IndexIntroductionTheoryLiterature ReviewStatisticsWarning SignsProtective FactorsReal-Life ExampleIntroductionThe Centers for Disease Control and Prevention and the U.S. Surgeon General have jointly declared suicide to be a crisis of public health (Whitlock, Wyman, & Moore, 2014). Adolescents and young adults are particularly susceptible to suicidal behavior and ideation due to the changes and challenges they face during adolescence. Suicidal behaviors include nonsuicidal self-injury (NSSI) and planning. Nearly 25% of all adolescents will engage in NSSI. NSSI is an act of self-harm typically caused by burning or cutting. Those who engage in this behavior tend to do so as a coping mechanism to reduce feelings of tension, anger, anxiety, and depression; some even self-harm to actually feel something rather than nothing. Research has found that those who engage in NSSI likely also have a friend or family member who participates (Steinberg, 2016). Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original EssayThe way the media portrays suicide victims and the way friends behave also influences a teenager's behavior. Studies of media reports on suicide have shown that adolescents are influenced by fictional and non-fictional cases of suicide, and how a victim is portrayed has a significant impact on whether an adolescent will copy the behavior. For example, if a victim is shown in light that they have been “liberated,” rather than the fact that they were suffering from an illness, the influence becomes stronger. Suicide experts at the Centers for Disease Control and Prevention (CDC), the Canadian Psychiatric Association and the World Health Organization prefer that the media cover suicide by emphasizing that the victim was under duress, that it is not a solution and that they encourage those who feel hopeless to ask for help. Additionally, adolescents are more likely to commit suicide if a friend, family member, or member of their community commits suicide (Feuer and Havens, 2017). This is known as suicide contagion, to which adolescents are more susceptible because they imitate behavior in their environment (Steinberg, 2016). This research and recommendation report discusses the different transitions that adolescents go through and how these transitions can affect their lives. decision to commit suicide, a review of current data and articles on suicide during adolescence, and recommendations on how to prevent suicide. Theory Adolescence is a difficult period due to the amount of biological, cognitive and social changes that an individual will go through. The hormonal changes that everyone goes through during puberty lead to changes in the body and sexual maturation, and depending on when the individual goes through these changes, it can lead to body image dissatisfaction. Research has shown that early and late maturation compared to peers can lead to emotional difficulties. The intense pressure that teenagers are under to be attractive and thin can lead to depression, anxiety, the development of eating disorders and even panic attacks. Two established risk factors for attempting suicide are psychiatric problems and stress (Steinberg, 2016). In addition to the various changes that the body undergoes, the adolescent brain matures and develops. Adolescents begin to think abstractly, hypothetically, and in multiple dimensions. During this periodthe development of understanding of the personality of others occurs through mentalization, that is, the understanding of someone else's mental state (Steinberg, 2016). Adolescents are also able to compare risks and benefits and become more emotional and more reactive to stress. Although adolescents experience a maturation of thought processes, adolescents are more likely to engage in risky behaviors than adults. These behaviors include reckless driving, unprotected sex and substance abuse. These risky behaviors can develop into coping mechanisms in depressed individuals that increase the risk of a suicide attempt (Risk Factors and Warning Signs, afsp.org, 2018). In social transitions, if there are discontinuous transitions, that is, transitions that are not smooth and the entry into new life events is more sudden, adolescents are at greater risk of stress. Being under stress is another established risk factor for attempting suicide. The fourth and final concerns parental rejection, family breakdown or extensive family conflict. During the period of social transition, adolescents are likely to be increasingly separated from their parents. Typically this occurs through summer camps or boarding schools. This separation, while not an inherently bad thing, can weaken relationships and make it difficult for teens to know where to turn for help. Literature Review Statistics Suicide is the tenth leading cause of death in the United States and the second leading cause of death among individuals ages 10 to 24. Approximately 157,000 of these individuals are treated in emergency rooms for self-inflicted injuries and/or suicide attempts and 4,600 die each year (Suicide Statistics, afsp.org, n.d.). 10% of female adolescents and 5% of male adolescents will attempt suicide, and males are more likely to actually die by suicide. The current suicide rate is the highest in 10 years. Research suggests that the increased availability of drugs, alcohol, and firearms may be a factor in this (Steinberg, 2016). In 2016 alone, firearms were used in 51% of suicides. The American Foundation for Suicide Prevention (AFSP) estimates that suicide attempts are likely underreported due to the stigma surrounding mental illness (2018). There are several organizations with similar goals of raising awareness, educating the public about mental health, and providing resources and help to those affected by suicide. AFSP and Suicide Prevention Resource Center (SPRC) are two organizations referenced in this report. Warning Signs There are 3 categories of warning signs that someone may be considering suicide. Important warning signs to look out for are any changes in the way an individual talks (e.g. talking about killing themselves, wishing they were dead, feeling trapped or hopeless), behaves (e.g. increased drug or alcohol use , isolating, saying goodbye, or giving away valuables), or any drastic or sudden change in mood (for example, depression, loss of interest, feelings of shame or humiliation, or very sudden improvement) (Risk Factors and Warning Signs , afsp.org, 2018). Protective Factors In an effort to end this epidemic, there are some protective factors or environmental characteristics that help protect people from suicide. These include effective behavioral health care, connection to individuals, family and community, life skills, self-esteem and sense of purpose in life, and cultural, religious or personal beliefs that discourage suicide ( Risk factors eprotection, sprc.org, n.d. ). In the article Connectedness and Suicide Prevention in Adolescents: Pathways and Implications, published in the Official Journal of the American Association of Suicidology, Whitlock, Wyman and Moore for the Centers for Disease Control and Prevention launched an initiative to increase connectedness; connectedness is often used interchangeably with related contexts such as attachment, bonding, and social support (Whitlock et al., 2014). It is important to note that connection with colleagues and friends is not enough to prevent suicidal thoughts and behaviors (STB). Peer disconnection and peer connection may increase the risk of STB due to groups that may unconventionally support STB. Whitlock et al., suggest that there are two areas to focus on to improve connectedness: positive, subjective cognitive and emotional experiences and evaluations of relationships with adults, peers, and social systems such as schools, and structural interrelationship between networks in which young people are integrated (2014). The article Help-Seeking Behaviors of Emotionally Disturbed Adolescents: A Survival Assessment The Teens Suicide Prevention and Depression Awareness Program, published in the Journal of School Nursing and written by Strunk, Sorter, Ossege, and King, analyzes help-seeking behaviors among emotionally disturbed adolescents. They describe the Surviving the Teens program, aimed at high school students and its secondary level, Steps to LAST. The Steps to LAST initiative uses a mnemonic tool to help troubled teens help themselves in times of crisis. For the individual, LATEST stands for Let someone know what worries you, Ask for and accept support from others, Share feelings, and Tell an adult who can help you. When reaching out and helping a troubled teen, the LAST steps are to listen and look for signs of depression/suicide, ask specific questions about suicide, show support, and tell an adult who can help. This program also trains educators on how to look for warning signs in their students. Strunk et al., found that this program had promising results in schools (2013). Finally, in the article Teen Experiences Following a Suicide Attempt by Holliday and Vandermause, found in the Archives of Psychiatric Nursing, there are two models of suicide attempts: attempting as communicating and attempting as transforming. In the scheme of suicide as communicators, adolescents have difficulty telling others about their suffering and the attempt was their “telling”. In this case the attempt preceded the language. In one case study, a girl named Jennifer explained that she attempted suicide because she was unable to communicate her suicidal thoughts. She is reported to have said that she felt betrayed due to the fact that people close to her had not picked up on the little signals she would give off. Steinberg wrote that adolescents who attempt suicide usually ask for help and tend to feel trapped, hopeless, and worthless. The support they seek from friends and family is not received, which coincides with Jennifer's (2015) account. In the attempt-as-transformation model, attempts created a shift between life before and after the attempt. Interviews conducted by Holiday and Vanermause found that respondents felt disconnected from their support group before their attempt. After the attempt, however, they experience a reconnection with family and the beginning of a connection with counselors. The connection with counselors helped adolescents realize that the connection with family had always been there (2015). Real life example My family and I thought thatmy little brother Nathan was just a normal thirteen year old with normal difficulties. He liked video games and playing with LEGO. He seemed happy even though he had recently been struggling at school. He had also had problems with other students and some teachers, but he seemed to be doing well. Dr. Rachel Mallory, Ph.D., RPsych said that sometimes it is difficult to see the warning signs when warning signs are the norm (2014). It was late when my mother called. My husband and I were at home when she told us we needed to go to the hospital as soon as possible; Nathan had been in an accident. My stomach dropped and I immediately knew there was more to the story. I asked him if he was hurt. My mother paused: “Yes, hurry up.” Nathan is the youngest in our family, so only him and my other brother live at home. One of my little sisters had come to visit me from college that weekend since Sunday was Mother's Day. It had been a busy Friday night and everyone was out of the house. Nathan had cleaned his room and once he was alone, he went into his closet with a belt. A short time later, my parents and another sister came home and my dad went to check on Nathan. If you ask my parents, they'll tell you it was all in slow motion. They worked quickly to get him down, start CPR and call for help. By the time my father managed to revive Nathan, an ambulance was there to take him to the hospital and not even a moment before he started having seizures. Nathan hadn't written a note. My father greeted my husband and me in the emergency room when we arrived. He was crying. My mother was with Nathan and my little sister was with them when they found him. My other siblings were in a waiting room. When everyone had arrived, we entered the room. Nathan was still with us, even though he was tied to the hospital bed and there were tubes everywhere. I was angry, sad, confused, and most of all, heartbroken. I couldn't understand how we couldn't know this was going to happen? Why didn't he come to us for help? Weren't we there for him? Why would he do that? After just a few hours in that hospital, he was transferred to Primary Children's Medical Center in the Pediatric Intensive Care Unit. We would later find out that the staff at the first hospital didn't think he would make it and had Nathan travel by ambulance instead of being flown. He was placed in a medically induced coma so his brain could heal from the lack of oxygen and resulting seizures. He remained in a coma for more than a day. By some miracle, he had survived. But we all wondered “would he be in a wheelchair and need diapers? When will he wake up? Would it be the same? How could we ever be the same?” Naters spent several days in the PICU recovering from his attempt. We visited it every day we could. On Sunday we all signed a card for my exhausted mom. Nathan wrote "Happy Birthday!" While it provided much-needed levity during a very difficult time, we all wondered how we could think it was our mother's birthday when we had simply told her it was Mother's Day. Would he suffer permanent memory loss? Later, my parents spoke to him privately about why they thought he was in the hospital; he kept saying it was due to a car accident that happened 5 years ago. My mother told him how he got hurt and why he was in the hospital. Nathan was shocked and kept wondering why he would do this. We didn't know. We don't know yet. Over time, we stopped focusing on why it happened and started focusing on.