for Suicide Prevention.
MENTAL HEALTH DISORDERS
Suicide is caused by a constellation of risk factors and underlying vulnerabilities, including mental health issues, environmental and cultural factors (psychosocial), and family and health history, in addition to trying to resolve emotional pain with impaired or underdeveloped problem-solving skills. With most mental illnesses there is treatment and the earlier the intervention, the better the outcome.
The following is a brief overview of some of the more widely known mental health disorders that can affect teenagers and increase suicide risk.16
Major Depressive Disorder (Depression)
Major depressive disorder is a mood disorder affecting between 20% and 50% of youth that causes a persistent feeling of sadness, and loss of interest and motivation.17 It's important to recognize that in children and adolescents, the mood may be irritable rather than sad.18 Depression affects how an individual feels, thinks, and behaves, and can lead to a variety of emotional and physical problems. Normal day-to-day activities take considerable effort and can lead many to feel that life isn't worth living. Depression is more than just the blues; it isn't a weakness and can often require long-term treatment, including therapy and sometimes medication. These are often the kids who appear unmotivated or tired, fall asleep in class, and are frequently absent.
The total number of teenagers who reported experiencing depression increased 59% between 2007 and 2017.19 While we cannot pinpoint one single reason that mental illnesses such as depression and anxiety took such a significant jump in this age group, we do know the contributing factors. Adverse childhood experiences (trauma also called ACEs, acesconnection.com), increased digital screen time, grief, marginalization, less in-person face time, sexual orientation, bullying, poor sleep, poor diet, relational difficulties, family history, health history, genetics and more all play a part.
Conduct Disorder
Conduct disorder is diagnosed when children or adolescents show an ongoing pattern of aggression toward others, including property destruction, bullying, fighting, being cruel to animals, and shoplifting. The major characteristic of the disorder is the violation of social norms and the rights of others.20 Youth with conduct disorder violate these social norms at home, at school, and with peers. These are the kids who often start fights, bully others, skip school, have frequent suspensions on their record, drop out of school, run away, ignore curfews, end up as discipline problems, and at juvenile detention centers. Children with conduct disorders are more apt to become injured and often have trouble with family and peer relationships. Conduct disorders frequently co-occur with depression, but the depression is rarely diagnosed in these cases because the conduct issues are more prominent.
Bipolar Disorder
To be diagnosed with bipolar disorder, the individual must have met criteria for a depressive episode and have had at least one episode of mania, which is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood.21 It can last a week or more and include grandiose feelings of self-esteem, marked by sleeplessness, talking fast, bursts of creativity and ideas, and increased risk taking. Hormonal changes also make it difficult to discern between normal teen emotional behavior versus manic symptoms. In addition, bipolar disorder in teens is often misdiagnosed as ADHD and vice versa, and can be overlooked initially because the teen might have already been diagnosed with depression or anxiety instead of bipolar disorder because mania isn't always the first symptom to express itself. Those experiencing mania can have elevated mood, feel extremely agitated, behave brashly or lavishly, assume superiority or grandiosity, or dress and act flamboyantly. They might post obsessively on social media or start telling dirty jokes at inopportune times and in front of inappropriate audiences. Some with bipolar disorder (and depression) have psychosis and hear voices that can sometimes tell them to suicide.
Substance Use Disorder
Substance use disorders are patterns of symptoms resulting from continued use of a substance, despite harmful consequences. Addiction is the most severe form of substance use disorders, a chronic relapse disease caused by repeated misuse of one or more substances.22 Substance misuse can lead to substance use disorder but whether it does or not depends on age, family, and health history, as well as environment, which can include mental illness and/or exposure to traumatic events. Developing teen brains are more susceptible to substance use disorders than adult brains and there are many substances to which someone can become addicted. The most common substance is alcohol, followed by marijuana, prescription medications, over-the-counter medications such as cough syrup with dextromethorphan (e.g. Robitussin®), air dusters, and aerosol whipped cream (e.g. Reddi-Wip®). The misuse of easily accessible substances can lead to the eventual dependence on street drugs. The development of physical withdrawal symptoms, which can be relieved by taking more of the substance, is what separates addiction from substance misuse. Teens often start using to fit in, experience highs, “numb” feelings related to an adverse event, or normalize or regulate their moods pertaining to grief or a mental illness. Substance use disorders can co-occur with other mental illnesses and disorders. Drinking alcohol at an early age, binge or heavy drinking, and drinking behaviors that meet criteria for mild, moderate, or severe alcohol use disorder can all lead to increased risk of suicidal ideation and attempts. Persons with heavy alcohol use are five times more likely to die by suicide than social drinkers23 and toxicology reports on suicide decedents indicate that 75% of suicides involve one or more substances.24
Eating Disorder
An eating disorder is a severe disturbance in people's eating behaviors and their related thoughts and emotions. Preoccupation with food, body weight, and shape are other symptoms of eating disorders. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. A substantial number of individuals affected by an eating disorder may also be suffering with a mood disorder, especially major depressive disorder.25 Eating disorders are often accompanied by thoughts of suicide or suicide attempts, as this is the most common cause of death among individuals with eating disorders. Eating disorders have the highest mortality rate of all psychiatric disorders.26 Studies have shown that within the eating disorder population, people with anorexia have the highest rate of suicide death and those with bulimia have the greatest number of attempts. Furthermore, one study also found that half of the people struggling with binge eating disorder have attempted suicide. Suicide attempts by individuals with anorexia tend to be planned, while attempts by individuals with bulimia tend to be more impulsive.27
Schizophrenia
Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with
