Introduction

There are times when you think that nobody loves you or you are too left out and alone in this world. Such thoughts coming in minds of adolescents are quite common. Adolescence is the time when these teenagers are in a state of role confusion and they have a lot of on-going pressure in their minds like the pressure to fit into peer group, pressure to get good grades, parental pressure, and expectations from school and home. Sometimes there is a lot more stuff going in their mind than we can imagine. There is a wide array of changes going from physical to psychological and emotional changes. This causes a lot of emotional turmoil and behavioural disturbances among teenagers.

What causes suicidal thoughts in teenagers?

Mood swings are very common among teenagers. The mood swings are unexplained; there are some periods of extreme hyperactivity and elated mood while at other times the teenagers feel very low, lonely and depressed. These periods of depression are common and are often accompanied by thoughts which correlate with low self-esteem, feeling of being too lonely, guilt and most common that nobody loves and cares about them.

Mood swings are a part and parcel of pubertal growth and often regress or get better by themselves. These thoughts often don’t interfere with daily routine activities. Routine activities such as sleeping, eating, going to school are not very disturbed by the mood swings. But certain special scenarios such as bereavement or separation from a loved one in the family or friends may cause depression lasting for weeks or months. But such kind of a depression is normal as it is a transient grief response to loss of a loved one.

Just being cut out from the whole world and not engaging in any activity in this period of grief or an episode of low mood aggravates the depression many times. A teenager who starts missing his/her school, starts avoiding social gatherings and normal social or group activities in school, has a problem with sleep and appetite and most important has a feeling of hopelessness and helplessness is surely at an increased risk for suicide.

Teenage is also the time for lot of hormonal changes which means episodes of adrenaline rush which makes teenagers more violent and angry sometimes. This causes the teenagers to influence others by their actions and these actions when accompanied by anger and violence may be suicidal. This scenario in particular holds true for males. It is not that these teenagers have a strong wish and urge to die rather it is sometimes just an impulsive action which springs out due to violence and anger.

While females in this group usually resort to such actions as a means of getting back someone, to gain attention, to frighten another person or get their wishes fulfilled. For them it is mostly a fear of rejection or acceptance which prompts them to commit suicide. Adolescents with serious psychiatric disease such as acute schizophrenia or psychotic depressive disorder are also at risk for suicide.

Who is at risk and how it can be assessed?

Usually teenagers have a lot of mood swings. At one moment they are completely enthusiastic about something while at the other moment they feel low and depressed. Thoughts pertaining to low self-esteem and that their existence is worthless is quite a common thought. But as discussed earlier when the teenager is consistently depressed and the depression starts interfering with normal daily activities it leads to negative or suicidal thoughts.

Once such thoughts are observed by a family member, friend or a teacher, they should not be taken lightly and a health care provider should be consulted at the earliest. The health care provider determines and assesses the extent of depression and the pertaining suicidal risk. The physician may even then think about referring the individual to a psychiatrist. The physician may need to talk with both the teenager and the family and enquire about a complete medical, social, emotional, and academic background. The physician may inquire about-

1. The changing moods and how the teenager feels
2. About any event at school or home that might be particularly disturbing for the adolescent
3. Recent social activities and whether the individual participates or withdraws from social or group activities
4. Drug or substance use and abuse
5. Any underlying psychotic illness, such as delusions or hallucinations
6. Any history of behavioural problems such as rebellious behaviour, running away from home, reckless driving, or other acting-out behaviour and risk.

At times these questions might not be sufficient to assess the suicidal behaviour. The physician might need to deeply probe to assess the risk. He might do this by asking indirectly about the patient’s zest to live. Physician might do this by asking indirect questions and if the response to questions is affirmative then further probing of the scenario might help to develop a confirmative diagnosis and risk assessment for the individual.

Who is at risk?

The teenagers with following history fall into high risk category for the suicidal tendencies. The high risk categories are-

• Teenagers with drug abuse and addiction
• Teenagers with scattered and disturbed family
• Teenagers who are socially cut off
• Teenagers who have high risk and rebellious behaviour
• Teenagers who have a family history of suicidal attempts or suicide.

Treatment

Adolescents just like us require a lot of love, care and affection as we do. At times they might be more rebellious and stubborn but remember it is just a temporary phase. Give them love, care and respect they deserve and you will notice a complete change in their behaviour, they will be more responsible and independent individuals. But if you observe that in spite of all the efforts depression is a major issue and low mood is persistent than you should consult a healthcare provider or a physician.

The physician or a health care provider is often the first one to identify an adolescent at risk for suicide, because many teenagers who attempt suicide seek medical attention in the weeks preceding the attempt. These visits are often for vague somatic complaints or conversion disorder. If the physician feels that the patient has depression than the suicidal tendencies and risk assessment should be done.

Once the risk assessment is done and evaluated, if the patient falls into high risk category than the emergency psychological counselling for the teenager should be done. Adolescents with mild depression and low risk for suicide should be followed closely, and the extent of the depression should be assessed on an on-going basis. If it appears that the patient is worsening or is not responding to supportive counselling, referral should be made.

References

1. Nelson textbook of paediatrics, 19th edition, Kliegman, Stanton, St. Geme, Schor, Behrman. Elsevier publication. ISBN: 978-1-4377-0755-7. Chapter-25
2. Current Pediatric Therapy, 18th edition, Frederic et al, ISBN-13: 978-0-7216-0549-4. Chapter-6