«Suicide attempts among girls have increased significantly»

Mr Berger, you deal with depression and suicide attempts by children and young people on an almost daily basis. What is the overall situation in this country?

In Switzerland, we have between 30 and 50 suicides per year among under 20-year-olds, mainly among 13 to 19-year-olds, rarely among 10 to 13-year-olds. However, the number of unreported child suicides is probably higher, as accidents are often unknowingly assumed.

Has this value changed in recent years?

The number of suicides among adults and older people is falling in most countries. Among adolescents and young adults, however, they are relatively constant. Unfortunately, initial data from the USA on current developments show that the figures are actually rising significantly, especially among female adolescents.

Is this transferable to Switzerland?

Experience shows that, yes. The figures are reported more quickly in the USA, and the effects and trends can be read more accurately there because the country has 330 million inhabitants. Here, just a few suicides among minors can change the statistics for this age group.

Why are the figures rising?

In the case of girls and young women, this is probably because suicide methods are shifting. Hanging or shooting used to be chosen mainly by men, but now women are increasingly opting for so-called «hard methods». The media also plays a major role. In the Netflix series «13 Reasons Why», a young, strong, eloquent, intelligent girl takes her own life. We have a modern-day Werther effect (copycat effect, editor's note); in the USA, a significant increase in suicides among young people, especially women, was recorded when the series was broadcast.

So better not to show any suicides?

It depends on how this sensitive topic is dealt with. Dealing with the topic of suicide is frequent and important in this phase of life, as surveys from Switzerland also show. However, the question of how it is reported is central here. Adolescents who have no predisposition are probably able to deal with explicit depictions of suicide, but we are talking about adolescents who are already struggling with the topic and have psychological problems. For such so-called vulnerable adolescents, films like «13 Reasons Why» lower the threshold for suicidal behaviour. In my experience, however, suicide in adolescence is not due to a single cause, but rather a complex combination of many different factors. In order for the Werther effect to take effect, it probably has to come up against a stressful environment and a corresponding life story.

It also seems to me that the pressure on young people has increased significantly.

Social pressure is generally increasing. In sport, at school, at work - everything is a little more extreme, which also puts a strain on the adolescent psyche. The variety of opportunities and role models that are disconnected from the real world also make it difficult to develop a healthy identity. The frequently changing and more complex family structures are also stress factors. Added to this are changed peer group structures, which have a completely different lever than ten years ago thanks to social media.

Why through social media?

In the past, marginalisation or bullying was usually limited to the six or eight hours spent at school. Today, it doesn't stop at all - the internet is available 24 hours a day. And whereas in the past, classmates from your own class and maybe even the parallel class were involved, today the whole community is aware of it in no time at all.

Are there other reasons?

According to my observations, young people today consume drugs such as alcohol, cannabis or designer drugs at a younger age. The substances traded on the street are often much more potent than in the 70s and 80s. And if you have a depressive disposition, such drugs can reduce your inhibitions, and then jumping from a great height suddenly doesn't seem so bad any more.

If you know all this, how do you try to prevent suicides?

In Switzerland, suicide prevention measures are being implemented at various levels, which are particularly focussed on people who we know are at an increased risk of suicide, for example people who have been discharged from hospital. The early detection of depression has been improved and there is no longer as much delay in providing help as before. Even if the number of suicides remains constant in Switzerland, the sharp increase in emergency consultations in child and adolescent psychiatry suggests that the number of suicide attempts has risen significantly in the last ten years.

What exactly does self-harming behaviour mean?

The classic example of this is scratching. Children and young people scratch the skin on their arms and legs with sharp objects such as knives or shards of glass. This has spread like a pandemic, and there is now hardly a senior school class in Switzerland in which one or two girls do not scratch themselves. We know that this increases the risk of a later suicide attempt.

How can teachers and parents take preventative action?

Mental health problems such as depression, addiction, self-harming behaviour and suicide should be discussed openly at school and in general. Talking to others about their problems helps children and young people, which is an important contribution to general prevention. Teachers and parents are often afraid that they will drive someone directly to suicide if they broach the subject. This has now been scientifically refuted - on the contrary, talking about it can help someone to seek help and no longer feel so alone.

What advice do you have for parents?

If there are signs that something is wrong, I recommend that parents speak openly to their child about it and seek help at an early stage. Unfortunately, parents are much less able to recognise depression than young people themselves. They notice when their child withdraws socially or eats less well. But other important factors such as sadness, sleep disorders, lack of energy or an inexplicable drop in performance are often not recognised by parents, or are less noticeable. Much is blamed on puberty, especially the irritability and social withdrawal. It is a challenge for parents and therapists to recognise these warning signs, take them seriously and get to the point where the adolescent and parents are ready to accept help.