In recent years there has been an alarming and dramatic increase in suicide attempts among children and adolescents around the world. Social and economic pressures, the COVID-19 pandemic, physical and mental health conditions, experiencing abuse, violence or familial trauma, academics, and sexual orientation are among some of the contributing factors that push children and adolescents to suicide or suicidal thoughts.
Defining suicide
Suicide is a death caused by ‘self-directed, harmful behavior with the intent to die’ (Nationwide Children’s, n.d). A suicide attempt is when the exact same criteria lead to a non-fatal injury rather than death (Nationwide Children’s, n.d). Prior to attempting suicide, young people may have thoughts related to, or have considered, suicide. When this is the case, it is referred to as suicide ideation (John Hopkins Medicine, n.d).
Global prevalence and trends
The World Health Organization (WHO) estimates that globally there are over 700,000 suicides annually (WHO, 2023). This is likely an approximation owing to the varied quality of suicide research worldwide. Only 80 United Nations’ Member States collect registration data that can be used to make estimates of suicide prevalence (WHO, 2023). As a result of sparse data collection, chronic underreporting and misclassification of suicide deaths, all statistics related to suicide must be presented with reservations (WHO, 2023).
Suicide is especially prevalent among younger populations. It is the second-leading cause of death for children aged 10-14 (Cammarata, 2023). It is the fourth leading cause of death among 15–29-year-olds (World Health Organization, 2023). For people aged 15-24, it is the third leading cause of death (John Hopkins Medicine, n.d). Suicide is more prevalent in older adolescents than younger ones (Lovero, Santos et. al., n.d).
Boys are roughly four times as likely to die from suicide than girls, even though girls are more likely to attempt suicide (John Hopkins Medicine, n.d). Existing data also points to a gradual global decline in the age of suicide since the mid-1900s (Solomon, 2022).
In terms of geographical prevalence, suicide rates per population are highest in low- or middle-income countries (LMICs), with the highest rates observed in Lesotho, Guyana and Eswatini (World Population Review, 2023). The United States of America hosts the highest suicide rate per 100,000 people among highest income countries; under the age of 25, 1 in 5 women and 1 in 10 men experience a clinically diagnosed episode of major depression (Prinstein, 2022).
Risk factors
Multiple risk factors can increase the likelihood that a young person will commit, or attempt to commit, suicide. The main factors include:
Physical and mental health conditions
Young people suffering from physical or mental health challenges face an increased risk of psychological disorders and suicide. It is estimated that 95% of people who die by suicide have a psychological disorder at the time of their death (Cammarata, 2023). Studies from the United Kingdom (UK) in 2016 demonstrated that over 35% of children and young people who had committed suicide sought medical help for a physical health condition prior to their death (University of Manchester, 2016).
Nearly half of all 11–16-year-olds with a mental health disorder in the UK have either self-harmed or attempted suicide (Royal College of Pediatrics and Health, 2021). The prevalence of physical and mental health challenges increases the likelihood of psychological disorders and makes young people more susceptible to maltreatment, bullying and abuse. This risk is heightened for individuals suffering from long-term or chronic mental or physical health conditions, such as severe psychiatric disorders or HIV (Lovero, Santos et. al., 2023).
Socioeconomic status
Over 70% of global suicides occur in countries that are considered low- or middle-income (WHO, 2023). Estimates suggest this number rises to 90% for adolescent suicide deaths (Lovero, Santos et. al., 2023). A lack of resources limits the availability and accessibility to health services, which causes desperation through the denial of food and other essential services, and can be linked to a higher prevalence of suicide (Lovero, Santors et. al., 2023).
Cultural factors
Cultural norms, practices, values and expectations can drive increases in youth suicide rates by creating stressful environments. For example, South Korea possesses the fourth highest suicide rate in the world and, notably, an exceptionally high suicide rate among students linked to academic pressures and the dishonor that alcohol failings can bring to families (World Population Review, 2023).
Abuse, violence and neglect
Maltreatment of children and young people can drive them towards psychological disorders and, in the most extreme cases, suicide. Nearly 20% of all suicides in the UK have been linked to abuse and neglect (University of Manchester, 2016). Globally, abuse and neglect is identified as one of the most significant risk factors for adolescent suicide (Lovero, Santos et. al., 2023).
Firearms access
In countries where firearms are more accessible, the accessibility of guns is a key risk factor for suicide related to younger people. In the USA, nearly 60% of all suicides are committed with a gun (Cammarata, 2023). This number remains over 50% for youth suicides (John Hokins Medicine, n.d).
Familial trauma, bereavement and a history of suicide
Youth suicide rates have been shown to be higher in children whose families demonstrate a history of depression or suicide (Cammarata, 2023). Young people who have suffered significant loss are also vulnerable to suicide ideation. Over a quarter of the UK’s suicide attempts have been linked to bereavement (University of Manchester, 2016). Across LIMCs, adverse childhood experiences, weak relationships and family conflict have been identified as some of the main socioecological factors that increase suicide risk in young persons (Lovero, Santos et. al., 2023).
Gender identity and sexual orientation
Children and young people who identify as a minority sexuality within their community risk alienation and mistreatment which can lead to an increased risk of suicide (Cammarata, 2023). In a study carried out by the Just Like Us charity between December 2020 and January 2021, 2,934 LGBTQIA+ adolescents and young people were surveyed between the ages of 11-18, and it was found that 68% had experienced suicidal thoughts. The study found that 74% of adolescents who identified as lesbian and 77% who identified as transgender were more likely to have suicidal thoughts (Storer, 2021).
Further to this, the study found that nearly a third of LGBTQIA+ adolescents had self-harmed, in comparison to 9% of non-LGBTQIA+ adolescents. Amongst black LGBTQIA+ adolescents, 89% had experienced suicidal thoughts in comparison to 67% of white LGBTQIA+ adolescents. LGBTQIA+ adolescents reported feeling unsafe in schools due to homophobia, transphobia, verbal abuse from teachers, and other students which led to depression and an increase in suicidal thoughts (Storer, 2021).
Academic pressures and bullying
Young people facing academic pressures and mistreatment at school are at an increased risk of suicide. More than a quarter of the young people who committed suicide in the UK in 2016 were facing exams or exam results at the time of their death (University of Manchester, 2016). Extreme forms of bullying can trigger mental health challenges and push young people towards suicide. In the UK, 22% of suicide attempts among young people can be linked to instances of bullying (University of Manchester, 2016).
Indicators of suicide risk
Children and young people often display similar tendencies when considering suicide. These warning signs can help families, carers and relevant institutions identify and mitigate suicide risks. These indicators can broadly be grouped into several themes:
- Suicidal expression – young people who are considering suicide often display that intention through their actions. This can noted through suicide notes and images, or verbal phrases that suggest or state they do not intend to live much longer (John Hopkins Medicine, n.d). In more obvious instances, suicidal tendencies can be displayed through self-harm (Rodway, Tham et. al., 2022). Suicidal expression can also be more covert. In 2016, the UK identified suicide-related internet use in over a quarter of children and young people’s suicide deaths (University of Manchester, 2016).
- Radical changes in behavior – children and young people who are considering suicide will often display significant changes in their behavior for otherwise normal actions. This can include changes in eating and sleeping patterns, in activities and hobbies, and in physical appearance (John Hopkins Medicine, n.d). In the most obvious cases, children and young people will demonstrate rash or reckless behavioral patterns and may struggle to control their emotions (New York State Department of Health, n.d).
- Disinterested tendencies – Young people considering suicide often withdraw from their communities as their mental and emotional state leads them to feel detached from everyday life. This withdrawal can take multiple forms. In less obvious instances it can include poor performance, withdrawal from friends and family, and a lack of response to praise (John Hopkins Medicine, n.d). In more extreme cases this can involve giving away personal possessions and trouble focusing clearly (John Hopkins Medicine, n.d).
- Substance misuse – abuse of drugs and other substances can be a chief indicator of youth desperation and escapism and an indicator of possible suicidal tendencies. Dependence on drugs and alcohol can be both a driver and an indicator of suicide risk (New York State Department of Health, n.d).
Global responses
To comprehensively reduce suicide rates, countries and regions need to combat the problem from multiple complementary angles. These include:
- Research – greater research is required to understand youth suicide at national and global levels. This research can help inform countries on how to approach the particularities of their challenges tied to socioeconomic and cultural factors.
- Awareness raising and education – at a global level, opportunities must be taken to raise awareness of the prevalence of youth suicide. World Suicide Prevention Day is an example of how countries can share experiences and lessons learned to support the exchange of best practices (WHO, 2023). Nationally, populations need to be educated on the prevalence, risks and indicators of child suicide to help combat the challenge.
- National prevention strategies – research conducted by the WHO in 2013 illustrated significant discrepancies in the national capacity to support young people with suicidal tendencies. Of the 157 countries surveyed on suicide prevention, only 90 responded and just over a quarter possessed action plans to combat suicide (WHO, 2014). The absence of national strategies inhibits countries’ ability to provide a comprehensive and cohesive response to suicide risks (WHO, 2014). This also enables particular sectors to evade responsibility for their role in increasing child suicide risk, such as video gaming industries, technology companies and media organizations (The US Surgeon General’s Advisory, 2021).
- Training and capacity building – particular sectors and individuals in positions of responsibility towards children require specialized training to help protect suicidal children and young people. These include parents and carers, teachers, health care providers and health care workers. If people who interact with children daily are not trained to identify suicidal tendencies, there is a risk of missing out on key pointers.
- Accessible helplines and social care systems – children and young people who are considering suicide require an array of social services to help them overcome their mental health obstacles. These can include helplines and hotlines, hospital stays and facilities, opportunities for therapy and focus groups. It is crucial for children and young people to have multiple opportunities and outlets to talk and to be heard.
Written by Vanessa Cezarita Cordeiro
Internally proofread by Aditi Partha
Last updated on 20 November 2023
References:
Appleby, L., Kapur, N., Shaw, J., Turnball, P., Windfuhr, K., Ibrahim, S., Rodway, C., & Tham, S.. (2016, May). “Suicide by children and young people in England: National confidential inquiry into suicide and homicide by people with mental illness.” Retrieved from The University of Manchester, accessed on 17 November 2023.
Cammarata, C. (2023, April). “About teen suicide.” Retrieved from Psychology Behavioral Health at Nemours Children’s Health, accessed on 17 November 2023.
Johns Hopkins Medicine. (2023). “Teen suicide.” Retrieved from Johns Hopkins Medicine, accessed on 18 November 2023.
Lovero, K., Dos Santos, P., Come, A., Wainberg, M., & Oquendo, M. (2023, May 13). “Suicide in global mental health.” Vol 25(6). Retrived from National Library of Medicine National Center for Biotechnology Information, accessed on 17 November 2023.
Nationwide Children’s. (2023). “Suicidal behaviors.” Retrieved from Nationwide Children’s, accessed on 16 November 2023.
New York State Department of Health. (n,d). “Suicide prevention, children’s ages 10 to 19 years.” Retrieved from New York State Department of Health, accessed on 17 November 2023.
Prinstein, M. (2022, February 7). “US youth are in mental health crisis – we must invest in their care.” Retrieved from American Psychological Association, accessed on 16 November 2023.
Rodway, C., Tham, S., Turnball, P., Kapur, N., & Appleby, L. (2020, October 1). “Suicide in children and young people: can it happen without warning.” Vol 275. Retrieved from Journal of Affective Disorders, accessed on 16 November 2023.
Royal College of Paediatrics and Child Health. (2021). “Suicide.” Retrieved from Royal College of Paediatrics and Child Health, accessed on 18 November 2023.
Solomon, A. (2022, April 4). “The mystifying rise of child suicide, a family tragedy sheds light on a burgeoning mental-health emergency.” Retrieved from The New Yorker, accessed on 18 November 2023.
Storer, R. (2021, May 17). “LGBT+ youths twice as likely to contemplate suicide, survey finds.” Retrieved from The Guardian, accessed on 7 January 2024.
The U.S Surgeon General’s Advisory. (2021). “Protecting youth mental health.” Retrieved from the U.S Surgeon General’s Advisory, accessed on 17 November 2023.
World Health Organization. (2014). “Preventing suicide: a global imperative.” Retrieved from World Health Organization, accessed on 16 November 2023.
World Health Organization. (2023, August 28). “Suicide.” Retrieved from World Health Organization, accessed on 17 November 2023.
World Health Organization. (n,d). “World suicide prevention day 2023: creating hope through action.” Retrieved from World Health Organization, accessed on 18 November 2023.
World population review. (2023). “Suicide rate by country 2023.” Retrieved from World population review, accessed on 18 November 2023.
