This paper examines eight published articles that contain results, from research conducted on adolescent suicide. The said articles also discussed treatment and intervention strategies used by mental health clinicians. Although the articles agree that adolescent suicide is a major social problem in developed countries, there is no agreement when it comes to treatment and intervention strategies (Berman, year). This can negatively affect treatment adherence. These are the challenges faced by modern day mental health clinicians. This paper will attempt to understand the underlying problems that prevented the development of appropriate post-treatment and intervention strategies in helping reduce the incidence of future suicidal threat and suicide ideation in the life of a suicide survivor.
Definition of Adolescent Suicide and Treatment and Intervention Strategies
Adolescent suicide is a major problem in developed countries. In Canada alone it was estimated that deaths resulting from adolescent suicide account for 15,000 years of potential life lost (Ashworth, 2001). In the United States adolescent suicide is the third leading cause of death and it is responsible for a greater number of deaths than the next seven leading causes of death combined (Goldston, et al., 2008). It is even considered as an international concern by many researchers (Moskos, Achilles, & Gray, 2004). Aside from the significant number of deaths there is also an increase in the number of suicide attempts in developing countries. This paper will focus on post-attempt treatment and intervention strategies.
Before going any further there is a need to discuss commonly understood terms related to adolescent suicide. First of all, suicide is an action that resulted in death due to injury, poisoning or suffocation; there must also be evidence that the damage was self-inflicted and the adolescent intended to kill him/herself (Ashworth, 2001). This is type is also known as fatal suicide. With regards to this study, the object of interest is the non-fatal type of suicide, which can be further divided into two categories: a) suicide attempt with injuries and b) suicide attempt without injuries.
Adolescent suicide-attempters that fall into the first category are the most visible because in the injury was so severe that they require medical treatment. Although adolescent-suicide attempters who belong to the second category may choose not to seek help they are also included in the target group that must receive post-treatment and intervention procedures. For both categories the challenges faced by mental health clinicians are significant because this is the age group that usually detests the idea of seeking help (Ashworth, 2001). Thus, mental health clinicians must not only develop effective treatment and intervention strategies they must also attempt to understand how to draw out suicide-prone teens to ask for assistance.
Treatment and Intervention Strategies
It is not possible to administer a standard treatment procedure for non-fatal adolescent suicide. Each attempter is unique and the confluence of many issues like family background and other social factors can make it extremely difficult to find out the trigger for the suicide. Therefore, it would be a challenge to eliminate the problem that led to the suicide attempt. Berman (year) was able to put it succinctly when he said that there are different types of suicide states as well as the idiosyncratic nuances of the suicidal mind as manifested in the young person contributes greatly to the complexity of the problem.
This does not mean that no attempt was made to deal with the problems that drive teenagers to attempt suicide. But for the most part these treatment and intervention strategies failed to reduce the number of deaths due to adolescent suicides (Spirito, 1997). This is true for psychosocial interventions (Fristad & Shaver, 2001). Yet critics are the first to admit that there is a dearth in empirical research when it comes to psychosocial interventions (Fristad & Shaver, 2001).
Researchers must increase their efforts when it comes to developing “well-established” psychosocial intervention strategies (Fristad & Shaver, 2001). On the other researchers are quick to acknowledge the difficulty of designing an experiment involving adolescent suicide-attempters (Fristad & Shaver, 2001). So for the longest time there is little in the way of systematic treatment research in this area (Spirito, 1997).
On the other hand there are those who assert that adolescent suicide is the evidence of “treatment failure” (Moskos, Achilles, & Gray, 2004). As early the 1990s, authorities began to notice a reduction in the suicide rates among adolescents and this decline was attributed to the rapid increase in the use of antidepressants and mood stabilizers among adolescents (Moskos, Achilles, & Gray, 2004). This is a promising development that drugs can help in the fight against adolescent suicide.
Still, there is more work that must be done because most of the drugs manufactured to treat mood disorders linked to suicide, were developed for the adult population (Moskos, Achilles, & Gray, 2004). Based on the number of adolescents that died from self-inflicted injury, pharmaceutical companies and government agencies must work hand-in-hand to develop more effective psychotropic drugs.
Assuming that drugs and psychosocial interventions can be refined and improved to significantly reduce the incidence of suicidal threat and suicide ideations, this is not enough of a reason to be overly optimistic. Medical treatment and psychosocial interventions can be deemed effective but without adherence to treatment and intervention methods the suicide attempters can still entertain thoughts of suicide. They will experience “relapse” because there is a problem when it comes to treatment adherence (Rotheram-Borus, M. et al., 1996) This is due to many factors, including the following:
- the emergency-room staff’s recognition of post-attempt treatment;
- the establishment of positive behavior toward the attempter;
- the adolescent as his or her family’s conceptualization of suicidal behavior; and
- expectations about therapy and attitudes toward the medical setting (Rotheram-Borus, 1996).
Medical health workers may view adolescent suicide-attempters with disdain and without saying a word will make the adolescent more guilty and ashamed for what he or she has done (Rotheram-Borus, 1996). A judgemental environment will backfire for these at risk group of teens.
The parents can also contribute to the early demise of their son or daughter (Flouri & Buchanan, 2002). Lack of parental support and a wrong perception concerning suicide can increase the likelihood of suicide ideation for suicide attempters who survived the first attempt (Flouri & Buchanan, 2002). The failure of treatment can also be attributed to the lack of understanding particularly when it comes to the effect of drugs on adolescent suicide-attempters. This can be remedied by educating the adolescent, the parents and the health workers who will come in contact with the suicide attempter in a post-attempt treatment setting (Rotheram-Borus et al., 1996).
In one study the proponent pointed out the ambivalent attitudes of health workers and emergency-staff personnel toward suicide attempters that are likely to influence the quality of care and the adolescent’s adherence to treatment (Rotheram-Borus, 1996).
This is exacerbated by the fact that there are different types of suicidal teens and according to Berman (year), a “one-size treatment” does not fit all. Aside from these factors, mental health clinicians must also consider culture, ethnicity, and race in developing the said strategies (Goldston, et al, 2008). This has prompted many mental health clinicians to look into more effective treatment and intervention strategies that should involve the family and then the medical health workers who are the first group of people that adolescent suicide-attempters may encounter after the post-attempt treatment. These two groups must provide a safe haven for attempters instead of judging them and making them feel more alienated than they already are.
While it was established that there can be no standardized treatment for suicide attempters, the research done in this field of study has provided useful results (Ashworth, 2001). This must continue, in order to develop more sophisticated tools for assessment, understanding and conceptualizing different types of suicidal states (Berman, year). On the other hand, mental health practitioners must also acknowledge the considerable progress in this field such as the findings that adolescent suicide is highest among males (Goldston et al., 2008). It was also discovered that ethnicity and race is a factor as the highest risk group is composed of American Indian/Alaska Native males (Goldston et al., 2008). A whole range of strategy can be developed based on these findings.
For instance, when it comes to “self-reported suicide attempts” females scored high in this category. Thus, schools, civic organization as well as faith-based groups can work together to exploit this opening in a normally tough-to-penetrate defense mechanism of at risk teens (Fristad & Shaver, 2001). With regards to the high prevalence of adolescent suicide-attempters among American Indian/Alaska Natives psychosocial intervention strategies must be tailor-made to reach them.
This is merely the beginning in the development of effective intervention strategies. There are other authors who suggested that there must be well-designed empirical studies that will determine the efficacy of psychosocial interventions. There are conflicting results when it comes to the effectiveness of this type of intervention.
When it comes to psychotropic drugs pharmaceutical companies and researchers seemed to be focused on the adult population. This can be explained from a business standpoint but given the high number of deaths as a result of adolescent suicide it is high time to funnel resources into empirical studies that will determine the efficacy of medication that specifically target mood disorders among teenagers. This project can be initiated by the government if there is slow progress in this area.
Ashworth, J. (2001). Practice principles: a guide for mental health clinicians working with suicidal children and youth. (Ministry of Children and Family Development). British Columbia.
Berman. The treatment of the suicidal adolescent.
Flouri, E. & A. Buchanan. (2002). The protective role of parental involvement in adolescent suicide. Crisis, 23(1), 17-22.
Fristad, M., & E. Shaver. (2001). Psychosocial interventions for suicidal children and adolescents. Depression and Anxiety, 14, 192-197.
Goldston, D. et al. (2008). Cultural considerations in adolescent suicide prevention and psychosocial treatment. American Psychologist, 63(1), 14-31.
Moskos, M., J. Achilles, & D. Gray. (2004). Adolescent suicide myths in the United States. Crisis, 25(4), 176-182.
Rotheram-Borus, M. et al. (1996). Toward improving treatment adherence among adolescent suicide attempters. Clinical Child Psychology and Psychiatry, 1(1), 99-108.
Spirito, A. (1997). Individual therapy techniques with adolescent suicide attempters. Crisis, 18(2), 62-64.