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ScienceWeek
PUBLIC HEALTH: ON SCHOOL-ASSOCIATED STUDENT SUICIDES
The following points are made by J. Kaufman et al (Morb. Mort. Wkly. Rep. 2004;53:476):
1) During 1994-1999, at least 126 students carried out a homicide or suicide that was associated with a private or public school in the United States.(1) Although previous research has described students who commit school-associated homicides, little is known about student victims of suicide. To describe the psychosocial and behavioral characteristics of school-associated suicide victims, the Centers for Disease Control and Prevention (CDC) analyzed data from school and police officials. The results of that analysis indicated that among the 126 students who carried out school-associated homicides or suicides, 28 (22%) died by suicide, including eight who intentionally injured someone else immediately before killing themselves. Two (7%) of the suicide victims were reported for fighting and four (14%) for disobedient behavior in the year preceding their deaths; none were associated with a gang. However, potential indicators of suicide risk such as expressions of suicidal thoughts, recent social stressors, and substance abuse were common among the victims. The authors suggest these findings underscore the need for school staff to learn to recognize and respond to chronic and situational risk factors for suicide.
2) The need for safe schools has prompted considerable interest in understanding and preventing all types of lethal school-associated violence. The finding that 22% of students who carried out such violence took their own lives indicates that a sizeable proportion of lethal school-associated violence was self-directed. In addition, the finding that approximately one in four suicide victims injured or killed someone else immediately before their suicide suggests an overlap between risk for committing school-associated homicide and risk for suicide. Efforts to prevent incidents of lethal school-associated violence should address youth suicidal ideation and behavior.
3) Suicide-prevention efforts are needed not only to address the risk for school-associated violence, but also to reduce the much larger problem of self-directed violence among adolescents overall. In 2001, suicide was the third leading cause of death in the United States among youths aged 13-18 years, accounting for 11% of deaths in this age group.(2) In 2003, approximately one in 12 high school students in the US reported attempting suicide during the preceding 12 months.(3) Data from Oregon indicate that approximately 5% of adolescents treated in hospitals for injuries from a suicide attempt made that attempt at school.(4)
4) The finding that the majority of students who were school-associated suicide victims were involved in extracurricular activities suggests that these students could be familiar to school staff who might recognize warning signs. Although these students were unlikely to stand out (e.g., by fighting or involvement in gangs) in the manner of those who commit school-associated homicides,(1) other established risk factors for suicidal behavior were common (e.g., expression of suicidal thoughts, recent household move, and romantic breakup). These findings support the need for school-based efforts to identify and assist students who describe suicidal thoughts or have difficulty coping with social stressors. School-based prevention efforts are likely to benefit from school officials working closely with community mental health professionals to enhance the abilities of school counselors, teachers, nurses, and administrators to recognize and respond to risk factors for suicide.
5) The findings that one in four of the school-associated suicides were preceded by a recent romantic breakup and nearly one in five suicide victims were under the influence of drugs or alcohol at the time of their deaths underscore the potential importance of situational risk factors. Youth suicidal behavior often is an impulsive response to circumstances rather than a wish to die. Efforts to help students cope with stressors and avoid substance abuse are important elements of suicide-prevention strategies.(5)
References (abridged):
1. Anderson M, Kaufman J, Simon TR, et al. School-associated violent deaths in the United States, 1994-1999. JAMA. 2001;286:2695-702
2. CDC. Web-based Injury Statistics Query and Reporting System (WISQARSTM). Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, National Center for Injury Prevention and Control, 2004.
3. CDC. Youth Risk Behavior Surveillance--United States, 2003. In: CDC Surveillance Summaries (May 21). MMWR. 2004;53(No. SS-2)
4. CDC. Fatal and nonfatal suicide attempts among adolescents--Oregon, 1988-1993. MMWR Morb Mortal Wkly Rep. 1995;44:312-315, 321-323
5. Centers for Disease Control and Prevention. School health guidelines to prevent unintentional injury and violence. MMWR Recomm Rep. 2001;50(RR-22):1-73
Centers for Disease Control and Prevention http://www.cdc.gov
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Related Material:
PUBLIC HEALTH: METHODS OF SUICIDE AMONG ADOLESCENTS
The following points are made by Centers for Disease Control (MMWR 2004 53:471):
1) In 2001, suicide was the third leading cause of death among persons aged 10-19 years.(1) The most common method of suicide in this age group was by firearm (49%), followed by suffocation (mostly hanging) (38%) and poisoning (7%).(1) During 1992-2001, although the overall suicide rate among persons aged 10-19 years declined from 6.2 to 4.6 per 100,000 population,(1) methods of suicide changed substantially. To characterize trends in suicide methods among persons in this age group, CDC analyzed data for persons living in the US during 1992-2001.
2) The results of that analysis indicated a substantial decline in suicides by firearm and an increase in suicides by suffocation in persons aged 10-14 and 15-19 years. Beginning in 1997, among persons aged 10-14 years, suffocation surpassed firearms as the most common suicide method. The decline in firearm suicides combined with the increase in suicides by suffocation suggests that changes have occurred in suicidal behavior among youths during the preceding decade. Public health officials should develop intervention strategies that address the challenges posed by these changes, including programs that integrate monitoring systems, etiologic research, and comprehensive prevention activities.
3) Among persons aged 10-14 years, the rate of firearm suicide decreased from 0.9 per 100,000 population in 1992 to 0.4 in 2001, whereas the rate of suffocation suicide increased from 0.5 in 1992 to 0.8 in 2001. Rate regression analyses indicated that, during the study period, firearm suicide rates decreased an average of approximately 8.8% annually, and suffocation suicide rates increased approximately 5.1% annually. Among persons aged 15-19 years, the firearm suicide rate declined from 7.3 in 1992 to 4.1 in 2001; the suffocation suicide rate increased from 1.9 to 2.7. Rate regression analyses indicated that, during the study period, the average annual decrease in firearm suicide rates for this age group was approximately 6.8%, and the average annual increase in suffocation suicide rates was approximately 3.7%. Poisoning suicide rates also decreased in both age groups, at an average annual rate of 13.4% among persons aged 10-14 years and 8.0% among persons aged 15-19 years. Because of the small number of suicides by poisoning, these decreases have had minimal impact on changes in the overall profile of suicide methods of youths.
4) Among persons aged 10-14 years, suffocation suicides began occurring with increasing frequency relative to firearm suicides in the early- to mid-1990s, eclipsing firearm suicides by the late 1990s. In 2001, a total of 1.8 suffocation suicides occurred for every firearm suicide among youths aged 10-14 years. Among youths aged 15-19 years, an increase in the frequency of suffocation suicides relative to firearm suicides began in the mid-1990s; however, in 2001, firearms remained the most common method of suicide in this age group, with a ratio of 0.7 suffocation suicides for every firearm suicide.
5) The findings in this report indicate that the overall suicide rate for persons aged 10-19 years in the US declined during 1992-2001 and that substantial changes occurred in the types of suicide methods used among those persons aged 10-14 and 15-19 years. Rates of suicide using firearms and poisoning decreased, whereas suicides by suffocation increased. By the end of the period, suffocation had surpassed firearms to become the most common method of suicide death among persons aged 10-14 years.
6) The reasons for the changes in suicide methods are not fully understood. Increases in suffocation suicides and concomitant decreases in firearm suicides suggest that persons aged 10-19 years are choosing different kinds of suicide methods than in the past. Data regarding how persons choose among various methods of suicide suggest that some persons without ready access to highly lethal methods might choose not to engage in a suicidal act or, if they do engage in suicidal behavior, are more likely to survive their injuries.(4) However, certain subsets of suicidal persons might substitute other methods.(5) Substitution of methods depends on both the availability of alternatives and their acceptability. Because the means for suffocation (e.g., hanging) are widely available, the escalating use of suffocation as a method of suicide among persons aged 10-19 years implies that the acceptability of suicide by suffocation has increased substantially in this age group.
References (abridged):
1. CDC. Web-based Injury Statistics Query and Reporting System (WISQARSTM). Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, National Center for Injury Prevention and Control, 2004.
2. National Center for Health Statistics. Multiple cause-of-death public-use data files, 1992 through 2001. Hyattsville, Maryland: U.S. Department of Health and Human Services, CDC, 2003
3. Anderson RN, Minino AM, Fingerhut LA, Warner M, Heinen MA. Deaths: injuries, 2001. Natl Vital Stat Rep. 2004;52:1-5
4. Cook PJ. The technology of personal violence. In: Tonry M, ed. Crime and Justice: An Annual Review of Research, vol. 14. Chicago, Illinois: University of Chicago Press, 1991:1-71
5. Gunnell D, Nowers M. Suicide by jumping. Acta Psychiatrica Scandinavica. 1997;96:1-6
Centers for Disease Control and Prevention http://www.cdc.gov
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Related Material:
ON THE RISK OF ATTEMPTED SUICIDE THROUGHOUT THE LIFESPAN
The following points are made by S.R. Dube et al (J. Am. Med. Assoc. 2001 286:3089):
1) Suicide was the 8th leading cause of death in the US in 1998, and particularly high rates have been reported among young persons and older adults. Each year, more than 30,000 people in the US commit suicide, but recognition of persons who are at high risk for suicide is difficult, making efforts to prevent its occurrence problematic. In 1999, the US surgeon general brought attention to this complex public health issue by recommending that the investigation and prevention suicide be a national priority.
2) An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including substance abuse, depressive disorders, and attempted suicide among adolescents and adults. Childhood sexual and physical abuse have been strongly associated with suicide attempts. A recent study of Norwegian drug addicts demonstrated that a high proportion of them attempted suicide and that an even higher proportion of drug addicts who had experienced childhood adversity had attempted suicide. In another study, low-income women with a history of alcohol problems and experience of childhood abuse and neglect were at increased risk for suicide attempts.
3) The authors conducted a study to examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences. 17,337 adult health maintenance organization members (54 percent female) were surveyed. The authors report that a strong graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship.
J. Am. Med. Assoc. http://www.jama.com
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