears during this stage. In the next stage which is the formal operational stage the adolescent demonstrates his intelligence through logical handling of symbols related to abstract objects. Here in this stage, Piaget tells us, there is a return of the egocentric thoughts within an adolescent mindset. Piaget’s theory, though not supported by most of the modern researchers, are important when it comes to teaching parents and educators on how to correctly guide the adolescent mind so that the growing child enjoys a happy and healthy transition into adulthood. Erikson’s theory on adolescence: Erikson in his theory of psychosocial development has divided the developments in the life processes of a human being, into eight stages. Of these, the 5th stage known as the identity vs. the role confusion relates to adolescence age group (13 to 19 years). In this stage “the transition from childhood to adulthood is most important. Children are becoming more independent, and begin to look at the future in terms of career, relationships, families, housing, etc. During this period, they explore possibilities and begin to form their own identity based upon the outcome of their explorations. This sense of who they are can be hindered, which results in a sense of confusion ("I don’t know what I want to be when I grow up") about themselves and their role in the world” (PSY 345 Lecture Notes, 2007, 5). The next stage, this is the sixth stage, known as Young Adulthood: Intimacy vs. Isolation, also relates to the late adolescence period (age group 20-24 years). In this stage one learns to share his innermost thoughts and feelings more closely with others, and this leads to long term commitments in relationship outside the family circle. A successful relationship at this stage leads to the development of a sense of responsibility, a feeling of security. “Avoiding intimacy, fearing commitment and relationships can lead to isolation, loneliness, and sometimes depression” at this stage (ibid). Understanding this theory is also necessary when teaching parents and others concerned, on how to handle adolescents properly and guide them towards becoming a responsible adult and enjoying a bright future. 2.2 Who amongst the adolescents are more prone to committing suicides, in US context? As already mentioned not all adolescents go through the psychological turmoil, and such mental disturbances are perceived only in some teenagers. Various studies have revealed that girls showing signs of early maturity have problems when they try to adjust socially; while it is just the opposite in boys, those with early maturity, tend to be socially better adapted. It has also been seen, that adolescents living within the norms of a traditional society are faced with less of this “storm and stress’’ during their transitional stage. Thus, we find that there are many factors like that of familial support, influence of peer friends, and also the culture of the society that the adolescent lives in, which play an active role in the shaping of an adolescent mind. According to the Committee on Adolescence, “Suicide affects young people from all races and socioeconomic groups, although some groups seem to have higher rates than others. Native American males have the highest suicide rate, African American women the lowest...The National Youth Risk Behavior Survey of students in grades 9 through 12 indicated that nearly one fourth (24.1%) of students had seriously considered attempting suicide during the 12 months preceding the survey, 17.7% had made a specific plan, and 8.7% had made an attempt” (American Academy Of Pediatrics, 2000). Often teenagers have also seen to simulate suicidal behavior seen on television or in movies (Velting & Gould, 1997); and often the media coverage story of a teenage suicide death has seen to lead to ‘cluster deaths’ (Davidson, 1989) amongst other teenagers; and this feeling often stays on for weeks after the media first carried the story (Phillips et al., 1989). Here we will examine the factors that make certain adolescents more prone to committing suicide than others: Previous Suicide attempts: adolescents that have previously tried committing suicide, have been seen to be more prone to repeat their attempts in taking their own lives. In a more recent publication by the American Academy of Pediatrics (2007), we find that certain “Fixed risk factors include family history of suicide or suicide attempts, male gender, parental mental health problems, gay or bisexual orientation, a history of physical or sexual abuse, and a previous suicide attempt” (Shain, 2007) from important factors that increase the chances of suicidal tendencies amongst adolescents. So, while clinically dealing with problematic adolescents or teenagers with various mental disorders the doctors generally probe for past history of suicide attempts, to find out whether the patient has suicidal tendencies (in order to protect the child from trying to again commit suicide, while treatment is on). It is one factor which all educators must keep an eye on, and spread awareness about, in their various educative programs. History of mental disorders (depression): adolescents are often associated with mental disorders that may cause severe depression, like bipolar disorder; major depressive disorder; and dysthymic disorder. Since these disorders substantially tend to increase the risk of suicidal tendencies amongst the patients, it is important for the physicians or care givers dealing with problematic teenagers to check their medical records for any history of mental disorders. Adolescents with major depressive disorders show a lack of interest in all their previously favorite activities, and are extremely pessimistic, severely critical of themselves, and in general feel that their future is completely hopeless and bleak. Such depressive thoughts may lead to suicidal tendencies amongst the teenagers. Often owing to this disorder the patient turns extremely irritated and tends to show aggressive behavior. Depressed children tend to have auditory hallucination, they may be reluctant to meet people, or they may also exhibit somatic symptoms like stomach ache, head ache, body aches (Birmaher et al., 1996). Dysthymic disorder is another mental disorder with fewer external manifestations, but is generally more long lasting and more chronic. Here the child may remain depressed for years, and he may not even understand that his behavior is different from his peers, and there is a period in this disorder when the sufferer goes through one major phase of severe depression (Kovacs et al., 1997). Bipolar disorder is another medical condition where the patient alternates between elated mood and being extremely energetic, to plummeting to the depths of depression. When ‘high’ phase is on adolescents may show risky behaviors, like being overly confident and uninhibited, which may lead them towards a promiscuous life style, experimenting with banned drugs, and driving at extremely high speed. Shaffer & Craft, 1999 in their research papers have shown that 90% of the adolescents who commit suicide suffer from some sort of a mental disorder, just before their act of killing themselves. In their paper they have further shown that girls with mental disorders are more prone to commit suicide; whereas for boys the most vital indicator is their previous attempt to commit suicide, which increases the risk almost by 30 times, which is followed by mental disorder (increases risk by 12 times), aggressiveness and substance abuse (each increases suicidal tendencies by 2 fold). So as an educator it is important that he makes the parents or the care givers of adolescents aware of these factors of mental disorders, and substance abuse that make the latter more prone to commit suicide. Impulsive and aggressive behavior: “Freud proposed that human beings come to balance instinctual demands with social sanctions…when an imbalance between individual demands and societal pressures occur, the individual becomes anxious and the ego must deal with this discomfort. To deal with this anxiety an individual uses defensive mechanisms…” (Gullotta, Adams & Ramos, 2005). According to Anna Freud, there is a psychological misbalance that occurs within the mental makeup of an adolescent, owing to instinctive demands and the presence of ‘ego’, and opined that this imbalance causes the ‘storm and stress’ within minds of teenagers, which is also related to some extent to the newly found sexual urges that these young children find difficult to both express or repress. This in turn creates mental anxiety and often leads to aggressive behavior and conflicts with parents and society at large. As Hall (1904) aptly frames it, “the wisdom and advice of parents and teachers is overtopped, and in ruder natures may be met by blank contradiction" (Vol. 2, p. 79). However the educator must create awareness through his various programs where he must lay stress on the fact that such open defiance must be tackled efficiently, without the parents losing their temper and also showing aggressive nature in retaliation; or this may lead the child to develop stress; seemingly, hardly a factor to commit suicide, nevertheless may be precipitating factors within the complex minds of these young children. Cultural and religious beliefs (stigma): Children from conservative families generally tend to find it difficult to adjust to the modern American society, thus leading to a feel of isolation and a feel of stigma, when they cannot relate to their peers in schools and colleges. It may lead severe mental depression which we have already seen, that can cause suicidal tendencies. Some specific case problems related to a particular culture and race have also been found, like it has been seen that adolescents from the Eastern Asian cultures may show suicidal tendencies when they feel guilty and develop a feeling of shame if they fail to achieve what their families expect of them (Zane & Mak, 2003) while ‘acculturative stress’ is seen amongst Latin-American adolescents and is linked to deep inner thoughts about suicide (Hovey and King, 1996). Family history of child abuse or domestic abuse: Fig A: “In 2006, approximately 3.3 million reports involving 6 million children were made to Child Protective Services (CPS) agencies. Of these, 61.7% were accepted as needing further investigation, and, once evaluated; the investigations concluded that child abuse and neglect had affected approximately 905,000 children, with 16% of this total representing cases of substantiated physical abuse. The most common form of substantiated abuse in 2006 was child neglect, which accounted for 64.1% of cases, followed by child sexual abuse (8.8% of cases) and emotional maltreatment (6.6% of cases)” (Source: Giardino, and Giardino, 2010), *rectifications to be noted: US children mal treatment trends [not trands] and at the left hand side of the graph, it is, population < 18 years [instead of, 18 yes]. Child abuse going on for substantial time period affects the mental health of a child, causing deep psychological scars (Kazdin et al., 1985).  This can lead to mental disorders, and which may result into suicidal tendencies, as we have already seen. Bullying in school is another risk factor that often causes mental trauma and resultant disorders in adolescents, and is thus another potential cause for these young children to take their lives. In the modern era of Internet and social networking sites, like Facebook, Orkut, and Twitter, another risk factor is arising from the area of cyber bullying, which can be defined as “wilful and repeated harm inflicted through the use of computers, cell phones, and other electronic devices” (Hinduja & Patchin,2010). Fig B: In their paper, Hinduja and Patchin tell us that “In our work, we inform students that cyber bullying is when someone “repeatedly makes fun of another person online or repeatedly picks on another person through email or text message or when someone posts something online about another person that they don’t like.” Using this definition, about 20% of the over 4,400 randomly‐selected 11‐18 year‐old students in 2010 indicated they had been a victim at some point in their life” (Source: Hinduja & Patchin, 2010, 1). Adolescents with their fragile mental makeup that with their capability to think abstractly tend to “see beneath the surface of situations and envision hidden and more long-lasting threats to their well-being" (Larson and Richards, 1994, 86). This often leads to creation of extreme stress, from even normal everyday life situations, which may lead to an adolescent to take his life or even attempt to commit suicide. Thus, from the above discourse we comprehend the various factors that may lead to suicidal tendencies in adolescents, and also grasp the graveness of the entire situation in US. Those adolescents, who have tried to commit suicide and failed, end up with various physical deformations, or other serious damages like brain damage, or organ failures that make them disabled for life. Suicide amongst teenagers also affects the community health adversely, where the parents, friends and other members of the family of the deceased child may feel depressed, shock, anger, or guilt. The next step would be thus to find steps as an educator, to stop suicide attempts by teenagers in US. 3 Contextual framework for suicidal prevention in US Theories: “The prevailing prevention model in the interdisciplinary field of prevention science is the Universal, Selective, and Indicated (USI) prevention model. This USI model focuses attention on defined populations—from everyone in the population, to specific at-risk groups, to specific high-risk individuals—i.e., three population groups for whom the designed interventions are deemed optimal for achieving the unique goals of each prevention type” (Goldsmith, et al., 2002, 274). Universal prevention model generally include the entire population like the entire country, or school, or neighborhood. These models are targeted to affect everyone within the specific population and “reducing suicide risk though removing barriers to care, enhancing knowledge of what to do and say to help suicidal individuals, increasing access to help, and strengthening protective processes like social support and coping skills” (ibid). School based ‘awareness programs’, various campaigns that raise public education levels, awareness programs for the media, and crises management tasks and plans, all come under the purview of the Universal Prevention Model. Selective strategies “address subsets of the total population, focusing on at-risk groups that have a greater probability of becoming suicidal” (ibid). Thus these programs aim to prevent the starting of suicidal behaviors amongst the members of the targeted population. Screening programs, training programs for the adult caregivers and the helpers from the ‘peer group’, accessible risk service program, all come under this heading. Indicated strategies target only specific high-risk individuals who show early signs of suicidal tendencies. In this case “programs are designed and delivered in groups or individually to reduce risk factors and increase protective factors. At this level, programs include skill-building support groups in high schools and colleges, parent support training programs, case management for individual high-risk youth at school, and referral sources for crisis intervention and treatment”(ibid). References American Academy of Pediatrics. (2000). Suicide and Suicide Attempts in Adolescents. Policy statements. Pediatrics Vol. 105 No. 4 April 2000, pp. 871- 874. Retrieved from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/4/871 Arnett, J, J. (1999). Adolescent Storm and Stress, Reconsidered, American Psychologist, Vol. 54, No. 5, 317-326. Birmaher, B., Ryan, N. D., Williamson, D. E., Brent, D. A., & Kaufman, J. (1996). 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In, Chun K, Organista P, Marin G, editors. Acculturation: Advances in theory, measurement, and applied research. Washington, DC: American Psychological Association, 39–60. Read More