Depressive syndrome and major depressive disorder, however, both tend to include frequent thoughts about death and/or suicide, suicide plans, or suicidal acts (Achenbach, 1991). According to Geldard & Geldard (1999), adolescents who attempt suicide share some common characteristics. They tend to have very intense interpersonal relationships with only a few people, and to express their feelings by acting out rather than by communicating them verbally. It is also likely that they have an external locus of control regarding their situation, and that they express high levels of hopelessness, thinking that things are unlikely to ever improve.
This is also suggested by research that has shown that the cognitive characteristic of hopelessness is the single best predictor of eventual suicide (Freeman & Dattilio, 1992). Additionally, adolescents who are more likely to commit suicide are inclined to overreact to things, and can be hypersensitive. Dacey & Kenny (1997) also point out that adolescents who attempt and complete suicide frequently have more stressful lives, less coping strategies and poor school performance.
Suicide can be related to any number of problems that that person is experiencing at that time in their life, but specific problems that are often experienced by adolescents who attempt or commit suicide or self-harm are family problems, especially those which threaten the stability of the family, such as parental separation; a serious lack of communication between the adolescent and their parents or care givers; problems within peer relationships; not belonging to a group or having any friends; and what they perceive to be a failure to live up to expectation of others, such as parents (Geldard & Geldard, 1999).
Hawton et al. (1982) reported that over four fifths of adolescents who had attempted suicide reported being unable to discuss their problems with their parents. Bhugra et al. ‘s (2002) findings also support Geldard & Geldard’s comments. They found, in their study of Asian and white adolescents who had self-harmed over a three year period, that one of the major risk factors for the adolescents in this study was an unfavourable family environment, including issues such as parental separation, especially in the white groups.
Abuse of alcohol by a parent or sibling was another risk factor, and physical or sexual abuse at home another precipitating factor of self-harm. These problems seemed to be exacerbated by trouble with peers and problems at school, with over half of the whites and one third of the Asians reporting it. The problems at school varied, from academic problems to bullying, but whatever kind of problem it was, was a large precipitating factor. It is not surprising then, if adolescents are experiencing problems at home as well as problems at school, that they need “time out”.
Taking an overdose was reported by the participants in the study as a way of getting “time out” from all these pressures, even if it was only for a short time (Bhugra et al. , 2002). Only two of the ninety-nine cases in Bhugra et al. ‘s study, however, mentioned racial harassment as a triggering factor, so it would appear in this case that racism is not a major issue. This contradicts results of former studies that have implied racial issues can be a risk factor. When examining the prevalence of suicide among differing ethnic groups, the findings are apparently contradictory.
MIND (1995) published statistics that suggest suicide rates are much higher among ethnic minority groups, stating for example, that immigrant status increases the risk of suicide and attempted suicide, and that Asian females have a suicidal rate three times higher for the 15-24 year age group than the national average. However, Bhugra et al. (2002), in the study cited above, found that Asian adolescents are no more likely to take overdoses. This implies that figures may have changed over the last few years.
Obviously, there are bound to be discrepancies between different studies, and Bhugra et al. ‘s study did have a relatively small participant sample, and was based purely on case notes. It would be interesting to see the results of a similar study carried out with a larger sample size, and using a more qualitative approach, to try and understand the reasons for the differences between ethnic groups, if any are found at all. This could lead to important discoveries regarding risk factors and triggers for suicide and self-harm within different cultural settings in today’s society.
The rate of suicide attempts in adolescents is also increased in those who have been abused during childhood, another risk factor identified in Bhugra et al. ‘s research. Adolescents who have been physically abused can experience feelings of powerlessness and helplessness (Kaplan et al. , 1997), and are therefore more at risk of developing other risk factors associated with suicide, such as depression, substance abuse and disruptive behaviour. Sexual abuse during childhood and adolescence has also been documented as contributing to suicidal gestures and attempts (VanderMay & Meff, 1982; Bagley et al., 1997).
Boys who are sexually abused have significantly more behavioural and emotional problems, including suicidal thoughts and behaviour, than do girls, according to research by Garnefski & Diekstra (1996). Another risk factor associated with adolescent suicide is the loss of a loved one. This risk is increased when that person committed suicide themselves, and it has been noticed that bereavement after suicide is more complicated when compared to that of losing someone through natural causes, as there can be more guilt involved (Peters & Weller, 1994).
For these reasons, counsellors need to be aware of the nature of the loss suffered by their client. Bhugra et al. (2002) also found a marked increase in the prevalence of suicide in adolescents over the age of 14, highlighting the impact of puberty, and also suggesting that this is the age where individuation begins, causing further stresses at home. The favoured method for the adolescents involved in this study was overdosing on paracetamol, which has preventative implications. If access to drugs is restricted, then the rate of impulsive suicides may be reduced.
When working with adolescents who may be at risk of self-harm or suicide, special attention needs to be paid to this subject in the confidentiality contract, discussed and signed at the beginning of therapy. The counsellor needs to explain to their client that in the event of them disclosing plans of suicide, then other people, such as the clients’ GP or a professional emergency team, will need to be informed. It is best, however, whilst always taking into account legal, ethical and professional requirements, to try and give the client as much control over the disclosure of their intentions as possible (Geldard & Geldard, 1999).