Running head: ADOLESCENT SUICIDE PREVENTION 1

Strategies for Prevention of Suicide in the Adolescent Population

October 2019
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Strategies for Prevention of Suicide in the Adolescent Population

Adolescence is the timeframe beginning with the onset of puberty and ending with

becoming an adult, roughly ages 10-19, according to the World Health Organization (WHO)

(2019). The adolescent population is one in which many developments occur physically,

mentally, and emotionally. During this time frame, adolescents are beginning to understand who

they are and where they want to go in life; it is a time of exploration and learning.

Unfortunately, it is during this time frame that this population is also the most vulnerable to

suicide. In 2017, the Center for Disease Control (CDC) reported that suicide is the second

leading cause of death in adolescents (2017). In 2018, Indiana had 2.6% more adolescent

suicides than the United States average of 13.1 deaths by suicide per 100,000 adolescents (CDC,

2019). This statistic affirms the need for developing strategies to help prevent adolescent

suicide.

Facts and Risk Factors of Adolescent Suicide

Healthy People 2020 is an initiative started by the government to help improve the

quality of life. The initiative utilizes Leading Health Indicators (LHI’s), which are health issues

of great concern, to determine our nation’s health (Office of Disease Prevention and Health

Promotion, 2019). The adolescent suicide rate happens to be one of the LHI’s, and the

government would like to reduce this number by 10% by 2020 as the numbers have risen since

2007 (Office of Disease Prevention and Health Promotion, 2019). With adolescent suicide being

on the rise and an LHI, many prevention strategies have been developed and implemented, yet

rates continue to rise (Brown, Bunge, Dickter, Gladstone, Leykin, Marko-Holguin, Soares, and

Van Vorhees, 2019). Not only do the preventative measures need to be taken into consideration,

but the access to these preventions is an area that should be taken into consideration as well.
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Kirkwood, Parker, Story, and Weller (2016) found that in rural areas, not only is the rate of

adolescent suicide high, but the level of mental health literacy is low due to access to services

being low.

In order to create preventative strategies for this LHI, the cause of adolescent suicide or

suicidal ideation (SI) must be understood. Adolescents are facing many transitions and often

cannot adjust well; this is when they may turn to self-medication, they may develop depression,

anxiety, or behavioral issues; these areas are behaviors that could lead to SI (Mo, Ko, and Xin,

2018). Many adolescents who develop these behaviors and symptoms will not seek help because

they do not feel that they have a problem; they also will avoid formal treatment due to the stigma

attached to mental health issues (Mo, Ko, and Xin, 2018). Unfortunately, this stigma could lead

to internalizing the stigma causing the adolescent to have reduced levels of self-esteem and self-

efficacy, ultimately leading to SI (Kirkwood, Parker, Story, and Weller, 2016). There are also

indications that adolescents living in rural areas have a higher rate of SI and completed suicide

due to a lack of mental health literacy (Kirkwood et al., 2016). Knowing the factors that come

into play with adolescent suicide and SI allows understanding of where this demographic is and

what approaches can be useful.

Intervention Strategies for Combatting Adolescent Suicide

Due to the barriers of stigma and geographical location, it is apparent that a health

promotion strategy in this area would be access to mental health services in order to increase

mental health literacy. A school-based program discussing mental health concerns and screening

for at-risk students would be useful as this is a location where this demographic spends the

majority of their time. Ko, Mo, and Xin (2018) have determined that a "gatekeeper approach" to

this LHI would be most conducive due to the fact that teachers, counselors, coaches, and
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administrators see these adolescents on a regular basis and would be able to spot changes in

attitudes or behaviors (13). Unfortunately, many in these positions do not feel comfortable and

do not feel that they have the tools needed to approach students when they notice changes in

behavior (Ko, Mo, and Xin, 2018). This uncertainty is where training comes into play. Ko et al.

(2018) found that once training is complete, the participants felt more knowledgeable and skillful

in the area of approaching adolescents and were more likely to become involved and that this

intervention could help point adolescents in the right direction for help. Furthermore, Kirkwood

et al. (2016) found that this approach has been successful, most notably with the QPR method:

Question, Persuade and Refer, that aims to empower those in certain positions to recognize the

warning signs of a suicide emergency and to respond appropriately. This program also

emphasizes the need for social ties in rural communities so that SI is easier to identify (Kirkwood

et al., 2016).

The difficulty adjusting to the myriad of changes that adolescents face is another area that

is a root cause of adolescent SI and attempted suicide (Asarnow, Babeva, Fitzpatrick, Klomhaus,

and Sugar, 2019). The changes mentioned above in an adolescent's life can lead to poor

emotional self-efficacy or how the adolescents see themselves handling negative emotions

(Asarnow et al., 2019). These feelings of inadequacy can cause thoughts of not being alive any

longer to begin manifesting. Cognitive-Behavioral Therapy (CBT) is one intervention that has

proven successful in helping to change thought patterns and responses, Asarnow et al., (2019)

conducted a study in which CBT was found to have a large positive effect on adolescents with

SI, past attempts, or plans. SAFETY is the name of the CBT program; this program incorporates

the family into the treatment process in order to help the adolescent feel more connected as well

as working on creating safe settings and learning safe reactions to stress (Asarnow et al., 2019).
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While this program focuses on having the family come together for treatment sessions, CATCH-

IT is an online-based CBT program that also teaches skills to lessen the effects of stress and

depression, but it focuses on the interpersonal factors like worthlessness and helplessness (Bunge

et al., 2019). Both programs have successfully helped adolescents develop the skills needed to

decrease their depression and SI (Asarnow et al., 2019; Bunge et al., 2019).

Conclusion

The LHI of adolescent suicides is alarming, and the numbers prove that effective interventions

have not made it to the mainstream at this point. The favorable outcomes of gatekeeper training

and CBT approaches suggest that implementing these strategies into our schools would reduce

the incidents of adolescents completing suicide or dealing with SI altogether. Increasing mental

health literacy in adolescents, as well as the adults who surround them, will not only reduce the

stigma, it will also allow for a nurturing environment. This environment will provide the

adolescent to feel safe discussing their difficulties, thus reducing the tendencies of SI and self-

harming behaviors.
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References

Asarnow, Babeva, Fitzpatrick, Klomhaus, and Sugar (2019). Adolescent Suicide Attempt

Prevention: Predictors of Response to a Cognitive–Behavioral Family and Youth

Centered Intervention. Suicide and Life-Threatening Behavior. doi: 10.111/s1tb.12573

Brown, Bunge, Dickter, Gladstone, Leykin, Marko-Holguin, Soares, and Van Vorhees (2019).

Impact of an online depression prevention intervention on suicide risk factors for

adolescents and young adults. MHealth, 1–10. doi: 10.21037/mhealth.2019.04.01

FastStats - Adolescent Health. (n.d.). Retrieved October 5, 2019, from

https://www.cdc.gov/nchs/fastats/adolescent-health.htm.

Helping Youth Build the Strength to Prevent Suicide. (n.d.). Retrieved October 5, 2019, from

https://www.healthypeople.gov/2020/healthy-people-in-action/story/helping-youth-build-

the-strength-to-prevent-suicide.

Kirkwood, Parker, Story, and Weller (2016). Evaluation of the Better Todays/Better Tomorrows

Youth Suicide Prevention Program: Increasing Mental Health Literacy in Rural

Communities. In Best Practices in Mental Health (Vol. 12). Chicago, IL: Lyceum Books,

Inc.

Ko, Mo, and Xin (2018). School-based gatekeeper training programmes in enhancing

gatekeepers’ cognitions and behaviours for adolescent suicide prevention: a systematic

review. Child and Adolescent Psychiatry and Mental Health. doi: 10.1186/s13034-018-

0233-4

Trend: Suicide - Ages 15-24, Indiana, United States (n.d.). Retrieved October 5, 2019, from

https://www.americashealthrankings.org/explore/annual/measure/Suicide/population/suicide_15-

24/state/IN
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World Health Organization, Adolescent health and development. (2017, July 13). Retrieved

October 5, 2019, from

http://www.searo.who.int/entity/child_adolescent/topics/adolescent_health/en/.