Risk Factors Associated with Adolescent Suicide - Research Paper Example

A Comparative Analysis of Risk Factors Associated with Adolescent Suicide Introduction By 2004, the annual number of adolescents who committed suicide had risen to 12,050. This figure accounted for 9.1% of all deaths in young people according to global figures published by the World Health Organisation (2005). This rising trend, particularly in the 15-19 age group placed suicide as the leading cause of death for males and the third most common cause of death for females. As a result of these figures, suicidal behaviour in adolescents became a major health concern in both developed and developing countries. This paper will review studies that seek to identify risk factors in adolescent suicide. The research will pertain to two dissimilar geographical areas and their social milieu, namely New Zealand (the Beautrais, Drummond, Fortune, Heled, Langford, and Fleming studies) and Korea (the Lee, Park, and Kim studies). Half a world apart, the two countries have recorded rising incidences of suicide and suicide ideation among the children and adolescents in their societies. The aim of this study of both countries is to gain knowledge which would help implement new strategies to reduce the rising suicide figures. The study shall employ the Comparative Social Science Approach as research framework. Theoretical Framework This paper shall employ a variant of the Comparative Social Science Approach, a framework for cross border research projects carried out by international researchers. The framework is one of the several paradigms endorsed by the United Nations Educational, Scientific, and Cultural Organization. While this exercise does not employ a network of researchers, for which the framework is best suited, it is however useful in structuring a comparative study across borders, such as this one. The framework entails identification and discussion of the following elements: (1) Identification of criteria in the context of cross comparison and transferability (2) A better grasp of cross-national phenomena (3) Collective learning for the benefit of research for action. The first step indicates that there are varied criteria for research that would be relevant to each country specifically. However, there would also be criteria which would be relevant to both social environments, and therefore would prove useful in the transference and comparison of information across the theoretical divide. While the first step seeks what are common between the two societies, the second step entails an understanding of the differences between the two settings. An appreciation of the country-specific elements would shed light on the nature of the phenomenon studied – in this case, the incidence and ideation of suicide among adolescents. This understanding would prove invaluable in determining the usefulness and validity of the findings on the basis of the geographical location. Finally, the collective learning gathered should yield recommendations that would prove useful in the preparation of an action plan. Discussion of the academic literature Before applying the framework, the topic of study should first be compared for compatibility. The studies appear to agree that previous suicide attempts are predictive of future suicidal behaviours (Fleming et al, 2007: 214), with an important qualification. However, the New Zealand studies tackled the matter of fatal suicides – attempts that had resulted in a death. The Korean studies, on the other hand, dealt with suicide ideation, without information on suicide fatalities. The Kim study refers to an article published by Myers et al (1991) which states it would be inappropriate to generalize results from those who have attempted suicide to suicide ideators and adolescents who have actually committed suicide, as there may be qualitative differences in these groups. The Fleming et al study indirectly supports this theory when it quotes the work of Evans et al (2005) which states ‘few young people who report to have tried to kill themselves may in fact have wished to die, and very few will go on to complete suicide’. This is important to keep in mind as the studies discussed here deal with both suicide ideation and fatal suicides; however, the trends and factors shall still be studied, as there is a strong implication that the ideation of suicide would tend to lead to the act’s commission. The interest in this study is to provide basis for prevention; thus ideation is an important consideration. A cross sectional survey method was employed using an anonymous self-report questionnaire for nearly all studies, except for one longitudinal study on New Zealand that covered ten years. The longitudinal study employed a series of cross-sectional samplings, however, and therefore differs little in this case from the other studies. Cross-sectional sampling method produces easily obtainable data for analysis however a cross sectional survey does not take into account issues such as inconsistent cultural issues such as natural disaster, war or economic crisis or individual emotional states during data collection. Furthermore, whilst anonymous questionnaires allowed the participants freedom to be honest, it does not account for difference in perceptions of participants, particularly in responses where a scale is used to measure the response. (1) Identification of common criteria in the context of cross comparison and transferability The New Zealand studies and the Korean studies likewise provided results which detail risk factors for suicide attempts among adolescents, including personality traits, family dynamics and peak age groups. Whilst it was not possible to compare most of the data on a ‘like for like’ basis, the studies were able to provide a conceptual framework for risk factors which can be used to inform professionals such as teachers, health staff and social workers. Furthermore, in the current global economic conditions policy makers and resource managers rely on data from robust scientific studies to guide where limited resources are allocated in order to help groups who are most at risk. These studies may have successfully identified a number of factors which will determine where resources and protective policies are most needed however; further research is necessary to strengthen the evidence that studying adolescents who have attempted suicide presents a stronger case than mortality studies or individual case studies of successful suicide attempts, before it can be certain that global efforts to reduce the adolescent suicide are as effective as possible. The results of the Kim study showed student adolescents reported a lower rate of suicide attempts than delinquent adolescents, however suicidal behaviour in both groups was significantly related to five risk factors. These are coping strategies, parental-child rearing patterns, depression, parent-child relationship and psychosomatic symptoms. Many of the results are supported by the findings of the Fleming et al study which reported depression, alcohol or substance abuse, problem behaviour, family violence and issues of sexual orientation as significant risk factors in adolescent suicide attempts. However, it is not possible to compare the results of all the studies on a ‘like for like basis’ as the researchers employed different measurements to obtain and analyse data for each risk area. For example, the Fleming et al study assessed family dynamics using seven single questions requiring a yes/no answer. In contrast, the Kim study used seven indicators of family dynamics, each consisting of a varying number of items totalling fifty questions, each requiring a response on a Likeart Scale, and seven separate questions to assess family problems, each requiring a yes/no answer. The only question which provided ‘like for like’ data for comparison was previous suicide attempts as both studies had a similarly worded question which required a straight forward yes/no response. The matter of age of suicides or suicide ideators appears to be consistent for all studies.. The studies of both countries found the peak age for students to attempt suicide was approximately 15 years. The Kim study found the peak age for delinquents to be 17-18 years. Aside from age, the factors pertaining to family history and family composition at the time of the suicide were also equally determinative. The Beautrais study pointed to several contributory factors. Many of the suicides (more than 60%) were not living with both biological parents, and usually involved social welfare oversight. The suicide death occurred commonly after an argument with a parent or parent figure, or on the occasion of a disciplinary crisis. Most deaths occurring among children were linked also to disadvantaged and problematic family backgrounds, particularly because more of them were under the supervision of social welfare authorities. For suicides among children, mental health is less of a determinative factor than suicides among the youth. Furthermore, proportionally more suicides among children were Maori (57%), while this ratio was a lower among youths (30%), suggesting that ethnicity is a greater factor among the suicides in the younger age range. For the very young, the profiles closely match those of the “expendable child,” referring to those children who feel that their families would be better off without them (Sabbath, 1969, in Beauvais, 2001). (2) A better grasp of cross-national phenomen Biculturalism and ethnicity. One aspect of social life that appears to differentiate New Zealand and Korea is the existence of diversity factors (biculturalism and perceived ethnic inferiority) in New Zealand, which was not present in the Korea studies. Longford, Ritchie and Ritchie (1998) reported that of 23 Organization for Economic Cooperation and Development (OECD) countries, New Zealand ranked highest in terms of fatal suicidal behaviour for males 15-24 years old, and third for fatal suicidal behaviour among females within the same age bracket. This was according to the World Health Organization’s (WHO’s) 1995 World Health Statistics Annual. Likewise, a study conducted by the UNICEF in 1996 among 32 countries identified New Zealand as the third highest country for male fatal suicidal behaviour, and the eighth highest for female fatal suicidal behaviour, within the age group 15-24 years. These statistics represent a trebled rate over the past 20 years (Drummond, 1997, p. 925). This trend has been linked to the many social, technological and economic changes this small country has undergone, which have caused drastic socio-economic shifts among the populace. The added factor of a bicultural background is seen to work in the case of Aotearoa/New Zealand, an area populated by Maori and non-Maori residents. In a country with a relatively small population and an even smaller minority group, an alarming rise in youth suicide was registered in this particular segment of New Zealand society. It is particularly ironic, since the Maori language does not even have a precise word for suicide (Longford, Ritchie & Ritchie, 1998, p. 100). The dramatic changes have placed pressures on families which social support services have been seeking to keep abreast of. Specifically, there has been and increase in risk factors associated with suicide, such as depression, substance abuse, aggressive behaviour, physical and sexual abuse, family violence, and school dropout rate. There are factors over and above those that impact upon the non-Maori population, that add to the repercussions for the Maori group. Concisely stated, these factors pertain to the Maori youth’s identification with “the socioeconomic status of a deculturated, colonized, and detribalized population” (Longford, Ritchie & Ritchie, 1998, p. 104). Gender. A further difference was noted in the higher risk of female youths thinking of committing suicide (the Korean studies), although actual fatal suicides were committed by male youths, specifically by Maori in New Zealand. In the study by Park, Schepp, Jang & Koo (2006), the link sought was between factors pertaining to the adolescents, and the ideation of suicide – that is, the inception of the idea to commit suicide. In the New Zealand studies, much of the research was done on the basis of fatal suicides, and focused mostly on ethnicity and the biculturalism that characterised society. In the Korean study, gender was the variable of interest, as there was little basis for distinguishing across cultures as the youth respondents were of homogeneous race and ethnicity. The study designated suicidal ideation as the dependent variable, and independent variables included demographic, historical, psychosocial-environmental, protective, and behavioural variables. The results showed that factors in suicide ideation are gender skewed. The cross-sectional study revealed marked differences between factors that yielded suicidal ideation among males and females. These are summarized below: Factors that triggered suicidal ideation (Park, et al. 2006) Male Female Demographic 48 males (7.3%) 78 females (11.9%) Historical and Personal variables Suicidal attempt, depression, hostility, smoking, communication with friends Depression, hostility Psychosocial-environmental Parental divorce and parental alcohol abuse None Protective Inability to express emotion, lack of self-esteem Lack of self esteem Behavioural All Victims of bullying behaviour and sexual orientation Overall, contrary to the studies conducted in New Zealand, female adolescents surveyed in the Korean study were found to be at greater risk of suicide ideation than male adolescents. In this case, as shown in the table above, only 7.3% of male respondents indicated that they tended to think about suicide, while as many as 11.9% (i.e., 50% higher than the proportion of males) of females among the respondents indicated that they did tend to think of suicide (Park, et al., 2006). In another study by Lee, Choi, Kim, Park & Shin (2009), certain specific behavioural factors were the focus of study as far as the influence it exerts on suicidal ideation among adolescents in Korea. Gender was likewise a qualifier in this study. The study found that anger was a significant predictor for suicidal ideation in boys, while school life satisfaction and anger were the more significant predictors for suicidal ideation in girls. Overall, girls were affected more than boys. The study was able to identify threshold anger points particularly for the female gender. At the threshold anger point of 117.67 in the scale developed in the study, approximately 12.5% of girls are identified to belong to the high-risk group. Self-esteem. In a study by Kelly, et al (2001), based in the US, self-esteem was found not to be predictive of suicide ideation for males. Nor was self-esteem a determining factor in the case of New Zealand. However, studies based in Korea yielded the opposite result, with lack or absence of self-esteem as a predictor variable for suicide ideation for males. This tends to suggest that culture is a factor that tends to influence the effect of lack of self-esteem on suicide ideation. (3) Collective learning for the benefit or research for action Based on the findings in the preceding studies, certain recommendations may be made to be incorporated in any future plan of action. In the case of the Maori youth, five courses of action that may be taken have been identified by youth interviewees: 1) Prevention and intervention may be taken for those age ranges where stressors are noted. For instance, leaving school is observed to be a precursor for other patterns of risk-taking behaviour; for Maori, this phenomenon occurs at a younger age range than non-Maori. 2) Even before intervention becomes necessary, risk-taking and health promoting behaviours should be identified and encouraged among high-risk groups. 3) Stressor should be determined which appear to be unique to ethnic and age groups, in order to understand their possible causes, indicators, and effects. 4) Regional groups should be organized in the data gather and definition of risk behaviours, and the design of intervention programs in an integrated manner. 5) A national registry should be established to maintain a record of youth health and mental health information, in order to have uniformity for tracking information (e.g. sexually transmitted disease, HIV/AIDS cases, depression, physical and sexual abuse, fatal and nonfatal suicide). Drummond (1997) describes the measures taken by the National Youth Council in New Zealand, which initiated the Youth Mental Health Project, whose sole aim is the reduction of the youth suicide rate. Its prevention strategy was based on the Antoniades model, to promote mental health by dissemination knowledge and holding skills workshops to enable young to cope with their problems. Basically, youths at risk asked for three things: first, to be provided with basic information about how to look after themselves; second, cheaper and easier access to medical and mental health care; last, to be afforded a venue through which they may express their thoughts and opinions, and reduce their feeling of powerlessness. For this, a network of crisis telephone lines called Lifeline was established (Taylor, 1992, in Drummond, 1997, p. 931-932). In comparison, the updated youth interview conducted by Heled & Read (2005), suggested the establishment of crisis support services to be located in schools and youth centers, organizing of youth activities as well as educational programs, assistance to be extended to youths to discuss their feelings and to bolster their self-esteem, and financial aid. Remarkably, none of the interviewees mentioned mental health services, and nobody thought that media coverage of suicides should be reduced in order to solve youth suicides. Beauvais (2001) recommends a study to identify the vulnerable, high risk children among those already in welfare care. Profiling should include family composition, living arrangements, school circumstances, and involvement with mental health and welfare services. Support must be provided also to parents, families, schools and communities, both before, and especially after such deaths. It is necessary also to establish a protocol among police and coroners for investigating child suicides; since these deaths are so few, they are often overlooked as systemic phenomena. There are certain factors that appear to exert a greater influence for one or the other gender, as well as one or another cultural, ethnic or racial group, depending upon the social environment (Park, et al., 2006). Gender specific patterns that relate anger and suicidal ideation appear to be regulated by threshold points; therefore, further research into the idea of threshold points would prove useful in designing targeted suicidal preventive programs through anger management and control (Lee, et al., 2009). Conclusion The foregoing study is essentially a survey of academic literature related to the suicide ideation, attempts, and occurrences among adolescents, within the context of two different countries and cultures – New Zealand, and Korea. The two countries are separated by geography, culture, history, and ethnic composition, yet both countries have had significant experience with a heightened incidence of adolescent suicide in the late twentieth to early twenty-first century. This study highlighted some factors that seem to be common to both countries, suggesting that some suicide triggers are ingrained in the human genetic make-up or in the psychological subconscious. On the other hand, there are also factors that appear to be prevalent in one society but not the other. These factors point to the possibility of history and social values and beliefs filtering in to a person’s decision to commit suicide. Finally, based on the suggested relationships among the factors, some directions have been suggested to be implemented when future plans are drawn. 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