CONTENTS

About This Course

Table of Contents

1. The Nature and Scope of Suicide
2. Recognizing the Progressive Development of Suicide
3. Substance Abuse as a Major Contributor to Suicide
4. Suicide Across the Life Span
5. Special Populations and Suicide Risk
6. Prevention and Early Intervention for Suicide and Substance Abuse Problems

Supplements
References
Resources

Holding the Lifeline
A Guide to Suicide Prevention

Suicidal Ideation

Suicidal ideation occurs when a person thinks about suicide or about wanting his/her life to end. Individuals exhibiting suicidal ideation usually do not have a plan to commit suicide or end their lives. Suicidal ideation is a common occurrence for people from adolescence onward, at some point in life. However, for some people suicidal thoughts become more intense and frequent and lead to suicidal plans.

Teenagers are the most likely to have had some thoughts of suicide. Most of what we know about adolescent self-reported tendencies toward suicide and other health issues comes from the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance (YRBS). According to the YRBS nationwide survey of high school students for 2003, 16.9 percent of students had seriously considered attempting suicide during the 12 months preceding the survey. ref

Example of an Adolescent with Suicide Ideation*

Sean, 15, is in tenth grade and says he "hates" his life. Sean has a hard time opening up, but once he gets started talking, he has a string of complaints about his family, school, and life. "My parents hassle me all the time," Sean says. "They hate my clothes, my music, they hate me."

Sean has been smoking marijuana daily for the past year, along with binge drinking on weekends. Sean is alienated from school and thinks the only good thing about it is "hanging out with my friends, listening to music, just hanging." Sean says getting high and drunk numbs his feelings for awhile, then he crashes and feels worse, and uses some more to get rid of feeling so down and angry."

Sean says "he needs to use more and more to get the same effect and then he feels even worse. To Sean's surprise, now when he smokes pot or drinks alcohol, he still feels really depressed and full of hate, but he doesn't want to stop using. Sometimes Sean hates himself and wishes he weren't around anymore.

"Some of Sean's concerns are particular to adolescence, but his thoughts and feelings also reflect problems that exceed typical teenage angst." He is having trouble concentrating and believes that his teachers think he's "stupid." Most of the time, Sean says he is "just out of it." But this also masks his depression and feelings of "being just plain down." When asked to describe this feeling, Sean says it's "like being sad but more so."

*Created for illustrative purposes only, not a real person.

Sean is a representation of thousands of youth with risky behaviors that increase the likelihood of self harm and other violent actions. As this example shows, with applicability to other stages in suicide, using alcohol and other drugs increases Sean's risk of suicide. It also increases the likelihood that Sean's depression will continue and lead to other problems.

Sean is socially isolated and shows tendencies of being both impulsive and emotional. Having access to alcohol and marijuana increases his risks. Sean needs to have people in his life who really know him, care about him, and who he can rely on to take action to help him.

Just how much of a danger does suicidal ideation cause along the spectrum, particularly for adolescents? Research shows why practitioners, parents, and others are concerned about the progression of suicide in youth. An analysis of data from the National Longitudinal Survey of Adolescent Health (ADD Health) of American adolescents in grades 7 through 12 found a number of factors were associated with suicide ideation, including having a gun in the household and lack of engagement in activities with their parents. Other conditions that increased the odds for both boys and girls of having suicidal thoughts included having a friend who attempted suicide in the past year, being depressed, having homosexual romantic attractions, or frequent substance abuse. ref