by Marianne E. Etherson
Suicide and self-harm are on the rise in young people.
Suicide and self-harm are heartbreaking outcomes of pain and distress. However, suicide is particularly devastating in young people with a lot of potential, promising futures, and much of life yet to live. Sadly, suicide is the third leading cause of death among 15–29-year-olds worldwide. Evidence also suggests that over one fifth of adolescents engage in self-harm. And alarmingly, recent evidence has found self-harm and suicidal behaviours in young people to be on the rise.
Why do young people engage in self-harm or suicide?
The answer is complicated. While it is not fully clear why young people may self-harm or attempt suicide, these behaviours are thought to be influenced by a range of biological, psychological, social, and cultural factors, including being more impulsive, knowing others who have engaged in self-harm or suicidal behaviours, and having a high pain threshold. Better understanding of the factors that increase or decrease the risk of self-harm and suicide is key to prevention.
More young people experience thoughts of self-harm and suicide than those who engage in self-harm or suicide attempts. Yet, the reasons why some young people with thoughts of self-harm and suicide engage in self-harm or suicide attempts and some do not are unclear. We set out to answer this question. Specifically, our research examined which factors may increase or decrease the risk that young people with thoughts of self-harm or suicide will act on their thoughts.
The distinct pressures placed on young people.
So far, reviews in adults have found various factors, including anxiety disorders, post-traumatic stress disorder, drug use disorders, traumatic events (e.g., maltreatment, sexual abuse), among others, to increase the risk of a suicide attempt in adults with suicidal thoughts. There are, however, thought to be unique factors that increase the likelihood that young people with thoughts of self-harm and suicide engage in self-harm and suicidal behaviours.
Suicide and self-harm among young people may reflect broader challenges facing young people today. Young people, for instance, face distinct pressures, such as academic stress, identity issues, and social media influences. In addition, young people exhibit greater sensitivity in social interactions, are more impulsive, and engage in more risky behaviours. As a result, young people are likely to differ from adults in their reasons for engaging in self-harm or suicide.
Our review:
Our review, published in PLoS One, aimed to better understand the risk and protective factors that distinguished whether young people (aged 13-25 years) with thoughts of self-harm and suicide acted on their thoughts. We searched for studies examining these factors over the last 13 years and found 99 studies (92 examining risk and protective factors distinguishing between suicide attempts and suicidal thoughts and 7 examining risk factors distinguishing between self-harm and thoughts of self-harm), which included over 100,000 young people worldwide.
Notably, various factors, including non-suicidal self-injury, physical, emotional, or sexual abuse, violence, and family conflict increased the risk that young people with thoughts of suicide engaged in suicide attempts. Whereas, greater closeness and support from parents, in addition to greater academic achievement decreased this risk. While there was a lack of research on self-harm thoughts and behaviour, young people with thoughts of self-harm were at greater risk of engaging in self-harm if they were female, had been exposed to self-harm or suicide in others (e.g., friends and family), and were more impulsive.
How can we help to prevent self-harm and suicide in young people?
While self-harm and suicide are extremely complex, difficult to detect, and the associated factors unique to each individual, our review helps to determine who among young people with thoughts of self-harm or suicide may be most at-risk of self-harm or suicide attempts. Better understanding and education of warning signs and preventive factors among those who engage with young people (e.g., teachers, parents, peers etc.) is crucial.
Mental health professionals, for instance, can help by identifying and targeting key risk factors, such as impulsive behaviours, or by helping young people to process and address past traumatic life events (e.g., exposure to suicide in others or abuse) that place young people at greater risk of self-harm or suicidal behaviours.
Our review, in particular, highlights the role of family and school. We may be able to reduce risk through resolving family conflicts, enhancing connectedness, encouraging engagement at school, as well as being aware of warning signs for self-harm and suicidal behaviours.
While our review highlighted key gaps related to other key risk and protective factors specific to young people (e.g., social media use), it brings us one step closer to a better understanding of why some young people act on their thoughts. With every step forward, we will be better placed to address the stark rates of self-harm and suicide evident in young people today.
If you or a someone you know are concerned about suicide or self-harm, please seek help from a professional.
References
Bayliss, L. T., Christensen, S., Lamont-Mills, A., & du Plessis, C. (2022). Suicide capability within the ideation-to-action framework: A systematic scoping review. PLoS One, 17(10), e0276070. https://doi.org/10.1371/journal.pone.0276070
Etherson, M. E., Lee, S., Loney, K. J., Steward, I., Ward, J., McClelland, H., Kandola, A., De Alcantara Mendes, J., Hollis, C., Townsend, E., Auer, D. P., & O’Connor, R. C. on behalf of the Digital Youth Team (in press). Exploring risk and protective factors which distinguish suicidal and self-harm behaviours from suicidal and self-harm ideation in young people: A systematic review. PloS One. 20(9): e0326381. https://doi.org/10.1371/journal.pone.0326381
Klonsky, D. E., & May, A. M. (2014). Differentiating suicide attempters from suicide ideators: A critical frontier for suicidology research. Suicide and Life‐Threatening Behavior, 44(1), 1-5. https://doi.org/10.1111/sltb.12068
May, A. M., & Klonsky, E. D. (2016). What distinguishes suicide attempters from suicide ideators? A meta‐analysis of potential factors. Clinical Psychology: Science and Practice, 23(1), 5. http://doi.org/10.1111/cpsp.12136
Suicidal Behaviour Research Laboratory 