Scope of the Problem
Suicide is the third leading cause of death for teens and young adults in the US
and Canada. The suicide rate among young teens and young adults has increased by
more than 300% in the last 3 decades. The rate in the US is now approximately 13
per 100,000 15-24 year olds. Since 1970, most of the increase in youth suicide has
been due to firearm associated suicide. Firearms are the most common method of suicide
for both male and female youth. The suicide rate for males is two to three fold
greater than for females.
Suicide has also increased among 10-14 year olds. During the decade of the 1980s,
suicide in this age group increased by 75%.
Suicide attempts by adolescents are very frequent. It is estimated that fewer than
1 in 50 attempts are successful. The 1995 Youth Risk Behavior Survey in the US found
that among high school students, 9% had attempted suicide in the preceding 12 months.1 Only 2% of those
who had actually attempted suicide came to medical attention.
The following link to the Surgeon General's
1999, Call to Action to Prevent Suicide provides additional information regarding
suicide prevention and the scope of the problem.
Prevention of youth suicide
In 1980, the US Public Health Service made suicide prevention one of the key goals
to improve health by 1990. Unfortunately, the target of a reduction of suicide to
11 per 100,000 was not achieved; instead suicide rates increased between 1980 and
1990 in this age group.
The number of proven effective interventions for youth suicide is extremely limited.
While many interventions have been implemented, few have been evaluated, mostly
with non-rigorous designs. The evaluation of suicide prevention programs is very
difficult because it is a relatively rare event, and because most suicide attempts
do not get reported. Thus, statistically significant reductions in suicide rates
are difficult to show and require very large samples. For example, to reduce the
suicide rate among young males by 20%would require an intervention group of nearly
3 million and a control group of similar size.2
As a result, most of the studies which have been conducted have examined changes
in knowledge and attitudes among the targeted youth. These results are very limited
because the injury prevention literature is replete with studies which show that
there is little correlation between attitude and knowledge and change in behavior.
No studies use random assignment of subjects to intervention and control groups.
Proposed interventions for the prevention of youth suicide have many different
mechanisms of action, ranging from primary prevention of mental health problems
to early detection (e.g., school-based screening programs) to restriction of lethal
means of suicide. One of the best frameworks for considering prevention programs
is that developed by Eddy, Wolpert and Rosenberg.3 Possible interventions
are grouped into six categories as outlined by these authors:
- Affective education to help youth cope
Early identification of high risk youth
- General community education programs
- Population-based screening
- School-based educational programs
Crisis centers and hotlines
- Crisis "hot lines", suicide prevention centers
- Call boxes on bridges
Training and availability of health care professionals
- Physician education programs
- Mental health services
Restricting access to lethal means
- Safe storage of guns
- Fences on bridges
- Removing carbon monoxide from house gas
- Restricting drugs/poisons
- Other restrictions on guns
Unfortunately, we found data on only four of the six categories.
In this review we examine 4 different potential prevention strategies for adolescent