Suicide rarely occurs before age ten, and although suicide rates for ten to fourteen year olds and adolescents greatly increased in the United States between the mid-1970s and the mid-1980s, suicide rates for children and adolescents are lower than for other age groups. Nevertheless, by the end of the twentieth century, suicide was the second greatest cause of death in adolescents, after (mainly automobile-related) accidents. In children age ten to fourteen suicide is the third leading cause of death, following unintentional injuries and malignant neoplasms. In the United States, males age ten to fourteen die by suicide three times more than females, and males age fifteen to nineteen have five times more suicides than females. The difference between male and female suicide rates may be explained by males being more vulnerable, or it may be due to their preferences for more lethal methods, particularly firearms: gunshot wounds are the leading cause of suicide deaths in the United States for all age groups. For each person who dies by suicide (a "completed suicide") there are an estimated 50 to 100 suicide attempts. When people under age eighteen are asked if they have ever seriously attempted suicide, at least one out of twenty say that they have.
The contemporary concern about adolescent suicide raises a complex historical problem. First, how new is the pattern? We know that adolescents and very young adults committed suicide in the past. In Germany in the late 1700s, the publication of Die Leiden des jungen Werthers (The Sorrows of Werter), a novel by Johann Wolfgang von Goethe, presumably spurred some suicides in young men who were attracted to death by the prevailing romantic culture. Studies of suicide in England in the late nineteenth century also reveal some adolescent suicides. It is unclear how much the current patterns reflect new developments, as opposed to new levels of attention and concern.
To the extent that there is change, the question then arises: what might the causes be? A culture permeated with images of violence, but in which children rarely experience death directly, is sometimes held accountable. New tensions at school and in peer groups may be involved, sometimes complemented by drug use. Suicide is closely linked, of course, to psychological depression, which also seems to be on the rise among young people.
Although young children (less than ten to twelve years) rarely die by suicide, contemporary children develop an understanding of suicide at an early age, and their conceptions of suicide may influence their behaviors later in life, when they experience the vulnerabilities of ADOLESCENCE.
Research indicates that by age seven or eight most children understand the concept of suicide, can use the word suicide, and can name several common methods of committing suicide. Young children, as young as age five and six, can understand and talk about killing themselves, even if they do not understand the word suicide. Children by age seven or eight report that they have talked about suicide with other children, and most have seen at least one fictional suicide on television. These suicides usually occur in cartoons in which the villain takes his or her own life when he or she has lost an important battle and has no way to escape. Children also experience suicide attempts and threats in adult television programs, including soap operas and the news. Despite children's knowledge of and exposure to the subject, they receive little guidance about it from adults.
Children age five to twelve generally have quite negative attitudes toward suicide; they consider suicide something that one should not do and generally feel that people do not have a right to kill themselves. When there is a suicide in the family or in the family of their friends, children usually know about the suicide, despite parents' attempts to hide the facts by avoiding talking about it or explaining that the death was an accident. For example, in studies conducted in Quebec, Canada, by Brian L. Mishara, 8 percent of children said that they knew someone who committed suicide, but none of the children said that they were told about the suicide by an adult. Surveys of parents found that 4 percent of children have threatened to kill themselves at some time but these threats are rarely taken seriously or discussed.
Children at a young age are curious about understanding death, and although they know that one can commit suicide, their view of what occurs when someone dies may be very different from an adult's understanding of death. However, children learn fairly early (generally by age seven or eight) that death is final–that someone who dies may not come back to life. Younger children often believe that people who have died are able to see, hear, feel, and be aware of what living people are doing.
Suicide is a relatively rare event that results from a combination of risk factors, usually a precipitating event combined with access to a means of committing suicide and a lack of appropriate help. Suicide is generally understood to be the result of complex interactions between developmental, individual, environmental, and biological circumstances. Despite the complexity of factors that may result in suicidal behavior, it is possible to identify children at risk.
Depression is a major risk factor for suicide, although depression symptoms in children may be difficult to recognize and diagnose. In prepubescent children, symptoms may include long-lasting sadness, frequent crying for no apparent reason or, conversely, inexpressive and unemotional behavior, including speaking in a monotone voice. Other signs include difficulty concentrating on schoolwork, lack of energy, social withdrawal, and isolation. Children and adolescents who threaten suicide or become interested in the means of killing themselves, such as tying nooses or playing suicide games or trying to acquire a firearm, should be considered as potential suicide risks.
The best way to verify the risk of suicide is to ask direct questions of the child. They might include the following: "Are you thinking of killing yourself?"; "have you thought about how you would kill yourself?"; "do you think you might really commit suicide?" Many adults hesitate to ask such questions because they are afraid they might "put ideas" in a child's head. However, decades of experience indicate that talking about suicide cannot suggest suicidal behavior to children and can only help children express their concerns to an adult.
It is also important to ask suicidal children what they think will happen when a person dies. If the child indicates that they think someone can return from the dead or that being dead is like being alive, it may be useful to correct that impression and describe with some details what it means to die.
Children who have symptoms of depression or threaten suicide may benefit from help from a mental-health professional. It is also important to talk with a child or adolescent when there is a suicide in the family or in the school environment. Most children already have a good understanding of what occurred and do not feel that this is appropriate behavior. However, in the event that the child glorifies or trivializes a death by suicide or feels that the suicide victim is "better off" after dying, it is important to clarify what occurred and, if necessary, seek counseling or professional help. It is also important to help children express their feelings about a loss by suicide, even if they include "unacceptable" feelings such as being angry at the suicide victim for having abandoned them. It is important to communicate that suicide is a tragic event that is usually generally avoidable and certainly is not beneficial for anyone.
Bailey, Victor. 1998. This Rash Act: Suicide across the Life Cycle in the Victorian City. Stanford, CA: Stanford University Press.
Kushner, Howard I. 1989. Self-Destruction in the Promised Land: A Psychocultural Biology of American Suicide. New Brunswick, NJ: Rutgers University Press.
Maris, Ronald W., Alan L. Berman, and Morton M. Silverman, eds. 2000. Contemporary Textbook of Suicidology. New York: Guilford Press.
Mishara, Brian L. 1999. "Conceptions of Death and Suicide: Empirical Investigations and Implications for Suicide Prevention." Suicide and Life-Threatening Behavior 29, no. 2: 105–108.
World Health Organization. 2001. Preventing Suicide: A Resource for Primary Health Care Workers. Geneva: World Health Organization.
BRIAN L. MISHARA