Suicide is a major public health problem. Each year, more than 30,000 Americans take their own lives. Among adolescents, suicide ranks as the third leading cause of death, behind unintentional injury and homicide. In 2001, 4,234 youth between the ages of 10 and 24 took their own lives, accounting for nearly 12 percent of all deaths for this age group. Despite declines among all age groups nationwide, for adolescents between the ages of 15 and19 the suicide rate has increased by 6 percent, and among children between the ages of 10 and 14, the rate has increased by more than 100 percent.
A far greater number of teens consider taking their lives each year. Survey data from 1999 indicate that 19.3 percent of high school students had seriously considered attempting suicide, 14.5 percent had made plans to attempt suicide, and 8.3 had made a suicide attempt during the previous year. The Substance Abuse and Mental Health Administration released data on September 12, 2005 showing that 900,000 youth planned suicides during an episode of major depression, and 712,000 attempted suicide during such an episode. "The public health burden of suicide is clearly demonstrated in the numbers," says Jerry Reed, executive director of the Suicide Prevention Action Network (SPAN-USA).
Causes and Prevention
Suicidal behavior is complex. Research shows that more than 90 percent of people who kill themselves have depression or another diagnosable mental or substance abuse disorder, with conditions often co-occurring. Risk factors associated with suicide include a previous suicide attempt(s); a history of mental disorders (namely depression); a family history of suicide; a family history of child maltreatment; impulsive and aggressive tendencies; barriers to accessing mental health services; such as cultural and religious beliefs or stigma attached to mental health and substance abuse disorders; and inadequate health insurance coverage.
Given the range of risk factors associated with suicide, prevention efforts must be multifaceted. Successful prevention efforts seek to minimize risk factors and maximize protective factors (i.e., effective clinical care for mental, physical and substance abuse disorders; family and community support; and promoting skills in problem solving, conflict resolution and nonviolent handling of disputes).
Addressing the overall health of children has demonstrated success. Providing effective, targeted and community-based mental health services for children and adolescents who are identified to be at risk for suicide is the primary suicide prevention tactic. Research shows that early intervention strategies that target risk factors for depression, substance abuse and aggressive behaviors and building resiliency may have promise in preventing youth suicide.
Ensuring that youth have adequate access to mental health services through mental health parity legislation is another prevention tactic. "You can have all the prevention programs in the world, but if people don’t have access to care, it’s meaningless," says Reed. Approximately 25 states have laws for full mental health parity that require insurers to cover mental illness to the same extent as physical illness.
Reed points out that suicide has been "so stigmatized for so long" that reliable data on prevalence and on effective prevention strategies are just beginning to become available. Surveillance data is "critically important" to understanding who is at risk and how to direct suicide prevention resources, Reed notes.
Following the 1999 release of the Surgeon General’s A Call to Action to Prevent Suicide, in 2001, the U.S. Department of Health and Human Services released the "National Strategy for Suicide Prevention (NSSP)," (http://www.mentalhealth.samhsa.gov/suicideprevention/default.asp) The NSSP, the combined work of advocates, clinicians, researchers and survivors, lays out a framework of action steps for suicide prevention. The NSSP also seeks to be an agent of "social change," working to transform attitudes toward mental illness, influence policies, and direct resources to prevention services.
In October 2004, Congress passed the Garrett Lee Smith Memorial Act, appropriating $82 million over three years to suicide prevention. The Memorial Act authorized into law the National Suicide Prevention Resource Center (http://www.sprc.org), a clearinghouse that provides prevention support, training, and informational materials to advocates, lawmakers, researchers and the public and that works to advance the National Strategy for Suicide Prevention using proven prevention strategies. In addition, in September 2005, SAMHSA awarded 5.6 million in grants to 14 states to develop youth prevention and early intervention programs and to 20 colleges to enhance behavioral health services.