When young people think about suicide
The good news first: not everyone who thinks about suicide actually carries it out. Nevertheless, two to three teenagers and young adults take their own lives every week in Switzerland. This makes suicide the second most common cause of death in this age group.
Around one million young people between the ages of 15 and 24 live in Switzerland. Puberty, which now begins two to three years earlier than it did 100 years ago, marks the start of a phase of biological, psychological and social change. More and more adolescents are overwhelmed by the many decisions they have to make in this phase of their lives, such as entering the world of work, leaving home, dealing with sexuality and developing their own identity.
Life becomes a dead end with only one emergency exit - suicide.
Young people today have to deal with a variety of opportunities that did not even exist a few generations ago. The personal and social development tasks that adolescents have to master have become more complex. There is a lack of actual role models or values that could provide guidance for adolescents in this important phase of their lives.
Parents are also often overwhelmed by the academic and social demands placed on their adolescent children. Single parents in particular - a situation that is no longer an exception today - often reach their limits. The search for their place in this society, which is becoming increasingly complex, seems to be overtaxing an increasing number of young people. Adolescents with few personal or family resources in particular often find themselves in a situation in which they are overwhelmed and which, in the worst case, can end in suicide.
Depression and suicide
A history of attempted suicide increases the risk of completing a suicide. In the year before the suicide, the criteria for a mental disorder are met in up to 90 per cent of cases. Around half of those affected are suffering from a depressive disorder at the time of the completed suicide.
The difficulty with young people, however, is that the depressive state often presents itself differently than in adults, especially in male adolescents. It is often not sadness that dominates, but rather irritability, restricted thinking, lack of drive, social withdrawal and an increased willingness to take excessive risks. Depressed adolescents tend to speak of a «zero mood», withdraw, complain about not feeling understood, are more aggressive than usual or display exuberant behaviour that is atypical for those affected.
Misjudged need
Sleep disorders in adolescents are often misjudged and attributed to a poor lifestyle. Increased media consumption or drug excesses are also trivialised far too quickly in adolescents. It is not uncommon for adolescents or young adults to be sent home from the GP, paediatric practice or emergency ward after such incidents of excessive drug use without a psychiatric assessment. The possibility that an underlying depressive disorder could be behind such changes in behaviour is often not considered by relatives or doctors for far too long.
It is understandable that those affected or their relatives do not want to psychiatrize such problems too early. However, failing to recognise the unbearable distress of young people in a suicidal crisis harbours great dangers.
People at risk of suicide describe the state before suicidal behaviour as, among other things, unbearable mental pain and suffer greatly. As a result, they are in a state of acute stress, in a dead end, so to speak, that restricts their thoughts and feelings, with only one emergency exit - suicide. The door to this emergency exit is opened at a time of extreme distress with the wish to end the unbearable suffering and not, as is often assumed, with the wish to die.
Well-considered suicide with a clear conscious? That happens very rarely.
As a rule, nobody likes to kill themselves, and it is very unlikely that adolescents and young adults want to end their lives in a well-considered way if they are conscious.
Intoxication as a risk
Studies have also shown that the probability of completed suicide under the influence of drugs is higher than when adolescents and young adults do not consume alcohol, cannabis or other drugs. It is also likely that the unbearable traumatic experiences suffered by adolescents in suicidal mode leave lasting traces in their minds and, taking into account the pronounced brain plasticity, result in brain-organic changes.
These traces, or rather scars, last a lifetime and explain, at least in part, the massively increased risk of suicide after a suicide attempt or after living through this mode, which can be reactivated in every suicidal crisis.
Hotspots and firearms
Countries such as Switzerland and the USA have a comparatively high rate of suicides by firearms. Despite this, a large number of citizens still believe that there is no connection between the availability of firearms and suicide.
However, it is not only firearms that are a problem, but also unsecured bridges or unsecured railway tracks. Suicide experts refer to these as hotspots. In regions where these have been secured, the suicide rate has fallen.
Survivors of a serious suicide attempt, for example a jump from the Golden Gate Bridge, do not die in 93 per cent of cases due to a repeat of the serious suicide attempt and are happy to have been saved. It is therefore important to work to minimise access to such methods of suicide.
A mental illness increases the risk of dying by suicide by a factor of about 10.
In Switzerland, this also means a contemporary and sensible use of service weapons. Especially because firearms greatly facilitate the possibility of extended suicide, in which other people are killed first - a particularly tragic form of suicide that occurs several times a year in Switzerland.
Accordingly, it is important to ask mentally ill adolescents or young adults, especially men, whether they have access to weapons at home or, if in doubt, to take appropriate measures. As a rule, a risk report to the police by a specialist is sufficient.
Personality factors
Adolescents often experience phases of self-harming behaviour, suicidal acts or suicide threats. If such behaviour occurs repeatedly in adolescents, it is likely that a mental disorder is present.
Specifically, it should not be forgotten that chronic suicidal behaviour is a common symptom in patients with an emotionally unstable personality disorder. And around 10 to 15 per cent of these patients actually take their own lives during the course of their illness.
The difficulty is that many adolescents exhibit similar behaviours, but these do not persist into adulthood and are therefore difficult to distinguish from normal adolescent development. Only a fraction of those affected actually seek professional help.
Nevertheless, it is extremely important that the underlying disorder - be it depression, an anxiety disorder, psychosis or addiction - is firstly recognised early and secondly treated effectively with all available means, including medication if necessary.
The plight of relatives
The distress associated with a completed suicide among relatives, friends, teachers and helpers such as psychologists and doctors is great. For every suicide, around six close relatives and people close to them are affected. In the case of young people, it is usually even more people, sometimes entire school classes and training organisations.
Options for prevention and help
Securing so-called suicide hotspots is an effective measure to ensure that young people in great distress do not go to places where it is known that people have already successfully committed suicide. This can involve structural measures such as setting up nets or installing surveillance cameras or emergency call pillars that still give those suffering the opportunity to get help. The structural protection of particularly exposed railway tracks not only reduces the suicide rate, but also has a preventative effect against the traumatisation of train drivers.
Prevention campaigns can be helpful
A number of studies of preventive campaigns in schools and the general population have shown that even general and carefully implemented prevention campaigns can reduce the suicide rate. The initial fear that such campaigns could encourage suicidal adolescents or young adults to imitate them in the sense of the «Werther effect» has not been confirmed. Appropriately addressing suicidal behaviour per se does not cause suicide.
If there is a change in a young person's behaviour that cannot be explained over several days, unexplained persistent irritability or social withdrawal, this should be taken seriously and the adolescent or young adult should be motivated to seek professional help. This is because the presence of a mental illness increases the risk of dying by suicide by a factor of about 10. It is important for professionals as well as relatives and carers to speak directly and openly if there is a suspicion of increased suicidal tendencies.
Offering people in emotional distress space and time
Suicidal people very often encounter rejection with their unfortunately still taboo problem and feel that their distress is neither taken seriously nor understood. If a trusted person offers young people space and time to express their emotional distress and unbearable mental pain, they feel significantly relieved and no longer alone in their suicidal crisis.
Suicide prevention and help is a complex endeavour. Maintaining or establishing sustainable relationships with the person affected is crucial. Suicide attempts should always be taken seriously, even if they occur in the context of personality disorders or situational problems. The early detection of mental disorders such as depression, anxiety, manic-depressive illness or psychotic illnesses such as schizophrenia is of great importance in the context of suicide prevention.
Early recognition and effective treatment of the underlying problems harbours the greatest chance of reducing the frequency of suicide. However, if parents or helpers notice that it is becoming increasingly difficult to establish a relationship and that the person concerned is becoming more and more withdrawn, it is advisable to seek professional help at an early stage and, if necessary, to consider admission to a psychiatric hospital as a last resort.
Risk factors for suicide
- Suicide attempt in own past history
- Mental disorders such as depression, which can manifest itself in irritability, restricted thinking, lack of drive, social withdrawal and an increased willingness to take excessive risks, or even sleep disorders
- Self-harming behaviour
- Suicide threats
- Drug use
- Hotspots: unsecured bridges or unsecured railway tracks
- Access to firearms
Here those affected and their relatives can find help
- Low-threshold services such as «Hilfe + Beratung 147» from Pro Juventute Switzerland, tel. 147, «Die Dargebotene Hand», tel. 143, or the «Elternnotruf», tel. 0848 35 45 55
- «Alliance against depression» (cantonal)
- Crisis intervention centres in Winterthur, Zurich, Basel, Bern and other locations
- Child and adolescent psychiatric service (KJPD)
- Organisations such as Trialogue Switzerland, where those affected, relatives and experts come together (e.g. through school visits)
- private providers such as the Crisis Intervention Switzerland of Clienia Schlössli AG, which advises companies and schools on how to deal with mental health crises
