American Behavioral Scientist

This article reviews the major life course factors and processes associated with the development of suicidal behaviors in young people. Key issues examined include (a) the spectrum of suicidal behaviors in young people; (b) changing risks of suicidal behavior during childhood, adolescence, and young adulthood; and (c) key risk and protective factors. It is concluded that suicidal tendencies are frequently the culmination of adverse life course sequences that involve multiple risk factors. Future research priorities include a focus on (a) greater understanding of the role of genetic and biologic factors in the development of suicidal behaviors, (b) exploration of factors that may protect young people against suicidal behaviors, and (c) evaluation of public health and clinical programs designed to minimize risk of suicidal behaviors in young people.

A review of international suicide rates indicates that although youth suicide rates are high, they are lower than rates for the elderly, have increased less dramatically in recent decades, and are higher for boys than for girls. It is argued that the increases in adolescent suicide rates that have occurred in some nations are a result of improved quality of life for adolescents, a factor that leads young people to blame themselves for failure.

Research is reviewed on family risk factors for youth suicidal behaviors. Both fatal and nonfatal suicidal behaviors have been linked consistently to negative parent-child relationships (e.g., high conflict, low closeness), child maltreatment, residing with less than two biological parents, and family history of affective and antisocial disorders. Parental separation/divorces and family history of suicidal behavior and alcohol/substance abuse are more strongly associated with completed suicide than with other suicidal symptoms, but family systems problems (such as low cohesion and adaptability) and insecure parent-child attachments are more consistently associated with nonfatal suicidal symptoms than completed suicide. Future research will benefit from attending to the temporal sequencing of putative risk factors and suicidal symptoms and from greater use of observational methods and parental reports.

Case-control studies show an association between firearms in the home and completed suicide, with higher risks associated with loaded guns and handguns in the home. Quasi-experimental studies also show a relationship between greater restrictiveness of gun control laws and lower suicide rates by firearms and overall, although some studies fail to show an effect or show method substitution. A prospective study shows that handgun purchasers have an elevated risk for suicide for up to 6 years after the purchase. Relatively few studies have examined the impact of intervention to encourage families to store guns safely or remove firearms from the home on suicidal outcome.

Universal and indicated school-based suicide prevention programs are described, including conceptual bases, program components, ineffective approaches, and evaluation outcomes. Controlled evaluations of second-generation programs report positive outcomes, including positive changes in knowledge, attitudes toward suicide, intent to seek help, and reduction of suicidal feelings. Two comprehensive programs reported reduced suicide rates in targeted counties subsequent to program dissemination. Caution is raised concerning variations in program quality. Currently, some model universal and indicated programs show promise and are candidates for more research on mediating and moderating variables and program outcomes.

Despite substantial attention to the problem of suicide among college students over the past several decades, reports on the extent of the problem have been largely inconclusive. This article reviews the findings of major studies of college suicide, noting how variations in campus and student characteristics, as well as inconsistencies in the way student suicides are defined and measured, have limited comparison of conclusions. Current evidence is reviewed that points to significant mental health problems on college campuses and suggests the need for outreach programs to identify students at risk for suicide and encourage them into treatment. One such program under development by the American Foundation for Suicide Prevention is described in detail. Problems related to its implementation are identified and discussed, notably the reluctance of many university officials to know the actual identities of suicidal students.

Numerous studies spanning the past quarter century have used varied designs and methods in multiple settings and have consistently demonstrated that sexual minority youth are among those most likely to report suicidality (suicidal thoughts, plans, and attempts). This article reviews the methodological challenges that have defined and limited research in this area, including issues of sampling, the measurement of sexual minority status, and the measurement of suicide risk. Attention is then given to risk and protective factors for suicide among sexual minority youth. Normative risk and protective factors, those common to all youth, and risk and protective factors unique to sexual minority youth are reviewed. In closing, attention is given to the state of suicide prevention and intervention efforts that target sexual minority youth, along with recommendations for further research.

Although there is a large and increasing literature on biological, psychological, and social characteristics of suicidal behavior, there is a relative lack of information dealing specifically with how to treat suicidal adolescents and young adults. A 10-session cognitive intervention for older adolescents and young adults who have attempted suicide is described in detail. A novel element of the therapy is that the treatment can be applied to individuals exhibiting suicidal behavior, regardless of psychiatric diagnosis. Information is provided about how to structure therapy sessions and how therapy progresses through the early, middle, and later stages. New, specific strategies are offered for helping suicidal individuals learn to cope more adaptively with crises and distress.

Research continues to demonstrate that vulnerable youth are susceptible to the influence of reports and portrayals of suicide in the mass media. The evidence is stronger for the influence of reports in the news media than in fictional formats. However, several studies have found dramatic effects of televised portrayals that have led to increased rates of suicide and suicide attempts using the same methods displayed in the shows. Recent content analyses of newspapers and films in the United States reveal substantial opportunity for exposure to suicide, especially among young victims. One approach to reducing the harmful effects of media portrayals is to educate journalists and media programmers about ways to present suicide so that imitation will be minimized and help-seeking encouraged. Recently released recommendations for journalists are attached as an appendix. Similar initiatives with the entertainment industry would be highly desirable.