ABSTRACT Despite the increased attention towards adolescent suicide prevention, several myths surrounding adolescent suicide still persist.  When such myths are accepted and unchallenged by health educators, suicide misperceptions by parents, students, community members, and school professionals may result.  A lack of support for suicide prevention programs may soon follow.  Faulty programs may be developed and adolescent lives lost.  Therefore, this article explores fifteen prevalent myths about adolescent suicide.  It is a hope that this article will help school professionals to develop factually-based programs, educate students, and prevent future student suicidal behavior.  A list of current internet sites is also provided to assist in gaining clarity on this issue.

INTRODUCTION

Adolescent suicide is presently the second leading cause of death among 15-19 year olds [1].  In 1994, 2270 youths died from suicide [2].  Considering that medical examiners underreport suicides by 25% to 50% [3] and that there are 100 to 200 suicide attempts per youth suicide completion [2], 1994 may actually have experienced as many as 4500 youth suicides and 900,000 youth suicide attempts.  Fortunately, increasing attention to this issue is occurring and school suicide prevention programs are being implemented throughout the US.  Unfortunately, there are many myths regarding adolescent suicide that are still commonly accepted.  Such myths could undercut the effectiveness of current and future suicide prevention programs.  Therefore, this paper provides a list of the fifteen prevalent myths about adolescent suicide and the actual facts that correspond to each.  It is a hope that such information may be used to more clearly understand this issue when developing future suicide prevention programs.

FIFTEEN PREVALENT MYTHS ABOUT ADOLESCENT SUICIDE

Myth 1.  Adolescent suicide is a decreasing problem in the United States

While the suicide rate for the general population has remained relatively stable since the 1950s, the suicide rate for adolescents has more than tripled [2].  Presently, the suicide rate for 15-24 year olds stands at 13.8 per 100,000 [2].  From 1980 to 1992, the suicide rate for 15-19 year olds and 10-14 year olds increased 28% and 120%, respectively [4].

Myth 2.  Adolescent homicide is more common than adolescent suicide.

For adolescents 15-19 years of age, suicide is presently the second leading cause of death and homicide is the third leading cause of death [2].  For adults, suicide is also more common than homicide.  In US adults, suicide is presently the ninth leading cause of death and homicide is the tenth leading cause of death [2].

Myth 3.   The majority of adolescent suicides occur unexpectedly without warning signs.

Nine out of ten adolescents who commit suicide give clues to others before their suicide attempt [5].  Warning signs for adolescent suicide include depressed mood, substance abuse, loss of interest in once pleasurable activities, decreased activity levels, decreased attention, distractability, isolation, withdrawing from others, sleep changes, appetite changes, morbid ideation, offering verbal cues (i.e., “I wish I were dead”), offering written cues (i.e., notes, poems), and giving possessions away [6,7].  In addition, the following risk factors place an adolescent at increased risk for suicidal behavior:  having a previous suicide attempt, having a recent relationship breakup, being impulsive, having low self-esteem, being homosexual, coming from an abusive home, having easy access to a firearm, having low grades, and being exposed to suicide or suicidal behavior by another person [6,8-10].  Moreover, most suicidal adolescents attempt to communicate their suicidal thoughts to another in some manner [11].  Not surprisingly, an effective way to prevent adolescent suicide is to learn to identify the warning signs that someone is at risk [7].

Myth 4.  Adolescents who talk about suicide do not attempt or commit suicide.

One of the most ominous warning signs of adolescent suicide is talking repeatedly about one’s own death [10,12].  Adolescents who make threats of suicide should be taken seriously and provided the help that they need [6].  In this manner suicide attempts can be averted and lives can be saved.
 

Myth 5.  Most adolescents who attempt suicide fully intend to die.

Most suicidal adolescents do not want suicide to happen [13].  Rather, they are torn between wanting to end their psychological pain through death and wanting to continue living, though only in a more hopeful environment.  Such ambivalence is communicated to others through verbal statements and behavior changes in 80% of suicidal youths [7].
 

Myth 6.  Educating teens about suicide leads to increased suicide attempts, since it provides them with ideas and methods about killing themselves.

When issues concerning suicide are taught in a sensitive educational context they do not lead to, or cause, further suicidal behaviors [14].  Since three-fourths (77%) of teenage students state that if they were contemplating suicide they would first turn to a friend for help [15], peer assistance programs have been implemented throughout the nation.  These educational programs help students to identify peers at risk and help them receive the help they need.  Such programs have been associated with increased student knowledge about suicide warning signs and how to contact a hotline or crisis center, as well as increased likelihood to refer other students at risk to school counselors and mental health professionals [16].  Furthermore, directly asking an adolescent if he or she is thinking about suicide displays care and concern and may aid in clearly determining whether or not an adolescent is considering suicide [6,11].

Myth 7.  Adolescents cannot relate to a person who has experienced suicidal thoughts.

Data from the 1997 Youth Risk Behavior Surveillance Survey (YRBS) [17], which surveyed 16,262 high school students, found that one in five students (24.1%) had seriously considered attempting suicide in the previous year.  A population study of 5,000 teenagers from a rural community showed that 40% had entertained ideas of suicide at some point in their lives [18].  Some researchers have estimated that it is more realistic that greater than half of all high school students have experienced thoughts of suicide [19].  Furthermore, a midwestern survey of over 400 junior and senior high school students found that almost half of the students reported having a friend who had attempted suicide [20].
 

Myth 8.  There is no difference between male and female adolescents regarding suicidal behavior.

Adolescent females are significantly more likely than adolescent males to have thought about suicide and to have attempted suicide [17].  More specifically, adolescent females are 1.5 to 2 times more likely than adolescent males to report experiencing suicidal ideation and 3 to 4 times more likely to attempt suicide [9,17].  Adolescent males are 4 to 5.5 times more likely than adolescent females to complete a suicide attempt [9,21].  While adolescent females complete one out of 25 suicide attempts, adolescent males complete one out of every three attempts [20].

Myth 9.  Because female adolescents complete suicide at a lower rate than male adolescents, their attempts should not be taken seriously.

One of the most powerful predictors of completed suicide is a prior suicide attempt [10].  Adolescents who have attempted suicide are 8 times more likely than adolescents who have not attempted suicide to attempt suicide again [22].  Between one-third to one-half of adolescents who kill themselves have a history of a previous suicide attempt [23,24].  Therefore, all suicide attempts should be treated seriously, regardless of sex of the attempter.

Myth 10.  The most common method for adolescent suicide completion is drug overdose.

Guns are the most frequently used method for completing suicides among adolescents [25].  In 1994, guns accounted for 67% of all completed adolescent suicides while strangulation (via hanging), the second most frequently used method for adolescent suicide completions, accounted for 18% of all completed adolescent suicides [30].  Having a gun in the house increases an adolescent’s risk of suicide.  Regardless of whether a gun is locked up or not, its presence in the home is associated with a higher risk for adolescent suicide [26].  This is true even after controlling for most psychiatric variables.  Homes with guns are 4.8 times more likely to experience a suicide of a resident than homes without guns [27].  In lieu of these findings, it should not be surprising that restricting access to handguns has been found to significantly decrease suicide rates among 15-24 year olds [28,29].

Myth 11.  All adolescents who engage in suicidal behavior are mentally ill.

As aforementioned, the majority of adolescents have entertained thoughts about suicide at least once in their lives.  Although there are cases of some adolescents attempting and completing suicide as a result of a mental disorder, most are in fact not suffering from a mental disorder [6].  Studies involving psychological autopsies of adolescents who completed suicide suggest that most adolescents are relatively rational and coherent at the time of their death [6].

Myth 12.  If an adolescent wants to commit suicide, there is nothing anyone can do to prevent its occurrence.

One of the most important things an individual can do to prevent suicide is to identify the warning signs of suicide and recognize an adolescent at increased risk for suicide [30].  School professionals should therefore be aware of these risk factors and know how to respond when a student threatens or attempts suicide [19].  The existence of a school crisis intervention team may assist with this process.

Myth 13.  Suicidal behavior is inherited.

There is no specific suicide gene which has ever been identified [7].  Studies involving twins have found higher concordance rates for suicide in monozygotic twins than in dizygotic twins; meaning that an identical twin would be more likely than a fraternal twin to engage in suicidal behavior if his/her co-twin committed suicide [31].  However, no study to date has examined the concordance for suicide in monozygotic twins separated at birth and raised apart, a requirement necessary to be met as a means to indicate inheritance of psychiatric illness [7].  Such a study could assess the effects that parental rearing style and familial environment have on suicidal behavior.  Interestingly enough, when compared to control subjects, adolescent suicide victims have been found to have had significantly less frequent and less satisfying communication with their parents [32].

Myth 14.  Adolescent suicide occurs only among poor adolescents.

Adolescent suicide occurs in all socioeconomic groups [5,7].  Socioeconomic variables have not been found to be reliable predictors of adolescent suicidal behavior [7].  Instead of assessing adolescents’ socioeconomic backgrounds, school professionals should assess their social and emotional characteristics (i.e., affect, mood, social involvement, etc.) to determine if they are at increased risk.

Myth 15.  The only one who can help a suicidal adolescent is a counselor or a mental health professional.

Most adolescents who are contemplating suicide are not presently seeing a mental health professional [14].  Rather, most are likely to approach a family member, peer, or school professional for help [33-35].  Displaying concern and care as well as ensuring that the adolescent is referred to a mental health professional are ways paraprofessionals can help [12,14].

CONCLUSION

In attempting to reduce suicide among adolescents, school professionals must have accurate information.  Remaining aware of and refuting the myths of adolescent suicide will assist in this process.  This paper has therefore provided a discussion of commonly accepted myths and their associated facts.  All school staff must feel they have a responsibility to play in preventing suicide for an effective and comprehensive suicide prevention program to take effect.  Therefore, school professionals are encouraged to share this information with their colleagues.  A list of current internet sites is also provided to further assist in gaining understanding on this issue (Figure 1).

Figure 1.  A Resource Guide to Suicide Education Sites on the Internet
 
 

Suicide Resource	Description	Internet Address
American Association of Suicidology	Resource for anyone concerned about suicide.  Provides information on current research, prevention, ways to help a suicidal person, and surviving suicide.  A list of crisis centers is also included.	www.cyberpsych.org/aas/index.html
American Foundation for Suicide Prevention	Provides research, education, and current statistics regarding suicide. Links to other suicide and mental health sites are offered.  Membership opportunity available.	www.afsp.org
Australian Institute for Suicide Research and Prevention	Provides information on youth suicide, suicide and families, and guidelines for the role of a helper.	www.gu.edu.au/gwis/aisrap/aisrap.html
Suicide Awareness –  Voices of Education	Provides suicide education, facts, and statistics on suicide and suicide and depression.  Links to information on warning signs of suicide and the role a friend or family member can play in helping a suicidal person.  Information can be sent via e-mail.	www.save.org
Suicide:  Read this First	Site aimed at those seriously considering suicide.  It  offers five thoughts to contemplate before attempting suicide and provides sources of on-line help.	www.metanoia.org/suicide
San Francisco Suicide Prevention	Offers information on warning signs and suicide  prevention programs.  Also provides a 24-hour crisis hotline number.	www.sf.suicide.org
Suicide@rochford.org	Information about warning signs, answers to frequently asked questions, current statistics, and interactive features are provided.	www.suicide@rochford.org
Youth – Depression and Suicide	Offers information on warning signs and ways to help suicidal and depressed youths.	www.jarig.my/befrienders/youth1.htm

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Please send all correspondence to:  Dr. Keith A. King, Assistant Professor, Health Promotion and Education Program, University of Cincinnati, ML 0002, 526 TC, Cincinnati, OH 45221-0002; or <keith.king@uc.edu>.  This article was submitted November 19, 1998 and revised and accepted for publication January 25, 1999.
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