Teen Suicide Prevention: Critical Actions

Suicide is consistently one of the leading causes of death in the United States each year, with teenage suicide alarmingly on the rise, according to the Centers for Disease Control and Prevention (CDC, 2018a). While mental health conditions are often highlighted as primary contributors to suicide, the reality is far more complex, involving a multitude of interrelated risk factors. These factors encompass aspects such as personal relationships, access to healthcare, education, interpersonal and problem-solving abilities, support from friends and family, gender identity, financial status, legal issues, substance abuse, and housing difficulties, among others (World Health Organization (WHO), 2018a).

Addressing this multifaceted issue requires a concerted effort from communities, healthcare systems, governments, and suicide prevention organizations to raise awareness and focus on prevention strategies.

Defining and Tracking Suicide Cases

A surveillance case definition is a standardized set of criteria used to define a disease for public health surveillance, allowing health officials to classify and count cases consistently across jurisdictions (CDC, 2017). While suicide is not currently among the list of mandatory notifiable conditions, the CDC has developed a Self-Directed Violence Surveillance publication that includes definitions and recommended data elements to address this gap. Suicide is defined as a "death caused by self-inflicted injurious behavior with an intent to die as a result of the behavior" (CDC, 2011, p. 23). This definition aids in improving communication among researchers, clinicians, and others working in this domain.

Data Sources and Determinants

Suicide rates and statistics are available from several sources, with many accessible via the CDC's website. The Web-based Injury Statistic Query and Reporting System (WISQARS) provides data on fatal and non-fatal injuries and their associated costs (CDC, 2018b). The National Violent Death Reporting System offers insights into violent deaths, including suicides, though only 40 states participate in this system (CDC, 2018b). Other resources include the National Vital Statistics System and the Youth Risk Behavior Surveillance System (YRBSS), both of which contribute valuable data for understanding suicide trends.

Understanding the determinants of suicide is crucial for prevention. Price and Khubchandani (2017) identify key risk factors categorized as intrapersonal, interpersonal, community, and societal. These include a history of suicidal ideation, mental illness, low self-esteem, access to firearms, experiences of abuse, low socioeconomic status, and inadequate access to mental healthcare. The WHO further highlights determinants such as stress, peer pressure, sexual orientation, and quality of home life (WHO, 2018a).

Healthcare Costs and Epidemiological Insights

The economic burden of suicide is substantial. In 2013, the medical and work-loss costs associated with suicide in the United States totaled $50.8 billion, with male suicides comprising 82% of these costs (National Institute of Mental Health, 2018). The CDC estimated that each suicide in 2013 cost approximately $1.2 million (CDC, 2015).

Morbidity and mortality rates indicate a troubling increase in suicide rates, with the CDC reporting a 30% rise in suicide rates across at least half of the states since 1999 (CDC, 2018a). The WHO estimated the suicide mortality rate in the United States at 15.3 per 100,000 people in 2016, with 43% of these cases lacking a known mental health diagnosis (WHO, 2018c).

Rural vs. Urban Suicide Rates

Suicide rates are notably higher in rural areas compared to urban regions, attributed to factors such as limited access to healthcare, socioeconomic challenges, and social isolation. A study in Germany found rural suicide rates ranged from 12.6 to 13.2 per 100,000, whereas urban rates were between 11.0 and 11.6 per 100,000 (Helbich et al., 2017). In the United States, teenage suicide rates in rural areas were found to be double those in urban areas (Fontanella et al., 2015).

Prevention Strategies

Effective prevention of teenage suicide involves addressing cultural differences and the stigma surrounding mental health care. Crowder and Kemmelmeier (2018) discuss how honor cultures, where self-worth is tied to reputation, may increase susceptibility to suicide due to the pressure of maintaining a public image. Historically, African American suicide rates have been lower than those of White Americans, possibly due to strong family ties, friendships, spirituality, and supportive networks (Utsey, Hook, & Stanard, 2007).

Primary and Secondary Prevention

Primary prevention efforts focus on reducing risky behaviors such as alcohol and drug use, promoting mental health, and building resilience among teenagers (CDC, n.d.). The WHO's mental health Gap Action Program (mhGAP) provides guidelines for identifying and supporting mental health conditions in resource-limited areas (WHO, 2018a).

Secondary prevention involves early detection and assessment, with tools like the Colombia-Suicide Severity Rating Scale (C-SSRS) identifying those at risk. This assessment, administered by various professionals, helps reflect changes in a patient's condition over time and is available in 114 languages (Oquendo & Bernanke, 2017).

Conclusion

The rise in teenage suicide is a complex issue requiring a multifaceted approach for effective prevention. By increasing awareness, improving access to healthcare, and promoting education on mental health, strides can be made to mitigate this growing concern. Healthcare professionals, particularly psychiatric mental health nurse practitioners, play a crucial role in recognizing warning signs, conducting assessments, and advocating for policy changes to enhance mental health services. Through collaborative efforts, we can work towards reducing the impact of suicide on individuals, families, and communities worldwide.

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