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Suicide Prevention Strategies
Youth and Elderly Populations
In recent years, rates of suicide in BC have tended to be
highest among the young (including teens and young adults)
and the elderly populations. A fairly typical trend line for
rates of suicide across the lifespan, shows noticeable peaks
occurring among both the younger and older age groups. While
much attention, in the form of media reports, research efforts,
and program development, has focused on the increasing rates
of suicide among the young, the high rates of suicide among
the elderly have received less widespread notice.
Part of this imbalance in overall attention may have to
do with the fact that the suicide rate for young people has
nearly tripled in the last several decades, with a leveling
out starting to occur in the 1980s (Health Canada, 1994).
Such a dramatic rise in the rate of suicidal behaviour among
teens and young adults has concerned parents, policy makers,
mental health professionals, and researchers alike, making
youth suicide prevention a fairly high profile issue. In response,
numerous books and articles have been published on this topic
and several youth suicide prevention programs have been developed.
In contrast, there has been a much less dramatic public
response to the high rate of suicide among the older generation,
which may well be a reflection of the fact that the elderly
have consistently shown high rates of suicide for a longer
period of time (Health Canada, 1994). Unlike the statistics
for youth, a high suicide rate for the seniors population
does not represent a new phenomenon.
On the other hand, the lack of visibility regarding the
issue of suicide among the elderly may also be a reflection
of ageist values, where the lives and concerns of the young
are seen as much more important than the quality-of-life concern
of the elderly. Without question, we live in a culture that
places a high premium on youth, vitality, physical beauty,
independence, and sex appeal. In the eyes of a youth-valuing
culture, when an elderly man kills himself at age 78, it is
somehow viewed as "less of a tragedy" than when a young man
of 17 kills himself, even though both deaths may have been
precipitated by identical circumstances and social conditions,
such as: unbearable losses, major depression, social isolation,
a lack of meaningful work (or role), and abuse of alcohol.
In this article the commonalities between youth and elderly
suicides will be highlighted and specific opportunities for
prevention will be discussed.
Risk Factors for Suicide
Suicidal behaviour is complex and cannot be understood to
be the result of any one single factor acting in isolation.
Several individual factors (e.g. depression or previous suicide
attempts) interact with other social factors (e.g. unemployment
of alienation) to produce a potential vulnerability to suicide.
Stressful life events can then exacerbate an existing vulnerability.
For example, the loss of a significant relationship can further
heighten the risk for suicidal behaviour.
Even though many of the risk factors for suicide are well
known through research efforts and by reviewing thousands
of cases of completed suicide, we still cannot predict with
any certainty which people will actually go on to kill themselves.
For example, many people experience several risk factors but
do not commit suicide.
We can, however, use the existing knowledge about suicide
risk factors to help us identify those who may be vulnerable
to self-harming behaviour so that we can intervene early and
hopefully avert a suicidal outcome. The risk factors for suicide
among youth and elderly populations are highlighted next.
Similarities Between Youth and Elderly Suicide
Risk factors for youth and elderly suicide are not that
dissimilar and include: a history of suicidal behaviour, presence
of a psychiatric disorder, substance abuse, social isolation,
access to the lethal means for killing oneself, unemployment,
and health problems. Men of both age groups kill themselves
more often than their female counterparts.
Declining health, adjustment to retirement, and significant
losses such as widowhood are stressful life events associated
with aging that can increase the vulnerability to suicide
among the elderly population. On the other hand, the risk
of imitative suicidal behaviour following exposure to peer
suicide or sensationalized media reports s greater among youth
populations.
Irrespective of their age or stage in the life cycle, the
bottom line is this: people kill themselves because they are
in unbearable psychological pain and they see suicide as their
only option. However, with proper support and intervention,
suicidal individuals can be assisted to make a choice in favour
of life, and family members and friends can play a critical
role in offering their support.
Providing Help to a Suicidal Family Member
Understanding the developmental challenges and life cycle
tasks facing youth and elderly populations can prepare family
members to provide assistance to a loved one who is experiencing
an emotional or suicidal crisis. For example, a key developmental
task of adolescence is identity formation. Successful mastery
of this life cycle stage will likely include separation from
parents and family and increased identification and need for
acceptance from one's peer group.
When an adolescent is faces with rejection from a peer or
the break-up of a relationship, family members need to know
that this is a serious threat to the equilibrium of the young
person and is not to be taken lightly or dismissed as unimportant.
Family members can communicate their concern and provide empathic
understanding, while still respecting the adolescent's need
for privacy and autonomy.
At the end of the life cycle, family members should be alert
to the potential crises being faced by their older relatives.
A key developmental challenge for those over the age of 65
is mastering the transition from work to retirement. For many
seniors, this adjustment can prove to be very difficult, resulting
in a temporary loss of identity and role confusion. Again,
family members can provide support and reassurance and communicate
their faith in the person's ability to master the challenge.
In either of these cases, determining whether or not the
person in crisis is considering suicide is very important.
Asking the question, "Are things so bad that you are thinking
of suicide?" will not put the idea into the person's head.
Instead, it will open up an opportunity for a potentially
life-saving discussion to take place. Only by asking the question,
can we establish whether or not suicide is an issue.
If the person acknowledges that he of she is considering
suicide, family members can be helpful by doing the following:(a)
reassuring the suicidal person that help is available; (b)
letting the suicidal person know that the family loves them
and will do whatever they can to ensure that they will not
hurt themselves; (c) finding out what community resources
are available to support the person in crisis, including family
physician, local mental health centre, 24-hour crisis line;
(d) making arrangements to get the suicidal person the necessary
help, which could include taking them to the hospital, making
an appointment with the family physician, advocating on behalf
of the suicidal person, or going with them to see a counsellor.
Denial Will not Make it Go Away
It is always upsetting to see someone we love in pain, and
dealing with a family member who is suicidal is definitely
scary business. For some people it might even be tempting
to avoid the topic of suicide altogether in the hopes that
it will go away. It won't.
Suicidal people need the opportunity to tell their stories
and they need to know that help is available. They need to
know that they will not feel this way forever and they need
to hear that family members will do whatever is necessary
to make sure that they do not harm themselves. Family members
also need to get support for themselves and they need to be
reminded that they can never be responsible for another person's
choice to live or die. Sadly, some people kill themselves
in spite of the fact that they had families who loved them.
What is most important to remember is that help is available
to suicidal individuals. Family members can play a critical
role in assisting someone in crisis by providing non-judgmental
support and by knowing which local community resources are
available to provide assistance.
Jennifer White is the Director of the BC Suicide Prevention
Program at CUPPL, Department of Psychiatry, UBC.
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