Every 40 seconds an individual commits suicide, making it the tenth leading cause of death globally (Karaman, D., & Durukan, İ., 2013). However, research on the risks and characteristics of suicide throughout human development has a lot of limitations. In this research paper, we will review the risk factors and characteristics of suicide as an individual develops from birth to death. Are the risk factors for each stage of development unique, or are they broad enough to be applied to every group? Currently, research on suicide focuses on one age group at a time and few research papers go over multiple stages of human development. By comparing the research done on various stages of development, we can recognize the symptoms of suicidal thoughts and potentially help prevent this type of event from happening. While some risk factors of suicide can cover multiple stages of development, each group has unique characteristics that need to be watched for.
Stages of Development
Childhood and Early Adolescence
There has been a large focus on suicide risks and characteristics for adolescent individuals, however elementary school-aged children are not well studied despite the recent spike (Sheftall et al., 2016). One reason for this is due to the rarity of suicide in children as well as the fact that suicide is never coded as a cause of death for children younger than four-years-old for developmental reasons (Sheftall et al., 2016). Most of the research on childhood suicide tends to be focused on the ages of 5 to 11 years old. According to the Centers for Disease Control and Prevention 0.17 per 100,000 children from the ages of 5 to 11 years old commit suicide in 2014 compared to 5.18 per 100,000 adolescents between the ages of 12 to 17 years old (Sheftall et al., 2016). While the number of deaths by suicide does increase with age, there is still a concern as to what characteristics and risk factors can contribute to childhood suicide. Sheftall et al (2016) theorized that the characteristics and circumstances that we look for in adolescents may not manifest in children between the ages of 5 to 11 years old.
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There are a few reasons for the differences in the manifestation of what we deem to be suicidal characteristics. One difference found was that children who committed suicide were more likely to suffer from ADD/ADHD (59.3%), whereas adolescents were more likely to show symptoms of depression (65.6%) (Table 2, Sheftall et al., 2016, P. 5). This could account for the difficulty of diagnosing children as suicidal since depression is the key factor we look for. Also, the results in Table 2 (Sheftall et al 2016, p. 5) show that alcohol and substance abuse was relatively low in children compared to adolescents at the time of death (1.6% vs 3.9%; P=.71). Another study found that 48% of female adolescents and 58% of male adolescents were under the influence of alcohol at the time of their suicide (Lahti, Harju, Hakko, Riala, & Räsänen, 2014). Unfortunately, this study did not have the data available to compare this result to the individual's previous alcohol use before their suicide (Lahti et al., 2014). One area that children and adolescents did not differ in was the percentage of those who disclosed their suicidal intent to another person before their death. In a study done by Sheftall et al (2016) 29.5% of children and 28.9% of adolescents spoke with another person about their intent before their death. Finally, the precipitating factors that lead children and adolescents to suicide were similar as well. The results in Table 1 (Sheftall et al., 2016, p. 4) show that 60.3% of children's suicides and 46% of adolescent suicides were related to friction or conflict with friends or family. Table 1 (Sheftall et al., 2016, p. 4) also shows that children and adolescents were likely to have school problems (32.1% vs 34.4%; P=.68) or a recent crisis (38.5% or 36.3%; P=.71) before their death.
As a child ages and turns in to an adolescent the risk of them committing or contemplating suicide increase as well (Lahti et al., 2014). While males are 4 times more likely to commit suicide, females are more likely to attempt suicide (37% vs 67%) (Lahti et al., 2014). Many believe that age would help an individual identify their problems and seek help. However, even though adolescents have more critical thinking ability than children, they may choose to conceal or deny any mental health problems they are dealing with. This could be due to the stigma that surrounds mental illness or the reluctance of friends, family, and even the individual themselves to seek help from professionals (Lahti et al., 2014). However, the study did find that not all individuals who committed suicide previously had mental health issues. According to Lahti et al (2014), findings in psychological autopsy studies found that 10% of individuals, usually male, did not have a diagnosable psychiatric disorder. One thing to keep in mind is that some mental disorders are genetic. For example, the serotonergic system is the most extensively investigated biological factor of suicide (Karaman & Durukan, 2013). Low serotonin levels are commonly associated with a mood disorder such as depression or bipolar disorder and are linked to suicidal thoughts and behavior (“Serotonin”, N.D.). Neves and colleagues (as cited in Karaman & Durukan, 2013) did a study in 2010 over the potential suicide rates in bipolar patients. They found that 26.77% of patients had a lifetime history of non-violent suicide attempts and 16.67% of patients had a lifetime history of violent suicide attempts (as cited in Karaman & Durukan, 2013). This type of disorder is genetic, which means that more adolescents could be at risk, and brush off the symptoms as “teen angst”. One main way to combat this risk factor is to reduce the stigma of accessing mental health services (Lahti et al., 2014).
While mental health is a large risk factor for suicide in all ages, others are just as important when it comes to adolescents. Suicide attempts are a large indicator that an individual might attempt to commit suicide again, however, some non-violent attempts go unreported when they do not result in death (Beghi, Rosenbaum, Cerri, & Cornaggia, 2013). Another risk factor is adverse life circumstances, such as physical or emotional trauma that leaves a lasting impact on the individual (Lahti et al., 2014). The last two potential impacts on adolescent risks of suicidal thoughts or behaviors are parent psychopathology and the availability of lethal methods. Parent psychopathology can impact a parent’s ability to care for the child, such as schizophrenia or substance abuse (Lahti et al., 2014). This can impact suicidal thoughts and behaviors as it could cause stress on the child or cause them to feel like they are the parent instead due to the responsibility it could assert onto them. Finally, the availability of lethal methods is key to the ability to perform suicidal actions. While those with strong impulses for suicide will usually find a method, the harder it is to find a lethal method the more likely the individual is to change their mind or seek professional help (Lahti et al., 2014).
Late Adolescence to Late Adulthood
Most of the research done on suicide prevention has been focused on adolescents and older adults (CDC, 2013). However, many of the risk factors and characteristics displayed in young adolescents are also present in late adolescence and early adulthood. A study done by DeJong, Overholser, and Stockmeier (2010) found that most suicides in adults were done while under the influence of drugs or alcohol. Another interesting thing that their study found was that while depression was a key indicator of a suicidal crisis, it was uncommon for patients to attempt suicide after recovering from their suicidal episodes (DeJong et al., 2010). This was not something that was researched when it came to childhood and early adolescent suicides. This could be since many individuals go undiagnosed until they reach early adulthood, if not later. Suicide attempts are also a risk factor with late adolescence and early adulthood. Beghi et al (2013) found previous suicide attempts were a strong indicator for future attempts, fatal and nonfatal, and can persist for decades. However, some risk factors are unique to adults. For example, a few risk factors unique to these stages of development are financial and job problems (DeJong et al., 2010). While this kind of stressor can be experienced in childhood and early adolescence, it is more common to be experienced later in life. History shows us that suicide rates tend to be parallel with business rates, for example, rates increases during times of economic hardship (CDC, 2013). Suicide ideation is the strongest predictor of suicides and suicide attempts but is not as strong for repeated suicide attempts (Beghi et al., 2013).
Late Adulthood and Elderhood.
Suicide rates tend to increase with age. Among the male population, those between 50 to 59 years old have an increased risk of suicidal thoughts and behaviors (CDC, 2013). The women population saw a great increase in suicide rates from ages 60 to 64 (CDC, 2013). The risk factors for suicidal thoughts or actions tend to remain the same but are focused in a few areas. According to Shin et al (2013) suicide risk factors in the elderly can be divided into three primary categories: mental illness, physical illness, and social problems. The highest correlation being between depression and suicide ideation or attempt (Shin et al, 2013). Social problems, such as social isolation, functional impairment, or loss of a spouse can also have a strong effect on suicidal thoughts and behaviors (Mezuk, Lohman, Leslie, & Powell, 2015). One contributing factor that is unique to late adulthood and elderhood is the prevalence of long-term care facilities that may contribute to suicidal thoughts. For example, as individuals age, they may not be able to care for themselves as much as they once were, and their family may not be available to help. Many who suffer from physical or mental disabilities seek out long-term care facilities to assist them. Long-term care facilities have been associated with a higher risk of suicidal behaviors according to Mezuk et al (2015), for factors that are unique to them. For example, the number of beds in a facility and high staff turnover rates can impact suicidal behaviors among residents (Mezuk et al., 2015). Also, depression is a more common diagnosis for new patients than dementia is (Mezuk et al., 2015). Many older individuals who attempted suicide were also less educated and unemployed (Suresh Kumar, Anish, & George, 2015). This could be due to the generational difference between an older individual verse a younger individual, as well as the fact that many older individuals are retired. Finally, older individuals are more likely to suffer from co-morbid physical illness, such as anemia and hyperthyroidism, which can increase the burden on caregivers, cause family discord, and drain financial resources (Suresh Kumar et al., 2015). However, despite the high-risk older individuals present of suicidal tendencies, research on the matter has received little attention (Shin et al, 2013).
Comparison
According to the Integrated Motivational-Volitional Model of Suicide Behavior done by O’Connor and Kirtley (Table 5, 2018, p. 2) suicide ideation and behavior have different factors influencing them. The question asked today was are the risk factors and characteristics of suicide universal to every stage of development or are they unique to each. By comparing the data found the answer is both. For example, one risk factor is the presence of a recent stressor leading up to the suicide attempt. Suresh Kumar et al (Table 3, 2015, p. 10) found that 83.8% of the elderly and 86.2% of young groups had a recent stressor. However, the type of stressor that caused the attempt was different for each group. While the older group's stressor was typically related to psychiatric illness and physical problems, the younger group's stressor was typically related to interpersonal issues with spouse and other family members (Suresh Kumar et al., 2015). Also, the elderly group tended to commit or attempt suicide one week after the stressor versus the younger group who would commit or attempt suicide with 24 hours of the stressor (Suresh Kumar et al., 2015). Another example is the difference found between the groups was the presence of mental illness. Both groups had similar results when it came to a psychiatric diagnosis, 75.9% for those below 65 years old and 86.5% for those above 65 years old (Table 5, Suresh Kumar et al., 2015, p. 12). However, the younger group was more like to be diagnosed with adjustment disorder compared to the older group's main diagnosis being depression (Table 5, Suresh Kumar et al., 2015, p. 12). One risk factor that is more prevalent to elder individuals is social isolation. Although this risk factor can be present in the younger generation, it is more likely to appear in the elderly due to spousal death, family moving away, or lack of mobility (Shin et al., 2013). Also, elderly risk factors are not always recognized in the elder as well, and normally thought to be normal complaints associated with aging (Suresh Kumar et al., 2015). The same is true for the risk factors of childhood suicide since many children do not understand the emotions they are feeling or are afraid to voice them Sheftall et al., 2016).
Conclusion
According to the CDC (2013), the number of suicide deaths eclipsed the number of deaths from motor vehicles in the U.S. Currently there is no psychological test, clinical technique, or biological marker sensitive and specific enough to predict short-term suicidal risk or repetition (Beghi et al., 2013). By reviewing the data above we can see that the risk factors and characteristics are not separated by the stage of development an individual is in. This means that an adolescent and an elder can be experiencing the same risk factors and displaying the same characteristics of suicidal intention. However, there are variations of the risk factors that are more unique to one age group than to another, such as social isolation or adjustment disorder. Also, more research needs to be done on childhood and elderhood suicide factors and characteristics to fully compare them to adolescents and adults. While some risk factors of suicide can cover multiple stages of development, each group has unique characteristics that need to be watched for.
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