Introduction
Suicide occurs more often in older than younger people; there is a lack of enough studies on some risk factors for suicidality. Suicide not only results in a direct loss of many young lives but also has adverse socioeconomic effects. From public mental health, suicide among young people is the main issue to address. Therefore, we need good insight into the risk factors contributing to suicidal behavior in youth. Provisional data from the CDC’s National Center for Health Statistics indicate that both the number and the rate of suicides in the United States increased by 4 percent from 2020 to 2021, after two consecutive years of decline in 2019 and 2020. The most significant increase in the rate of suicide occurred among males ages 15-24, an 8% increase (Kim 17). A study on standard risk factors, including physical, social, psychological, and drug and substance abuse for teenage suicidality, is crucial for understanding suicide among adolescents to develop better interventions.
Methodology
PRISM statement guidelines were followed to conduct a systematic two-step search. A PubMed search was performed using the following terms: teenage, adolescent, suicidality, suicide, and self-harm, risk factors. This action was by the US National Library of Medicine and the National Institutes of Health classification of ages. Upon search on PubMed, 23,092 studies were populated, ranging from up to ten years of publication. In addition, a narrow and specific search in Books and Documents, Case Reports, Clinical Studies, English Abstracts, Evaluation Studies, Meta-Analysis, Observational Studies, Reviews, and Systematic Reviews. A total of 899 articles were identified on the platform.
Selection Criteria
The abstracts of the free full-text articles were further independently evaluated and selected for this study. From this initial selection, the eligibility for inclusion in this review was determined by reading the abstracts of the individual articles. Relevancy to the purpose of this review was defined with the inclusion of the following descriptors or concepts: risk, risk factors, and population characteristics.
Papers were selected when they met the following criteria: Original articles published in English from initial online databases until November 2017. Focused on children of thirteen to eighteen years and adolescent participants; those under 18 years of age and the availability of the article in full text. The exclusion of the papers was based on the following criteria; Clinical conferences, clinical trial phase 1, 2, or 3, randomized control trials, and observational studies from veterinary were not considered for this study.
Additionally, Studies that investigated the benefit of therapy like pharmacological, psychotherapeutic, or community intervention, or only analyzed suicidal methods, or evaluated psychometric properties of assessment instruments were excluded. Finally, six studies and three other studies were considered for analysis while conducting this study. A total of 9 publications were investigated to understand the factors contributing to suicidality among teenagers today.
Results
Physical Factors
As youth grow, they fall at risk of being overweight due to various factors. This change can affect the teenager’s physical appearance, leading to negative feelings. A correlational analysis by Kim (11) links body image and weight control behaviors to suicidality among teenagers. Additionally, other physical characteristics like body image, weight control, and risky sexual behaviors have also been linked to teenage suicidality.
According to a linear aggression analysis on a survey by Kim et al. (12), the entire model predicted 19.6% of the variance in suicidal behaviors, and the overall relationship was statistically significant. A cross-sectional study of 21 Latin American and Caribbean Countries by Elia et al. (34) reveals interconnectedness between overweight/obesity and suicide ideation with planning among girls. These findings highlight the importance of strategies that engage with upstream and downstream determinants to improve adolescent nutrition and mental health.
Social Factors
Social factors encompass family characteristics, education, income, social support, social isolation, and job or school stressors. Family factors can have a substantial influence on teen suicidality due to various factors. The study by Kim (22) assesses family circumstances such as economic difficulty, family environment, parental disagreement, separation, and divorce in their contribution to teen suicidality. The findings reveal that family circumstances were more strongly associated with the adverse mental health of adolescents (Kim 30). This factor was represented by the OR=1.77 and 1.94 for depressed mood and suicidal ideation, respectively.
A study by Elia et al. (12) linked similar findings of family economic status to teenage suicidality. According to the study by Grimmond et al. (28), family issues represent some of the underlying risk factors for developing suicidality among teenagers. The qualitative review found that family issues like complicated family relationships, poor living conditions, death of a loved one, family violence, and poor living conditions are paramount in leading to teenage suicidality.
The death of a family member or close friend plays an essential role in a young person’s decision to end their life. Complex relationships with family members were the most commonly reported issue in the lives of suicidal youth (Grimmond et al., 32). Major family issues identified were relationship struggles with their distant or unavailable fathers and fractured families. Sibling conflicts also contributed to difficult family life. Harsh criticism, strictness from family members, and difficulty with communication within were crucial factors contributing to a problematic family dynamic. Some believed their suicide attempt would improve their relationships with their families, though this did not always occur. In Experiences and perceptions of youth suicide, a history of family violence and childhood maltreatment contributed directly to suicidal ideation.
Stressors from school or work amongst teenagers have significant contribution towards suicidality. A cross-sectional study by Kim et al. (20) used data derived from the Korean Youth Risk Behavior Web-based Survey (KYRBS), which had been conducted by the Korea Centers for Disease Control and Prevention (K-CDC) since 2005. the researchers combined and analyzed data from 2010, 2011, 2012, and 2015 KYRBS. The scholars included 291,110 middle- and high school students aged 12–18 years (Kim et al. 23). The study’s findings reveal that among the major stressors, schoolwork/career was the most predominant (54.7%) (Kim et al. 25). However, the odds ratios for depressed mood and suicidal ideation were the highest in conflict with peers.
Different meta-analyses and systematic reviews link teenage suicidality to parental education. The study by Chen et al. (17) reveals that family socioeconomic characteristics, lower parental educational level, and worries about family finance were the only factors associated with an increased risk of adolescent suicidality. The results show how critical it is to acknowledge the between-context variation in the association between parental education and youth mental health outcomes that lead to suicide.
Psychological Factors
Psychological factors and personality differences such as hopelessness, impulsivity, and resilience all have a bearing on a person’s likelihood of experiencing suicidal ideation. Hence, identifying and understanding these factors is essential in predicting and preventing suicide. A review of different studies demonstrated the relationship between adolescent psychological pain and risk factors for suicide.
According to the findings of Mento (13), the literature review showed that most adolescents with thoughts of suicide and psychological pain die by suicide. Between 1.9% and 8.7% were reported to engage in at least one suicide attempt, and between 5.6% and 14.3% reported suicidal ideation (Mento 17). A review by Cha (21) links emotion regulation to be structurally abnormal in suicide attempters. Additionally, a prospective study by Yen et al. (23) links borderline personality disorder to suicide and suicide attempt. Participants with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts.
Drug and Substance Abuse
Persistent cigarette smoking and other illicit drugs are associated with depressive symptoms and suicide risk. A study by Campo-Arias et al. (22) associated the use of cannabis with high suicide risk in high school adolescents in Santa Marta, Colombia. Additionally, Studies have consistently demonstrated that suicidal behaviors are more likely among adolescents who abuse alcohol. Alcohol and substance abuse may increase the inclination for suicidal behaviors by affecting emotional and cognitive development. According to Kim et al. (433), substance use positively correlates with adolescents’ suicidal behaviors. Adolescents who use substances such as alcohol or cigarettes open the gateway to using more severe substances and illegal drugs. Finally, they are placed at a more serious risk for suicidal behaviors.
Discussion
According to the analysis of the articles, different psychological, social, physical, and drug and substance abuse are the key factors contributing to suicidality among teenagers. Psychological factors such as personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were identified as risk factors for suicidal behavior. Social factors such as stressful school or work environment, family characteristics like economic difficulty, family environment, parental disagreement, separation, divorce, and parent level of education significantly contributed to teen suicidality. Additionally, the study found individual physical characteristics such as body image, weight, and weight control behaviors as crucial risk factors for suicidality among teenagers.
None of those, as mentioned earlier, risk factors, individually or in combination, have been shown to predict future suicidal behavior in suicide attempters reliably. However, several risk factors could come together to cause suicide conduct. When a person with a functional disorder, such as a mood disorder or a substance use disorder, is exposed to a stressful situation. For instance, a stressful situation frequently results from an underlying issue, such as loss, humiliation, or issues with the police or at school. Suicidal ideation may result from an abrupt mood change like worry, hopelessness, or anger. At that time, an underlying feature, such as impulsivity or a lack of social support, may have made the transition from suicidal thinking to actual suicide easier.
Conclusion
An integrative understanding of each specific risk factor for suicide is crucial. Clinicians must evaluate psychological, physical, social, and substance abuse amongst this group in a bid to develop an evidence-based strategy to counter teen suicidality. Analysis of the micro-interactions between individuals and their families and those within their larger social and environmental surroundings is essential when developing clinical interventions to reduce the prevalence of suicidality. To properly comprehend risk factors for suicide, it is necessary to consider mental or pathological states, the biological vulnerability of the individual, as well as psychosocial risk factors, such as acute or chronic stressors, facilitators of suicide, and the background factors involved in suicide, in a broad context.
Works Cited
Campo-Arias, Adalberto, et al. “Asociación Entre El Consumo De Cannabis y El Riesgo De Suicidio En Adolescentes Escolarizados De Santa Marta, Colombia.” Biomédica, vol. 40, no. 3, 2020, pp. 569–577. Web.
Cha, Christine B., et al. “Annual Research Review: Suicide among Youth – Epidemiology, (Potential) Etiology, and Treatment.” Journal of Child Psychology and Psychiatry, vol. 59, no. 4, 2017, pp. 460–482. Web.
Chen, P. J., et al. “Parental Education and Youth Suicidal Behaviours: A Systematic Review and Meta-Analysis.” Epidemiology and Psychiatric Sciences, vol. 31, 2022. Web.
Elia, Christelle, et al. “Association of Macro-Level Determinants with Adolescent Overweight and Suicidal Ideation with Planning: A Cross-Sectional Study of 21 Latin American and Caribbean Countries.” PLOS Medicine, vol. 17, no. 12, 2020. Web.
Grimmond, Jessica, et al. “A Qualitative Systematic Review of Experiences and Perceptions of Youth Suicide.” PLOS ONE, vol. 14, no. 6, 2019. Web.
Kim, Kyoung Min. “What Makes Adolescents Psychologically Distressed? Life Events as Risk Factors for Depression and Suicide.” European Child & Adolescent Psychiatry, vol. 30, no. 3, 2020, pp. 359–367. Web.
Kim, Yi Jin, et al. “Physical and Psycho-Social Predictors of Adolescents’ Suicide Behaviors.” Child and Adolescent Social Work Journal, vol. 28, no. 6, 2011, pp. 421–438. Web.
Mento, Carmela, et al. “Psychological Pain and Risk of Suicide in Adolescence.” International Journal of Adolescent Medicine and Health, vol. 34, no. 3, 2020. Web.
Yen, Shirley, et al. “Association of Borderline Personality Disorder Criteria with Suicide Attempts.” JAMA Psychiatry, vol. 78, no. 2, 2021, p. 187. Web.