Sustained abuse or simple childish outbursts lead many children and young people to take their own lives. While there may be many warning signs, these are misunderstood, unappreciated or remain uninterpreted.
“Free, free. My eyes will go on even though my feet will stop”. These are a few of the words written by a boy of 14 years old before he committed suicide by launching himself in to thin air on his bike from the top of the city walls in September 2004. It is difficult to read about such an act, even more so considering that it was committed by a young boy.
Unfortunately, this is something which is happening more often than you would imagine.
The incidence of suicide amongst adolescents has become a real problem in the west where it has tripled over the last 30 years, and is now between the second and third most common cause of death amongst young people between the ages of 15 and 19 years old.
What causes a minor to end their own life? Are there any telltale behaviours which would allow a suspicion of suicidal intentions? Can it be prevented? Should children who attempt suicide be hospitalised?
Experts confirm that stress and depression are the principal causes of suicide in children. But detecting depression in children is not easy, as the way in which it manifests varies depending on a child’s stage of development.
The people best placed to detect it are those closest to the young person, such as parents and teachers, and the general criteria for diagnosing depression include moods characterised by sadness, withdrawal or irritability along with symptoms such as demotivation and self-disenfranchisement.
However, the family, who are in a position to help prevent a potential suicide, might also, on occasion, be the cause itself.
The psychopathology of the parents, aggressive behaviour within the family as well as certain members’ drug or alcohol dependency issues could lead a child to develop suicidal tendencies.
The final cause is bullying, or harassment and verbal or physical mistreatment in schools. After suffering years of threats, humiliation, insults, blows and beatings, it was bullying that lead the boy mentioned at the beginning of this article to suicide.
The symptoms that might indicate possible suicidal ideation are isolation, unprovoked aggression, frequently talking about death, tying up loose ends for no apparent reason, lack of attention to personal care and appearance, or frequent problems at school.
On top of this, comments such as “if I’d never been born”, “I want to die” or those relating to how someone might commit suicide should be taken very seriously and not regarded as a joke.
Occasionally, children do not yet fully understand that there is no way back from death and when they think about suicide it is not about ending their life but an attempt to resolve unpleasant feelings such as sadness or whatever else they might be experiencing. It might also be a drastic and definitive way of seeking attention because they think the love that should be theirs is being directed at others.
On other occasions, a suicide attempt might be purely impulsive and fuelled by anguish and desperation following some kind of punishment or severe telling off by a parent or guardian because of trouble at school or with the authorities. However, if a suicide attempt fails, does that reduce the likelihood of further attempts? No; entirely the opposite. Anyone who has attempted suicide is 100 times more likely than the rest of the population to take their own life.
As for the methods children use to try and take their own lives, these vary from overdosing on prescription drugs and superficial cuts to the arms and neck to the use of firearms, hanging and carbon-monoxide poisoning.
When it comes to assessing a suicide attempt various aspects such as the method, the medical seriousness of the situation, the level of planning that went into the attempt and the ease of access to objects which present potential risk, such as knives, firearms and toxic substances need to be taken into consideration.
It is also important to distinguish between impulsive self-harm and instances that were planned out in advance, as well as to identify any subsequent feelings of remorse.
Initially, children and adolescents who have attempted suicide are examined and treated in an accident and emergency department. In order to determine whether they should be hospitalised, the patient needs to be evaluated within the context of their particular situation and the support structures they have around them.
Hospitalisation is necessary if the patient presents with a number of risk factors and has a limited support structure.
While the World Health Organisation (WHO) recognises that not all suicides can be prevented, the majority can be. It believes measures can be taken to reduce the risk, such as training primary care professionals and, when it comes to the media, paying special attention to published news items on successful suicides as, occasionally, they may provoke more attempts.
In any case, the family and the environment surrounding the child are often the most pertinent in the development of suicidal thoughts.
This means it is very worthwhile focusing our attention on the very youngest of children and trying to understand them so as to avoid a situation where human beings, whose whole lives lie ahead of them, instead choose to end them.
(Translated by Viv Griffiths)