Suicidal behaviour in adolescents

Nature and prevalence It is estimated that over 71,000 adolescents around the world commit suicide every year. Plans and attempts to commit suicide are 10 to 40 times more common. Suicidal behaviours are more prevalent in adolescent girls than boys and are more common in rural than urban areas. Data about suicide and suicidal behaviours do not exist in most low-and lower-middle-income countries as in some settings they are illegal and there is under-reporting due to inefficient civil registration systems, variation in coroners' practices, religious sanctions and social stigma. Where assessed, about one in ten adolescents reported a suicide attempt in the previous year and about one in five had suicidal thoughts. Determinants Suicide and suicidal behaviours in adolescents are multifactorially determined by interactions between risk and protective factors. In some there is an existing severe mental or substance abuse disorder, but in others suicidal behaviours are associated with personal, family, social and cultural factors, some of which are more common in resource-constrained countries. Exposure to violence within the family (including childhood physical, verbal or sexual abuse), school (including bullying and harsh or humiliating punishments) or society (including neighbourhood and community violence) is associated with suicidal behaviour. Younger age at marriage, arranged marriages, forced marriage, parental opposition to a partner of choice, and pregnancy out of wedlock are risk factors for adolescent suicides. Factors which induce shame and humiliation, including exam failure and impending punishment, are salient factors for adolescent suicides. Prevention and care None of the world's low-and lower-middle-income countries have instituted a national suicide prevention strategy for adolescents. A social and public health response to adolescent suicide which complements a mental health response is crucial in these settings. Primary health and community strategies, schoolbased strategies, responsible reporting of suicide in the media and the limiting of access to agricultural chemicals, are probable strategies to reduce adolescent suicide in resource-constrained countries. © 2011 The Author(s).