Suicide is a significant public health issue. The World Health Organisation estimates that close to 8,00,000 commit suicide every year and for each suicide, there are more than 20 suicide attempts. Suicides occur throughout the lifespan and in all regions of the world. Notably, among young people in the age group of 15-29 years (WHO, 2014). So why are adolescents so vulnerable?
Adolescence is a period of maturation between childhood and adulthood preceded by physiological signs and surging hormones of puberty. It is a time of expedited social and psychological exploration, accompanied by interpersonal, academic and emotional challenges as well as exploring new domains using their talents and experimenting with social identities.
Adolescence has been frequently conceptualised as a period of continual struggle, as a result of which adolescents experience severe psychological distress and a disruption of their usual conduct. Thus, psychological maladjustment, behavioural problems, conduct related problems, substance abuse, affective or mood disorders and other impairing psychiatric disorders emerge in nearly 20% of adolescent population. These psychological maladjustments are frequently seen in adolescents who fail to achieve a sense of identity, have low self-esteem, are socially isolated, feel socially rejected, lack optimism, are not able to maintain good peer relationships and have disturbed relationships with family members.
Additional factors such as changes in family dynamics, like divorce, siblings moving out, loss of a loved one, bullying, loneliness, abuse, and substance abuse in family members have also been commonly known to be a predictor of unhealthy or stressful transition to adulthood or maladaptive behaviours. Such adolescents are at a higher risk for emotional problems and psychiatric disorders. In order to escape painful feelings or difficult situations, they tend to indulge in activities such as behavioural or chemical addiction in which they can loosen themselves completely or absorb themselves mentally to reduce their tension and sadness.
To name a few, internet addiction, pornographic addiction, video game addiction, smoking, alcohol consumption, self-harm, bullying are most commonly the reported forms of maladaptive ways of coping with their emotional issues. Indulging in these may only give an immediate gratification but in the long run, it promotes anti-social behaviour, dependence, detachment, frustration, denial and guilt. The latter three are known to be the precursor for depression and suicidal ideation.
Suicide is a multi-factorial behavioural phenotype. Social, psychological, cultural, familial and other factors can interact to lead a person to suicidal behaviour. A teen’s bio-psycho-social make-up can predict the probability of his or her transition to adulthood as healthy or stressful transition.
Biological factors include thyroid disturbances, PCOD in girls, nutritional deficiencies such as Vitamin D or B12 deficiencies etc. are known to have negative consequences on one’s overall mental well-being such as onset of anxiety and depressive features. Proper sleep hygiene is one of the most important factors to be taken care of.
Psychological factors include traits and temperament, coping mechanisms, problem-solving and decision making skills, emotional regulation, one’s self-concept and self-acceptance.
Adolescence is the period where adolescents seek for and develop a sense of autonomy and identity. The above mentioned psychological factors play a very important role in a healthy transition to adulthood. Poor self-concept which includes low self-esteem, poor self-acceptance and self-worth may lead to development of a pessimistic set regarding oneself, the world and their future which often results in ideas of worthlessness, helplessness and hopelessness. These negative thoughts often make a child vulnerable to suicidal ideation and anxiety. Social factors that facilitate healthy transition to adulthood are in the form of an active and encouraging support system, one that validates their feelings. Not comparing a child to another, respecting their uniqueness, non-judgmental and non-critical attitude, providing them space to express their emotions regardless of their gender, realistic expectations, authoritative parenting and actively seeking help in cases of mental health issues, can work wonders.
What parents can do...
The first help that can be offered to an adolescent who seems to be suicidal or depressed or sad is ‘active listening.’ Avoid labelling or invalidating their distress as teenage melodrama. Majority of the times they don’t want to be preached or taught, rather they just want to be listened to. Parents should offer them the space for expression and confidence as well as ease of seeking professional help when needed. A healthy parent-child bond and social support system may not take away the challenges of adolescence but will definitely lead to ‘healthy transition’ to adulthood.
(The author is consultant clinical psychologist, Fortis Hospital, Bengaluru)