Adolescence

There are close to 3.1 million adolescents in Australia who contribute to 18.2 percent of the entire population (Australia Bureau of Statistics, 2022c). Adolescence is one of the most influential developmental periods of a person’s life and incorporates some specific challenges. During this time of life there are numerous neurological changes influencing memory, perceptions, emotion regulation, abstract thinking, and the acquisition and processing of information (Shettleworth, 2009; Steinberg, 2007; Yurgelun-Todd, 2007). Some behavioural challenges are also faced, most commonly regarding the participation in risky behaviours. A consequence of risky behaviours has resulted in an increase in the incidence of preventable deaths, including accidents and homicides (Casey, 2015). Road injuries and self-harm are also in the top three causes of injury for adolescents aged 15 to 19 (World Health Organisation [WHO], 2022e). Society presents challenges such as the pressure to develop independence, gain and maintain the correct friendships, educational goals, occupation and physique (Crosnoe & Johnson, 2011; Geldard et al., 2019). Some environmental challenges, which can be a significant influence on later life developments of mental ill-health for adolescents, are factors such as poverty, exposure to conflict or violence, forced migration, gender inequalities and humanitarian emergencies (WHO, 2021c).

Suicidal Ideation

In Australia results have shown that 7.5 per cent of people aged 12 to 17 years had seriously considered attempting suicide (Lawrence et al., 2015), which is a suicidal behaviour associated with suicidal ideation. Suicidal ideation is defined as thoughts that life is not worth living (Scanlan & Purcell, 2009). These thoughts range from brief thoughts every now and then to more determined and detailed plans for committing suicide. The number of adolescents who have considered suicide throughout their life is between 22 and 38 per cent (Scanlan & Purcell, 2009). Individuals are more inclined to experience suicidal ideation if they also demonstrate impulsivity, hopelessness, previous diagnosis of a mental disorder (Klonsky et al., 2016), alcohol use disorder (WHO, 2021d), or who have clinically significant symptoms of depression (Klonsky et al., 2016; Scanlan & Purcell, 2009; WHO, 2021d). Suicidal ideation can occur following an extreme event in a person’s life and an inability to deal with life’s stresses (WHO, 2021d). An extreme event for an adolescent could be a relationship breakdown or rejection, chronic pain, bereavement, history of abuse, family disturbances and social isolation (Geldard et al., 2019; Scanlan & Purcell, 2009). This list is not exhaustive and there could be many more factors which could influence someone to experience suicidal ideation, including a combination of multiple extreme events simultaneously. The incidence of suicidal ideation is also increased in many minority groups who are vulnerable and could have experienced discrimination (WHO, 2021d). Adolescents who have previously attempted suicide also have increased prevalence of suicidal ideation (Neupane & Mehlum, 2022; WHO, 2021d). Suicidal ideation does not discriminate and can affect adolescents at all stages of their development. If an extreme event has occurred in the life of an adolescent, they should be closely monitored in case they develop some warning signs of suicidal ideation.

Evidence of Symptoms 

Suicidal ideation is a mental health condition which may only be revealed during conversations or interactions with an at-risk individual. It is suggested to be mindful of particular warning signs for suicidal ideation, such as; an adolescent threatening to harm themselves, looking for ways to suicide, such as seeking pills or weapons, talking about death or suicide, feeling trapped, anxiousness, agitation or withdrawing from friends, family or society (Scanlan & Purcell, 2009). Alongside these internal aspects of suicidal ideation, there may be a number of external behaviours which can be prevalent when suicidal ideation is occurring. Someone experiencing suicidal ideation may participate in deliberate attempts to self-harm, such as scratching, cutting or burning themselves (Neupane & Mehlum, 2022; Scanlan & Purcell, 2009). Problematic externalising behaviours such as rage, anger, revenge seeking, increasing use of alcohol or substances and dramatic changes in mood could also indicate increased risk of suicidal ideation (Scanlan & Purcell, 2009). Inadequate sleep is indicative of increased suicidal ideation in adolescence (Scanlan & Purcell, 2009; Wong et al., 2011). Therefore, if there are dramatic changes of mood or sleep behaviours it would be prudent to explore why these changes are occurring. As stated, the most common precipitating factor for suicidal ideation is an extreme event, which is generally traumatic and quite negative for this individual. An extreme event which leaves an adolescent feeling pain, either physically or emotionally, coupled with feelings of hopelessness has been widely found to indicate potential for suicidal ideation (Geldard et al., 2019; Klonsky et al., 2016; McCallum et al., 2022; Scanlan & Purcell, 2009).

A number of experts have explored aspects of a person’s personality to investigate whether certain characteristics are more obvious for those who experience suicidal ideation (Endo et al., 2017; McCallum et al., 2022; Planellas & Calderón, 2022). Hopelessness, impulsivity, sensation seeking and high levels of anxiety sensitivity were all found to be implicated with increased suicidal ideation (McCallum et al., 2022). Planellas and Calderón (2022) also identified particular combinations of traits, from the Big Five Inventory, which are generally found with increased suicidal ideation. Specifically, some combinations discovered relevant to increased suicidal ideation were; high levels of neuroticism and low levels of extraversion, high neuroticism and low conscientiousness, high neuroticism and openness, and high neuroticism and agreeableness particularly with emotionally unstable adolescents (Planellas & Calderón, 2022). A personal preference for solitude and a socially isolated adolescent has been highlighted as the highest risk for suicidal ideation and self-harm (Endo et al., 2017). Given that adolescence is a time when individuals are developing more independence, they often pull away from their parents and find more connections with their peers. However, it is detrimental to adolescent well-being for parents to completely cease all monitoring and attempts at communication with their adolescent to allow for independence (Geldard et al., 2019). It is suggested that, despite the resistance they may experience, parents continue to maintain communication and attempts at monitoring as it will provide a support for their adolescent if or when they need it.

In order to identify potential risk of suicidal ideation which could progress to suicide attempts or completion there are a number of scales and measures to consider. Initially to assess personality trait risk factors a Big Five Inventory (Costa & McCrae, 1988) could be implemented. If there has been an extreme event occur for an adolescent then a Kessler Psychological Distress Scale (K10; Kessler et al., 2002) could be used to measure levels of psychological distress and identify needs for further treatment. There are also a number of scales specifically geared towards suicidal ideation which could be beneficial when referring an adolescent for further treatments. The Suicidal Ideation Attributes Scale (SIDAS; Van Spijker et al., 2014) or the Scale for Suicide Ideation (SSI; Beck et al., 1979) are suitable examples however it is not appropriate to administer all of these measures simultaneously. It would be dependent on aspects specific to each individual adolescent which would determine the appropriate course of action.

Impact on the Individual and Interactions

As stated, an adolescent who experiences an extreme event could be at risk for experiencing suicidal ideation. Following an extreme event an adolescent may feel supported or unsupported within their relationships. The most commonly supportive relationships are those between an adolescent and their parents or caregiver. Parental monitoring, supportive relationships with parents or caregivers, trust and communication will all benefit an adolescent following an extreme event (Stroem et al., 2021). When an adolescent feels supported and is encouraged to maintain adequate sleep, a healthy diet and develop protective coping strategies, such as active coping and support seeking, they are less likely to be at risk for mental ill-health (Cairns et al., 2014). Therefore, adolescents who could be prone to experiencing suicidal ideation can be supported in their relationships with family and friends and their mental health risks could diminish. When an individual is feeling unsupported, they could develop negative coping strategies which could increase their chances of developing depression, mental health disorders or suicidal ideation (Cairns et al., 2014). Similarly, peer relationships can contribute to the preoccupation with unhealthy habits which can prolong the time an adolescent employs negative coping strategies (Stroem et al., 2021).

Schools and communities can help in supporting adolescents at risk of experiencing suicidal ideation by creating environments which foster socio-emotional life skills in adolescents and learn about early identification, assessment, management and follow-up care for those affected by suicidal ideation (WHO, 2021d). Similarly, governments and communities may develop suitable protocols for media responses to reporting incidences of suicide (WHO, 2021d) as some adolescents can be triggered by media articles relating to suicide. If someone becomes triggered by reading or hearing about a suicide in the community either by the media or by personal interactions it could create a contagion effect (Liu et al., 2022). A contagion effect occurs when suicide is experienced and then subsequently publicised or talked about and others who previously were not considering suicide develop suicidal ideation or self-harm as a result (Liu et al., 2022).

Suggested Interventions

School counsellors and staff should be trained to be vigilant for warning signs of suicidal ideation for the adolescents they work with. It is suggested that extra supervision is provided to those who are more prone to suicidal ideation, such as females, minority groups, bully-victims or physically aggressive bullies (Espelage & Holt, 2013). If suicidal ideation can be discovered and support can be provided then there may be less likelihood of developing clinical depression and attempting suicide (Scanlan & Purcell, 2009). A school counsellor will obviously need to refer an adolescent for more specialised treatment in the case of suicidal ideation (Geldard et al., 2019). They can also work under close supervision to implement Rational Emotive Behaviour Therapy (REBT), after receiving appropriate training to do so, as this can relieve symptoms of suicidal ideation by challenging self-destructive beliefs, such as hopelessness (Geldard et al., 2019).

Suicide prevention, including addressing suicidal ideation, needs to include a coordinated and collaborative effort between all factors of society (WHO, 2021d). Therefore, education sectors, health, businesses, law, political and media institutions need to be working together. They could implement the recommendations by the World Health Organisation’s LIVE LIFE guide for suicide prevention (WHO, 2021d). When there are multiple factors in an adolescent’s environment working towards supporting them and their mental well-being the incidences of suicidal ideation may decrease.