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Adolescent Suicide Risk
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In the last section, we discussed a four step crisis intervention model for a suicidal teen client. The four steps in the crisis intervention model are to establish rapport, explore the problem, focus, and seek alternatives.
In this section, we will discuss six risk factors for teen suicide. These six risk factors are abuse, childhood loss, school performance, personality traits, parental relationships, and family patterns. Although so far this course has focused on cases in which suicidal behavior has taken place, this section will focus on risk factors that may prompt the therapist to be watchful for suicidal ideation. I will also describe how I used the round robin family technique with Vivian and her family.
6 Risk Factors for Teen Suicide
♦ Risk Factor #1 - Physical or Sexual Abuse
A first risk factor for teen suicidality is physical or sexual abuse. The link between abuse and suicidal behavior has been clearly established through research. For example, a 1989 study by Plummer revealed that adolescent suicide attempters had experienced more physical and sexual abuse than adolescents who only had suicidal thoughts. As you know, the increased risk of suicidal behavior may be linked to the increased rate of psychiatric disturbance in teens who have experienced physical or sexual abuse.
♦ Risk Factor #2 - Childhood Loss
A second risk factor for teen suicidality is childhood loss. Lester suggests that losses that occur in children between the ages of six and fourteen may be especially responsible for causing later suicidal behavior. Losses that can contribute to suicidal behavior may include death, divorce, or placement in foster care. Later losses re-arouse the pain experienced during the earlier loss, thus exacerbating the current pain and decreasing the teen’s ability to cope with the current crisis.
♦ Risk Factor #3 - School Performance
In addition to abuse and childhood loss, a third risk factor for teen suicidality is school performance. Studies consistently show that suicidal adolescents do not perform as well in school as non suicidal adolescents. Harter and Marold found that in middle school children who were suicidal were more likely to feel that their achievements were far below their parent’s expectations. As we discussed in Section 2, a dip in school performance may be sufficient impetus to assess a teen client for suicidal ideation.
♦ Risk Factor #4 - Personality Traits
A fourth risk factor for teen suicidality involves personality traits of suicidal adolescents. As you have experienced, suicidal teens are more likely to have low self-esteem, to blame others for their misfortunes and unhappiness. Pfeiffer also indicates that suicidal teens are sometimes found to be more aggressive, delinquent, and impulsive than their nonsuicidal peers.
♦ Risk Factor #5 - Parental Relationships
A fifth risk factor for teen suicidality involves parental relationships. As you are well aware, the families of suicidal adolescents tend to be more chaotic than those of their non-suicidal peers. Parents with problematic marriages, difficulty with employment, and difficulty with parenting are more likely to attempt suicide. Kashani also found that psychiatric disturbances in parents may be a significant risk factor for suicidal ideation and behavior in teens. Of course, a family history of suicide or suicide attempts provide a significant risk factor for teenagers in crisis.
♦ Risk Factor #6 - Family Patterns
In addition to abuse, childhood loss, school performance, personality traits, and parental relationships, a sixth risk factor for teen suicidality involves family patterns. Williams and Lyons looked at patterns of interaction in families with a suicidal teen. The study found that these families showed more conflict when discussing a problem, had less effective methods of communication, made fewer positive statements to one another and achieved less final consensus. These teens also displayed poorer relationships with their parents.
Vivian, 16, had made excellent progress in reestablishing coping skills following her suicide attempt. However, Vivian’s family was resistant to the treatment process. Vivian stated, "I feel like mom and dad and my brothers are banding together and keeping me from making any progress! They never want to talk about the problems that caused all this, and even in these group sessions I feel like they are avoiding what is important!"
Round Robin Role Playing Technique
I suggested that Vivian and her family might try the Round Robin role playing technique in our next session. In the session, I stated to Vivian, "Let’s do a Round Robin for your family, Vivian. Let’s have you play your mother, and your brother Jeff can play your father. And we can have your mother play you. Your father can take my role."
After a few minutes of role play, I asked the family to switch roles, until each member had had a chance to experience the role play from each perspective. After the role plays were complete, I asked Vivian’s family to evaluate their communication skills based on what they had learned from the experience.
Think of your Vivian. Would the round robin technique help his or her family address their communication difficulties?
In this section, we have discussed six risk factors for teen suicide. These six risk factors are abuse, childhood loss, school performance, personality traits, parental relationships, and family patterns.
In the next section, we will discuss the four step Hook technique for helping a teen client deal with the anger component of his or her depression. The four steps in the Hook technique are identify the hook, the hook book, identify the need, and fill the need.
Peer-Reviewed Journal Article References:
Capps, R. E., Michael, K. D., & Jameson, J. P. (2019). Lethal means and adolescent suicidal risk: An expansion of the peace protocol. Journal of Rural Mental Health, 43(1), 3–16.
Herres, J., Shearer, A., Kodish, T., Kim, B., Wang, S. B., & Diamond, G. S. (2019). Differences in suicide risk severity among suicidal youth with anxiety disorders. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 40(5), 333–339.
Reisner, S. L., Biello, K., Perry, N. S., Gamarel, K. E., & Mimiaga, M. J. (2014). A compensatory model of risk and resilience applied to adolescent sexual orientation disparities in nonsuicidal self-injury and suicide attempts. American Journal of Orthopsychiatry, 84(5), 545–556.
Zisk, A., Abbott, C. H., Bounoua, N., Diamond, G. S., & Kobak, R. (2019). Parent–teen communication predicts treatment benefit for depressed and suicidal adolescents. Journal of Consulting and Clinical Psychology, 87(12), 1137–1148.
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