Psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany
Possible causes of suicidal intentions and suicide in children and adolescents
Suicidal behavior usually has complex reasons. Both biological (e.g. genetic) causes should be mentioned as well as the personal development of a person, stressful life events, the social environment and underlying mental illnesses. As with all mental disorders, psychosocial distress alone is not the determinant of suicide or attempted suicide. Rather, this behavior can be based on a combination of a lack of individual ability to process and solve problems and insufficient support in the family.
Factors that increase the risk of acute suicidality:
acute alcohol and drug intoxication
high impulsiveness, presence of an impulse control disorder or emotionally unstable personality traits
previous suicide attempts (especially in the last year)
Suicides or suicide attempts in the patient's environment
critical life event
Biological factors
Suicidal behavior seems to be associated with a reduction in the neurotransmitter serotonin. For example, low levels of a certain serotonin metabolite (5-hydroxy-indoleacetic acid) in the cerebrospinal fluid (liquor) are associated with the frequency of a "hard" suicide attempt in children (and depressed patients) through an as yet unexplained connection. in context.
In families in which suicide has already occurred, an increased risk of suicide can often be demonstrated. About half of suicide victims have a first-degree relative who has also committed or attempted suicide. A genetic predisposition is therefore suspected. However, the imitation effect and the stress that suicide imposes on a family should also be taken into account in this consideration.
Personality & Development
The period from child to adult is a very delicate phase. It is characterized by development requirements, changes and crises (see also adolescence and adolescent crises). The ability to adapt socially is of great importance in mastering this phase of life. Adjustment disorders are a typical feature of children at risk of suicide. As a rule, adolescents with a tendency towards suicide either react impulsively aggressively to problems or they withdraw and take refuge in fantasies and ruminations. The children affected are often less socially accepted, feel lonelier, more hopeless and have low self-esteem.
Boys with late puberty and girls with early puberty have more psychological and social problems and an increased risk of suicide. Problems with sexual identity, such as homosexuality, can also be a stress factor in adolescents.
Stressful life events
An accumulation of traumatic experiences can be found in many children and adolescents who show suicidal behavior. Children and young people who have suffered sexual abuse, for example, have a three to four times higher risk of suicide. Suicidal behavior within the family increases the risk 2- to 6-fold.
Psychosocial environment
A difficult, conflict-ridden family situation can be a significant burden for children and young people. Divorce, frequent arguments, insufficient care and a lack of support or a lack of understanding burden children and young people. Some suicidal children and adolescents do not have reliable caregivers to guide them and help them deal with troubling feelings and situations. A permanent overstrain at school, which results in frequent arguments, fear of failure and bad grades, can lead young people into a serious crisis.
The availability of dangerous drugs or firearms in the household leads to a significantly increased risk of suicide, especially in children and adolescents who act impulsively.
Underlying mental illnesses
Depressed adolescents have a greatly increased risk of suicide. Young people who consume alcohol and drugs also show an increased risk. Suicidal thoughts and suicidal acts are particularly common in so-called "problem drinkers". It is not uncommon for a suicide (attempt) to be carried out under the influence of alcohol. On the one hand, this promotes impulsiveness and, on the other hand, lowers the inhibition threshold due to the anxiety-relieving and pain-relieving properties. On the other hand, self-injurious actions under the influence of alcohol/drugs can no longer be adequately controlled and can therefore be fatal, even if unintentionally. The presence of a social behavior disorder also increases the risk of suicide. Male, alcohol or drug addicted, socially excluded, depressed adolescents have the highest suicide rate. Other mental disorders associated with increased suicidality are impulse control disorders, anxiety disorders, personality disorders and post-traumatic stress disorder.
Suicidal acts, which are carried out in the context of acute psychotic illnesses, play a special role. The usual conditions leading to suicide are of secondary importance here. During an acute schizophrenic phase of the illness, under the influence of delusional phenomena and hallucinations (perceptual disturbances), thoughts of suicide often shoot up rapidly, with immediate and often almost impossible to prevent implementation. Sometimes deaths in adolescents with acute psychosis are not suicides (defined as acts with the intention of dying), but tragic deaths due to mishandling as a result of psychotic experience (e.g., jumping out of a window at the thought of flying).
Overall, the suicide risk in mentally ill children and adolescents is about 10 times higher than in the healthy population of the same age.
Triggering events
Children or adolescents who attempt suicide are almost always preceded by a crisis. Disputes in the family or the end of a partnership are most frequently given as triggering events. But an unwanted pregnancy or a failed exam can also be the trigger.
An increase in the suicide rate can also be observed, especially among young people, after suicide acts by prominent personalities or after the broadcast of corresponding television programs. This is known as the imitation effect, which usually lasts 1-2 weeks after the experience. Suicides in the area also increase the risk.
