Adolescents and suicidality

The term suicidal risk, or suicidality, refers to amental state in which a person's thoughts and behavior are directed toward causing his or her own death, i.e., committing suicide. This includes suicidal thoughts, suicidal plans, suicidal announcements, suicide pacts or suicide arrangements, and suicide attempts.

Suicidal thoughts or acts are not classified as a disease per se. However, they often represent the conclusion of a pathological development. In any case, they are an expression of external or internal distress and should be seen as a serious sign of an acute crisis .

This issue explains how young people can come across suicidal content on the Internet and provides tips for parents, educators and relatives of those affected.

Suicidal thoughts in adolescents do not always have to be the result of a mental illness. Thepreoccupation with the subject of death or the question of the meaning or meaninglessness of life is nothing out of the ordinary in adolescence, but rather a characteristic thought process marked by doubts during the difficult developmental phase of puberty. Young people are often insecure, overwhelmed or sometimes even dissatisfied with their lives. In addition, the general attractiveness of the topic of suicide or death for young people must be taken into account - among other things, because existing taboos can be broken here and boundaries can be crossed.

Thetrigger for serious suicidal thoughts or even a suicide (attempt) is often a crisis situation: Bullying at school, lovesickness, a conflict with the best friend, family problems, school failure or general fear of failure. In the adolescents' own assessment, these difficulties are usually seen in an unrealistically negative light. Those affected feel unable to continue living in the same way as before and have lost hope that the situation could turn around for the better. Suicide is seen as the seemingly only solution to a situation that can no longer be overcome.

However, the causes of suicidal tendencies usually lie deeper and are a complex interplay of previous life experiences, the social environment, the individual personality structure and psychological situation as well as the family and school experiences of those affected.

Basically, depression or depressive moods in children and adolescents play a major role in the risk of suicide; equally important are experiences of violence in the family, sexual abuse and/or negative experiences regarding one's own homosexuality. Other risk factors for suicidal acts are: Psychoses, addictive disorders, strongly pronounced aggressive behavioral disorders or impulse control disorders.

Suicidal children and adolescents usually send direct or indirect signals . They want someone to respond to them. Indications and alarm signs of danger may include:

• social withdrawal, breaking off social contacts,
• sad, depressed mood as well as mood swings,
• pronounced hopelessness, lack of future prospects,
• change in physical appearance and physical symptoms,
• written or verbal expressions, e.g. allusions such as "Soon I'll have it all behind me",
• giving away beloved things,
• specific actions in preparation for a suicidal act,
• suicide-related drawings and symbols,
• aggressively defensive behavior.

People also share their suicidal thoughts online. In particular, so-called suicide forums are a lively exchange between people in life crises. Some offer constructive help, while others are problematic because they confirm those affected in their suicidal intentions. In these prosuicidal forums, suicide is presented as the only solution with no alternative.

There is recurring web content that can have a particularly dangerous effect on young users and encourage them in their suicidal intentions. Particularly problematic are offers, profiles and posts thattrivialize or even glorify suicide in a one-sided way and present it as a possible or even the only logical way to get rid of problems. These include, in particular, detailed discussions of methods (on the most effective suicide method possible, on the procurement of the means of suicide and on the choice of location), descriptions of suicide attempts, but also suicide announcements, suicide partner searches and arrangements.

Furthermore, there is a trend towards posting prosuicidal posts, i.e. glorifying suicide pictures, videos or experience reports, particularly in the communities and video platforms popular with young people. When people with suicidal intentions view such content, memories of their own negative feelings and experiences can arise, which in turn can trigger the urge to endanger themselves again. This effect is known as a trigger (English: "to trigger").

On social media, we also frequently come across profiles, videos and images in which depictions of suicides are combined with content from the areas of self-harm and/or eating disorders . The use of hashtags brings up a whole range of extreme content in the search function of the services (source: Ging & Garvey (2017). In most major social media services, however, the well-known and very clear suicide hashtags are now blocked. The large overlap in suicide and self-harm content is particularly striking. Exposure to such content can trigger or reinforce dangerous behavior in children and young people, if not encourage them to try out other types of risk.

If there are clear indications, that a suicidal act is imminent, contact the local police directly or call an ambulance. The rule is that the more specific the suicidal thoughts, the greater the danger and the more action is needed.

If the suicidal threat is already very pronounced, you should immediately seek inpatient treatment or, again, call an ambulance. For this, you do not need an admission or referral from a doctor, but can have the affected person admitted directly to the nearest child and adolescent psychiatric clinic. Cooperation with experienced specialists is essential for accurate diagnosis. In outpatient and inpatient child and adolescent psychiatry and psychotherapy, you will find specialists for diagnosis, therapy, prevention and rehabilitation in cases of suicide risk.

If you have any doubts about whether there is an acute suicide risk, do not take any risks. Introduce the individual or individuals to professionals in the fields of child and adolescent psychotherapy or else child and adolescent psychiatry. Then let the professionals decide whether inpatient treatment seems reasonable and necessary. At www.bptk.de or at www.bundesaerztekammer.de you will find the appropriate specialists.