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Essays by KT

Teen Suicide in the United States

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Soc Lit Review
Fall 2008 (Aquinas)

INTRODUCTION
From 1952 to 1996, the youth suicide rate in the United States nearly tripled. In 2004 an estimated 1,600 teens from ages fifteen to nineteen killed themselves, and about one in five high school students considered doing so. About one third of those who considered suicide actually attempted it. Suicide continues to be the third leading cause of deaths among teens. Although, in 2004, the teen suicide rate had decreased twenty-nine percent since 1994, it’s debated whether this was due to a temporary decrease in suicides or if these rates would continue to decrease. (Hosansky 2004)
Mental health experts believe, in order to decrease these rates, it’s important to identify and treat those at risk. It is very difficult to identify at-risk youths; it is, therefore, difficult to treat them. When a teen commits suicide it is often because they have trouble dealing with rapid changes and peer pressure. It is very difficult to see warning signs in suicidal teens because these signs are often passed off as mere characteristics of being a teenager. There has been much debate over what leads one to suicide; consequently there has been debate over the best way to prevent it from occurring. Suicidal teens appear in all racial and socioeconomic classes; they are often successful and energetic, despite the common misconception. (Hosansky 2004)
Experts believe the frequency of suicide in rural areas may be due to the lack of mental health services and the availability of firearms. Some experts believe stricter gun control laws would decrease the suicide rate. Research shows more than half of all teens use guns to kill themselves. Although girls are twice as likely to attempt suicide, boys are four times more likely to succeed due to the use of more lethal means, such as guns. Other experts believe these teens would just turn to another way to kill themselves. Many experts believe it wouldn’t hurt to educate more about the dangers of guns and to experiment with stricter gun control laws. (Hosansky 2004)
Experts believe emotional problems are to blame, but some believe these emotional problems are due to changes in society while others think there are other causes as well. Some mental health experts believe the increase in suicide rates is due to the modern life and its increased pressures as compared to the traditional life. Divorce and substance abuse rates are higher, the importance of career in society has increased, and traditional supports such as family and community contribution as well as participation in religion have decreased. These factors may lead one to a feeling of emotional isolation, which is a major factor in teen suicide. The American Academy of Pediatrics believes the stressors of academic competition as well as an increase in media violence may also be factors in an increase of suicides. However, in 1910, when suicide rates were especially high, and society was much different than it is now, the supposed causes of suicide now didn’t exist. (Hosansky 2004)
Mental health experts believe there are psychological and physiological factors that may lead one to suicide. Some experts believe antidepressants may decrease the likelihood of suicide while others believe they may actually trigger suicide. Although the risks of antidepressants outweigh their benefits when given to children, some studies have linked the increase in the use of these antidepressants to a decrease in teen suicides. Many psychiatrists believe antidepressants are necessary for those who are severely depressed. According to studies however, despite being recommended only for the severely depressed, over half of the children in the United States who are being treated for depression are put on antidepressants. (Hosansky 2004)
Many schools don’t have suicide prevention programs due partially to the lack of government funding in that area and it is debated whether these programs are helpful. Suicide prevention programs have been shown to be cost effective and some experts believe they are very helpful. However, others say talking to teens about suicide may increase the problem. Experts who find this method helpful believe if the topic of suicide is presented, it must be done carefully, so as not to make suicide look like an option. Screening teens to find those at risk has been hopeful but its downfall is, once a teen is determined to be at-risk, many cannot afford the treatment. Often, teens become suddenly suicidal and this would not be picked up in a screening test administered only occasionally. (Hosansky 2004)
This paper examines teen suicide in the United States. It will reveal factors thought to put one at risk of suicide. It will also show ideas presented by experts of how to prevent suicide from occurring.
DISCUSSION
The topic of teen suicide has been receiving increased attention (Romer & Jamieson 2003). Suicide is the third leading cause of teens in North America (U.S. Public Health Service 1999 as cited in Evans, Marte, Betts & Silliman 2001; Lazarus & Kalafat 2001; Romer & Jamieson 2003). About one quarter of all teen deaths is due to suicide (Harkavy-Friedman, Asnis, Boeck & DiFiore 1987 as cited in Evans et al. 2001). Teen suicide rates have almost tripled over the last thirty years (Lester 1992 as cited in Evans et al. 2001; Lazarus & Kalafat 2001; Romer & Jamieson 2003). There has been an increase in the diagnosis and reporting of suicides, however, this does not account for this rise in the suicide rate (Romer & Jamieson 2003).
Although there has been a decline in reported teen suicides since 1994 (Lazarus & Kalafat 2001), suicidologists believe this to be because of suicides being underreported due to inaccurate diagnoses such as determining a death as an accident rather than a suicide (Lazarus & Kalafat 2001; Rockett, Samora & Coben 2006). There has also been an increasing acceptance of suicide (Romer & Jamieson 2003).
Risk Factors
Risk factors have been found to accumulate rather than merely coexist. A person who has more than one risk factor is much more likely to attempt suicide than if they only have one risk factor. This suggests suicidal behavior is not due to just one factor. Rather, a set of risk factors influences one’s decision to commit suicide. Studies show such a variance in data, though, that it is difficult to pinpoint what the risk factors are. (Lazarus & Kalafat 2001)
Some studies have shown urban students to be more at risk (Evans et al. 2001) while others have shown rural students to be more at risk (Forrest 1988 as cited in Evans et al. 2001) and still others show no difference between the two (Adcock, Nagy & Simpson 1991 as cited in Evans et al. 2001). Higher suicide rates have generally been found in rural areas, though (Middleton, Gunnell, Frankel, Whitley & Dorling 2003 as cited in Markowitz & Cuellar 2007).
Research has shown a link between access to firearms and increased suicide rates (Clark & Gould 1998 as cited in Lazarus & Kalafat 2001; Jessor 1996 as cited in Evans et al. 2001). Most youth suicides are committed with firearms (Centers for Disease Control 1997 as cited in Evans et al. 2001). The rate of suicide by firearms in the United States is thought to be because of the ease of access (Lazarus & Kalafat 2001). Restricting access to weapons may decrease both violence and suicide rates by limiting access to such means of violence and suicide (Evans et al. 2001; Romer & Jamieson 2003).
Suicide risk has also been connected to gender (Evans et al. 2001). Although suicide attempt rates are far greater for females (Evans et al. 2001; Romer & Jamieson 2003), suicide completion rates are higher among males (Gispert, Davis, Marsh & Wheeler 1987 as cited in Evans et al. 2001; Fernquist 2000). This is thought to be due to the means by which males and females attempt suicide. Men are likely to use more lethal means such as firearms, where as women are more likely to use drugs (Romer & Jamieson 2003). More females report suicidal thoughts and attempts, while more males report substance abuse and violence (Zweig, Phillips & Lindberg 2002).
Ethnic minority students have been shown in some studies to be more at risk (Evans et al. 2001) while other studies do not support this (Adcock et al. 1991 as cited in Evans et al. 2001). In addition, between 1999 and 2002, the suicide rates of whites were double those of blacks (Rockett et al. 2006).
Commonly thought risk factors don’t seem to hold up; blacks appear to be more at risk of suicide given these common risk factors but statistics suggest otherwise (Rockett et al. 2006). Little formal education is a risk factor (Hamermesh & Soss 1974 as cited in Markowitz & Cuellar 2007) and blacks have a higher rate of low education (Kellerman et al. 1992 as cited in Rockett et al. 2006). Unemployed and underemployed people have been shown to be more at risk for suicide (Hamermesh & Soss 1974 as cited in Markowitz & Cuellar 2007; Romer & Jamieson 2003) and again, blacks have much higher unemployment and underemployment rates than do whites (Cubbin, LeClere & Smith 2000 as cited in Rockett et al. 2006). No research has been found to explain the reason why blacks have a lower suicide than do whites in the United States (Rockett et al. 2006).
Religiosity is another factor related to suicide (Greening & Stoppelbein 2002 as cited in Markowitz & Cuellar 2007). In recent years, there has been an increasing interest in the relationship between religion and harm. Some studies have shown a relationship between religion and lower suicide rates. (Nonnemaker, McNeely & Blum 2003) A study by Nonnemaker et al. (2003) found that private religiosity has a significant relationship with lower suicide attempts, whereas, public religiosity was found to have a significant relationship with depression. Some studies, however, have shown no difference in risk depending upon religion (Evans et al. 2001).
Family factors may play a role in youth suicide rates (Romer & Jamieson 2003; Fernquist 2000; Sweeney 2007). Poor peer and family support and inadequate coping skills put a teen at an increased risk for suicide (Evans et al. 2001).
Media/Suicide Modeling
The social learning theory states that most human behavior is learned by observing (Bandura 1977 as cited in Gould, Jamieson & Romer 2003). Research has shown a link between suicide modeling and suicide risk. Suicide modeling includes suicide clusters, media suicides, and knowing someone who has committed suicide. (Evans, Smith, et al. 1996 as cited in Evans et al. 2001)
A suicide cluster, also known as suicide contagion, is a series of suicides that “spread quickly and spontaneously through a group” (Gould et al. 2003:2165). The possibility of suicide clusters occurring is two to four times higher among ages fifteen to nineteen than among any other age group (Gould, Wallenstein, Kleinman, O'Carroll, et al. 1990 as cited in Gould et al. 2003). It is argued that suicide is contagious and that the media have a strong impact on this (Gould et al. 2003).
An increase in media suicides has resulted in an increase in suicide rates (Lazarus & Kalafat 2001; Gould et al. 2003). Media suicides include both suicide news coverage and suicides being presented in television shows and movies. Evidence suggests that media coverage on suicides has a strong impact on this. Television and newspaper reports about suicide have been connected to higher suicide rates. A group of suicides following news coverage of such is commonly known as the Werther effect based on the belief that Goethe’s 1774 novel caused an increase in suicides. (Gould et al. 2003) In response to the evidence of the media’s large influence on the suicide rate, the Centers for Disease Control has made guidelines for media programs about suicide (O’Carroll & Potter 1994 as cited in Lazarus & Kalafat 2001).
Copycat suicides in reaction to real suicides are about four times more likely to occur than those in reaction to fictional suicides (Stack 2000 as cited in Gould et al. 2003). Celebrity suicides are more likely to heighten the suicide rate than are non-celebrity suicides (Wasserman 1984 as cited in Gould et al. 2003).
Violence
Violence among teens is more common in the United States than in any other nation (Centers for Disease Control 1997 as cited in Evans et al. 2001). Suicide and violence among teens have often been viewed as separate topics. They are now being looked at as possibly being linked together (UCLA School Mental Health Project 1999 as cited in Evans et al. 2001). There is a strong relationship between homicide and suicide (Lazarus & Kalafat 2001).
Youth who have been perpetrators, victims, or witnesses of violence or bullying are far more at risk of suicidal behaviors than those who haven’t been (Evans et al. 2001). Those who witness violence are twice as likely to report suicidal thoughts (Pastore, Fisher & Friedman 1996 as cited in Evans et al. 2001). Some believe youth service providers need to focus on the link between violence/victimization and suicide risk in order to more successfully prevent suicide (Evans et al. 2001).

Substance Abuse
Substance abuse has been found to increase suicidal behaviors (Markowitz & Cuellar 2007; Jessor 1996 as cited in Evans et al. 2001; Zweig et al. 2002). Drug and alcohol use are leading risk factors (Cherpitel, Borges & Wilcox 2004 as cited in Rockett et al. 2006; Simonds, McMahon & Armstrong 1991 as cited in Evans et al. 2001; Romer & Jamieson 2003; Fernquist 2000). Females are most likely to use drugs to attempt suicide (Romer & Jamieson 2003).
Depression/Antidepressants
Depression is a leading risk factor for suicide (Markowitz & Cuellar 2007; Simonds et al. 1991 as cited in Evans et al. 2001; Romer & Jamieson 2003). In a study done by Evans et al. (2001), about sixty percent of the sample reported depression or suicidal thoughts.
There has been a major increase in the use of antidepressants within the last two decades as well as an increasing concern about their risks (Markowitz & Cuellar 2007). In October of 2004 the United States Food and Drug Administration issued that a warning be placed on all antidepressants, which stated that these drugs increased the risk of suicidal thinking and behavior in studies of some children (Markowitz & Cuellar 2007). NGAs are the only types of antidepressants that have been linked to a decrease in suicide rates among fifteen- to nineteen-year-olds. The other types of antidepressants, SSRI/SSNRIs and TCAs, don’t have any significant relationship to suicide rates (Markowitz & Cuellar 2007).
Suicide Prevention
Some ways to help those who have attempted suicide have also been found and are being used (Romer & Jamieson 2003) but there is a lot that is not known about how to prevent suicide. Some believe schools should have suicide prevention programs (Lazarus & Kalafat 2001). Such programs may reduce suicides as well as other problematic behaviors (Lazarus & Kalafat 2001; Romer & Jamieson 2003). These types of programs initially failed but have improved; more effective ways of identifying and helping at risk youths have been found and are beginning to be used in these programs (Romer & Jamieson 2003). Peers are usually the first to know about an at-risk youth but are hesitant about telling anyone (Vossekuil et al. 2000 as cited in Lazarus & Kalafat 2001). School programs that focus on suicide awareness and prevention may help decrease suicide rates (Kalafat 1997 as cited in Lazarus & Kalafat 2001). Research has suggested that prevention programs for teens more at risk than the average teen may be beneficial (Zweig et al. 2002).
CONCLUSION
Teen suicide rates have almost tripled in the past thirty years (Lester 1992 as cited in Evans et al. 2001; Lazarus & Kalafat 2001; Romer & Jamieson 2003), placing suicide as the third leading cause of death among teens in the United States (U.S. Public Health Service 1999 as cited in Evans et al. 2001; Lazarus & Kalafat 2001; Romer & Jamieson 2003). There is a lot of disagreement about what puts a teen at risk of suicide. Because of this disagreement, there is also a lot of disagreement about the best way to prevent suicide from occurring. Experts are in agreement that it is a combination of factors that lead one to suicide, but what those factors are thought to be, vary. (Lazarus & Kalafat 2001)
Factors that may influence an individual’s decision to commit suicide vary from gender, ethnicity (Evans et al. 2001), and religion (Greening & Stoppelbein 2002 as cited in Markowitz & Cuellar 2007), to family (Romer & Jamieson 2003; Fernquist 2000; Sweeney 2007; Evans et al. 2001), peer (Evans et al. 2001), and media influences (Evans, Smith, et al. 1996 as cited in Evans et al. 2001), to involvement in violence (Evans et al. 2001; Lazarus & Kalafat 2001) and drugs (Jessor 1996 as cited in Evans et al. 2001; Markowitz & Cuellar 2007; Cherpitel et al. 2004 as cited in Rockett et al. 2006; Romer & Jamieson 2003; Fernquist 2000). The mental health of the individual is also an influence (Markowitz & Cuellar 2007; Simonds et al. 1991 as cited in Evans et al. 2001; Romer & Jamieson 2003).
Teen suicide has been receiving increased attention (Romer & Jamieson 2003). Risk factors are being researched (Lazarus & Kalafat 2001) in hopes that suicide can be prevented (Lazarus & Kalafat 2001; Romer & Jamieson 2003). Although there is a lot that is not known about how to prevent suicide (Lazarus & Kalafat 2001), some possible ways have been found and are being used (Romer & Jamieson 2003).


REFERENCES
Evans, William P., Ricardo M. Marte, Sherry Betts and Benjamin Silliman. 2001. “Adolescent Suicide Risk and Peer-Related Violent Behaviors and Victimization.” Journal of Interpersonal Violence 16(12):1330-1348.
Fernquist, Robert M. 2000. “Problem Drinking in the Family and Youth Suicide.” Adolescence 35(139):551-558.
Gould, Madelyn, Patrick Jamieson and Daniel Romer. 2003. “Media Contagion and Suicide among the Young.” American Behavioral Scientist 46(9):1269-1284.
Hosansky, David. 2004. “Youth Suicide: Should Government Fund More Prevention Programs?” CQ Researcher 14(6):125-148.
Lazarus, Philip J. and John Kalafat. 2001. “Suicide Prevention and Youth: Recommendations for Public Policy.” The International Journal of Sociology and Social Policy 21(3):22-37.
Markowitz, Sara and Alison Cuellar. 2007. “Antidepressants and Youth: Healing or Harmful?” Social Science & Medicine 64(10):2138-2151.
Nonnemaker, James M., Clea A. McNeely and Robert W. Blum. 2003. “Public and Private Domains of Religiosity and Adolescent Health Risk Behaviors: Evidence from the National Longitudinal Study of Adolescent Health.” Social Science & Medicine 57(11):2049-2054.
Rockett, Ian R. H., Julie B. Samora and Jeffrey H. Coben. 2006. “The Black-White Suicide Paradox: Possible Effects of Misclassification.” Social Science & Medicine 63(8):2165-2175.
Romer, Daniel and Patrick Jamieson. 2003. “Introduction.” American Behavioral Scientist 46(9):1131-1136.
Sweeney, Megan M. 2007. “Stepfather Families and the Emotional Well-Being of Adolescents.” Journal of Health and Social Behavior 48(1):33-49.
Zweig, Janine M., Stacey D. Phillips and Laura D. Lindberg. 2002. “Predicting Adolescent Profiles of Risk: Looking beyond Demographics.” Journal of Adolescent Health 31(4):343-353.