This literature review will describe several aspects of adolescent suicide including (1) risk factors, (2) protective factors, (3) barriers to effective interventions, (4) methodologies, (5) and the limitations and further research needed as it pertains to the factor of alienation in suicide. The significance and objective of this review is to explore the current dilemmas and complications to addressing adolescent suicide, and to introduce the importance of substantiating the relevance of alienation and parental relationships in intervention and prevention strategies.
Suicide in adolescence is not just defined by its finality of life; it is characterized by years of mental anguish and suffering that is prolonged, intense, and unmanageable. There are no palliative measures available that appears to ease the acute and often times inexpressible pain and suffering that is often endured in private silence.
The death process that is chosen by these children to relieve their suffering is as unbearable to the survivors as the life process was to the adolescent committing it. The death leaves the family members, friends, and loved ones trying to make sense of what appears to them to be a senseless act, and to deal with their own feelings of loss, guilt, and shame without answers.
Nationally, according to the Centers for Disease Control and Prevention (CDC, 2011) suicide is the third leading cause of death in fifteen to twenty-four year olds, these rates have tripled since 1970 (CDC, 2011). Ninety percent of those that die by suicide have been diagnosed with some form of mental disorder including depression (CDC, 2011).
Personal characteristicsinclude: mental disorders, most commonly depressive and anxiety disorders; a history of a prior suicide attempt; and substance abuse; personality factors such as aggression, lying, defiance, shyness, and emotional reticence; cognitive factors such as poor problem-solving ability
biological factors such as abnormalities in serotonin function and attachment disorders; demographic factors such as gender, males are four times more likely to die from suicide then females; race issues, whites, Native American, and Alaskan Natives are the most at risk ethnicities to be affected by suicide; and sexual orientation (CDC, 2011).
Family related factors include: History within the family of suicidal behavior; higher rates of generational depression and substance abuse within the family; family disruption or separation, and damaged parent-child relationships (Joiner & Ribeiro, 2005).
Adverse life situations include: Stressful life events, including personal losses such as romantic and interpersonal relationships; bullying; legal or behavior problems; and childhood trauma, especially physical, mental, or sexual abuse (Joiner & Ribeiro, 2005).
Socio-environmental factors include: Peer relationships; dropping out of school; not working; impact of the media hype about the perception of copycat suicide; socio-economic status; availability of lethal means; social isolation; and barriers with mental health treatment (Joiner & Ribeiro, 2005). Of all of these risk factors, there are only three that can be linked through research, to independently operate and effect the other factors and these are mental disorders; family trauma and alienation; and history of a prior suicide attempt (Kakhnovets, Young,Purnell, Huebner, & Bishop, 2010).
Protective Factors Several protective factorshave also been identified which are basically the opposite effects of the above risk factors, they include: family unity; community and social support; problem solving and conflict resolution skills; cultural or religious beliefs especially those that discourage suicide behavior or support and value life; self-esteem; self-awareness of direction and purpose; availability of a caring adult, both within the family and in relation to the school environment; and effective clinical interventions and support for mental, physical or substance use disorders (Joiner & Ribeiro, 2005).
Methodology and Findings One common theme of methodology concerns in the articles reviewed was that many had sample variation limits and thus the ability to generalize to other situations was compromised. With the current research, additional research is also needed to compare individual coping styles and other individual strengths and what relationship they have to amending risk factors. Although an increasingly large number of empirical studies have been published concerning social factors and adolescent suicide suggesting a strong indication for the importance of social variables to be included in our understanding of suicidal ideation and behavior among adolescents.
The relationship between a number of risk factors and individual strengths may impact different individuals and individual communities at different times in varied and unique ways, these relationship differences must be taken into consideration when attempting to understand which how these factors affect the outcome of suicidal behavior (De Man, 1999; Kakhnovets, Young,Purnell, Huebner, & Bishop, 2010; Taylor et al., 2011). Further empirical data is necessary in more universal situations, in order to make specific claims with the data collected (Jiang, Perry, Hesser, 2010; Kaminski, Puddy, Hall, Cashman, Crosby, Ortega, 2009).
Interventions Interventions need to be diversified and unified to be effective. School programs such as suicide awareness programs, problem solving, and coping skills trainings, along with screening programs, and multisystem support for adolescents with severe emotional problems or family disruption can be effective. Within assorted community programs, it has been noted that the restriction of firearms and trainings that educate the public about media influence show the most promise (Kakhnovets, Young,Purnell, Huebner, & Bishop, 2010 ).
Barriers to Effective Interventions Effective treatment and intervention face a number of identifiable barriers, including stigma of both mental illness and suicide, financial barriers with limited program or insurance coverage of mental health services, and mental health system barriers in limited and fragmented services especially in rural areas. There are barriers in the school system as school-based programs are often times not in adequate communication with mental health services or substance abuse agencies, and do not adequately address the issue of the importance of family to the suicide prevention process (Jiang, Perry, Hesser, 2010; Kaminski, Puddy, Hall, Cashman, Crosby, Ortega, 2009).
Strengths and Limitations of the Studies Research to adolescent suicide has gaps that affect the outcomes of the overall effectiveness of the studies. Literature and research is missing in certain demographic groups in regards to alienation or this information is demographic specific and cannot be generalized over populations, because of this, the difficulty of making concrete conclusions to the issue is compounded shown in (De Man, 1999; Kakhnovets, Young,Purnell, Huebner, & Bishop, 2010; Taylor et al., 2011).
A complication to the research is that much of the evidence is based on studying suicide attempts verses successful suicides, as research gathering with those that complete suicides can only be done from retrospect information, this brings question to whether the data can be generalized over both populations (Blake, Kim, McCormick, & Hayes, 2011). Within the studies of adolescent suicide, there is not enough research as to what degree of effect risk factors have on the event, or on their relationship to how effective prevention interventions are due to their influence (Joiner & Ribeiro, 2005).
Further Research With suicidal behavior being so multi-faceted and complex in its interactive relationship with risk and protective factors, there is a great deal of need for ongoing investigation as to how it is influenced by the aspect of alienation. In addition, more in-depth qualitative research is needed in how geographic, demographic, and cultural aspects affect coping skills (Joiner & Ribeiro, 2005). Future research should also investigate which precise facet of school environment might be most likely or most unlikely to prevent the development of suicidal behavior or impact the issue (Jiang, Perry, Hesser, 2010; Kaminski, Puddy, Hall, Cashman, Crosby, Ortega, 2009).
Questions should be posed such as, can both the connectedness factor and suicidal thoughts and behaviors be influence by another shared variable, or reversely, can thoughts and behaviors related to suicide cause adolescents to become less socially connected. Studies are lacking investigating this reverse influence factor (Joiner & Ribeiro, 2005).
Literature Review Adolescent Suicide and Alienation By Sunny Bossenmaier
The objective of this review is to explore the current complications ofadolescent suicide, and to introduce the importance of alienation and parental relationships in intervention and prevention strategies.
Suicide in adolescence is not just defined by its finality of life; it is characterized by years of mental anguish and suffering that is prolonged, intense, and unmanageable.
The death leaves the family members, friends, and loved ones trying to make sense of what appears to them to be a senseless act, and to deal with their own feelings of loss, guilt, and shame without answers.
Socio-environmental factors include Peer relationships . Dropping out of school . Unemployment . Media Impact Socio-economic status . Availability of lethal means . Social isolation Barriers with mental health treatment (Joiner & Ribeiro, 2005)
Protective Factors family unity . community and social support . problem solving and conflict resolution skills cultural or religious beliefs . self-esteem . self-awareness . availability of a caring adult effective clinical interventions (Joiner & Ribeiro, 2005)
Strengths impact different individuals at different times in different ways
Further empirical data is necessary in more universal situations, to make specific claims
with the data collected (De Man, 1999; Kakhnovets, Young,Purnell, Huebner, & Bishop, 2010; Taylor et al., 2011). (Jiang, Perry, Hesser, 2010; Kaminski, Paddy, Hall, Cashman, Crosby, Ortega, 2009)
Interventions School programs .Problem solving / coping skills . Trainings and screening programs. Emotional problems / family disruption support . Fire arm restriction . Media influence training (Kakhnovets, Young,Purnell, Huebner, & Bishop, 2010 )
Barriers to Effective Interventions Stigma of mental illness and suicide . Financial barriers .Mental health system barriers Fragmented services in rural areas . School-based programs lack communication with support agencies. Lack of attention to the importance of family to the suicide prevention process (Jiang, Perry, Hesser, 2010; Kaminski, Puddy, Hall, Cashman, Crosby, Ortega, 2009)
Literature and research missing in certain demographic groups in regards to alienation
Lack of demographic variation does not allow generalizing over populations
(De Man, 1999; Kakhnovets, Young,Purnell, Huebner, & Bishop, 2010; Taylor et al., 2011)
Strengths and Limitations Continued Researchfrom retrospect information Datacan not be generalized over both populations Not enough research to what degree of effectrisk factors have on the event Questions to how effective prevention interventions are due to risk factor influence (Joiner & Ribeiro, 2005)
Additional research is needed to find interventionand prevention tactics as children are committing suicide at the alarming rate of about 5,000 each year, with hundreds of thousands making the attempt.
The rate of deaths in children and young adults due to suicide will continue to grow as more lethal means for attempts are more accessible and the factor of alienation within families continues to skyrocket in our country.
School is where mostinterventions for adolescents are made.
Most school prevention strategies have focused on the aspects of connectedness to fellow students, teachers, or the academic environment and ignored the important factor of family relationship.
Summary and Conclusion Continued With additional research the importance of supporting positive family connections, in order to increase the effectiveness of suicide prevention programs (Kaminski, Puddy, Hall, Cashman, Crosby, Ortega, 2009)
References Blake, J. J., Kim, E. S., McCormick, A.L., & Hayes, D., (2011). The dimensionality of social victimization: A preliminary investigation. School Psychology Quarterly, 26 (1), 56-69.
Bureau, J.F., Martin, J., Freynet, N., Poirier, A.A., Lafontaine, M.F., & Cloutier, P., (2010). Perceived dimensions of parenting and non-suicidal self-injury in young adults. Adolescense, 39 (5), 484-494.
Center for Disease Control (2011). Retrieved from http://www.cdc.gov/
De Man, A.F., (1999). Correlates of suicide ideation in high school students: the importance of depression. The Journal of Genetic Psychology, 160 (1), 105-14.
Everall, R.D., Bostik, K.E., & Paulson, B.L., (2010). I'm sick of being me: developmental themes in a suicidal adolescent. Adolescence, 40 (160), 693-708.
Jiang, Y., Perry, D.K., Hesser, J.E., (2010). Suicide patterns and association with predictors among Rhode Island public high school students: a latent class analysis. American Journal of Public Health, 100 (9), 170-7.
Joiner, T.E., Ribeiro, J.D., (2011). Assessment and management of suicidal behavior in teens. Psychiatric Annals, 41 (4), 220-225.
Kakhnovets, R., Young, H.L., Purnell, A.L., Huebner, E., & Bishop, C., (2010). Self-reported experience of self-injurious behavior in college students. Journal of Mental Health Counseling, 32 (4), 309-323.
Kaminski, J.W., Puddy, R.W., Hall, D.M., Cashman, S.Y., Crosby, A.E., Ortega, L.A., (2010). The relative influence of different domains of social connectedness on self-directed violence in adolescence. Journal of Youth and Adolescence, 39 (5), 460-73.
Mazza, J.J., Fleming, C.B., Abbott, R.D., Haggerty K.P., & Catalano, R.F., (2010). Identifying trajectories of adolescents’ depressive phenomena: an examination of early risk factors, Journal of Youth and Adolescence, 39 (6), 579-593.
Taylor, P. J., Gooding, P., Wood, A., & Tarrier, N., (2011). The role of defeat and entrapment in depression, anxiety, and suicide. Psychological Bulletin, 137 (3), 391-420.