Adolescence

Adolescence is a tumultuous period characterised by a development of new cognitive skills, changes in personal and sexual identity, negotiating through puberty and emerging independence from parents on a personal, financial and emotional level (Christie & Viner, 2005). Nowadays adolescence is characterised by school, training and university which covers a period of ten years of more and can well be seen as a separate life stage due to its longevity and range of transitions. This is the stage that tests adolescents’ ability to cope with new life requirements and opportunities. It is therefore considered an important part of the life course as it shapes a person and subsequently influences all succeeding life phases (Hurrelmann & Quenzel, 2018).

Suicidal Ideation

Suicidal Ideation (SI) or otherwise known as suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, desires and plans for death or suicide. Harmer et al. (2022) highlight that SI presents in a waxing and waning manner. Therefore, it is vital to treat SI as heterogeneous in nature as it varies in intensity, duration and character depending on each individual (Harmer et al., 2022). According to Headspace (2019) “30% of young people between the ages of 12 and 20 have experienced suicidal thoughts.” What is more concerning are the statistics published by the Substance Abuse and Mental Health Services Administration (SAMHSA; 2020) stating that suicide is the second leading cause of death for adolescents and young adults between the ages of 15 to 24 years. It is therefore paramount that SI is identified early, as it has been shown to be the most significant predictor of suicide attempt and completion (Hu et al., 2022).

Evidence of Symptoms 

Social connectedness with family, peers and school plays an important role in preventing the risk of SI (Gunn, 2020). If an adolescent lacks social interaction particularly with peers, this may result in them feeling more socially isolated and suffer subsequent low self-esteem which are contributing triggers for SI. Moreover, the literature by Dickerson et al. (2021) highlight social status within school as a contributing factor to SI. For instance, adolescents that perceive themselves as a lower social status than their peers are often more at risk of SI. Girls in particular are at higher risk as there is more pressure to appear and act a certain way amongst peers, resulting in more distorted self-perceptions. Recent literature has shown that social exclusion and emotion dysregulation relating to anxiety and depression amongst adolescents are important predictive precursors of SI (Morese & Longobardi, 2020).

Literature by Burke et al. (2015) highlight the increase in cognitive vulnerabilities associated with the transition from early to mid-adolescence, as many adolescents experience a higher risk of the onset and growth of SI and suicidal behaviours. Wenzel and Beck (2008) theorised that individuals who tend to display negative cognitive thought processes and maladaptive information processing biases will more likely be triggered by stressful life events, thus eventuating in SI (Burke et al., 2015). As a result of these cognitive vulnerabilities, adolescents may display low mood or have low self-esteem and view their world from a negative perspective which may result in SI.

Adolescents experiencing SI may either display internalising or externalising behaviours. Some may become disengaged in school and show a decrease in academic performance or spend less time with their peers. School work such as poetry, essay writing or artwork may also indicate thoughts of SI made by an adolescent. In contrast, other adolescents may use drugs or alcohol, get in trouble with the police or attempt to run away (Raising Children Network, 2021c). What is important for schools, peers and families is to be made aware of these behaviours in order to help identify SI early and prevent subsequent suicidal attempts.

Self-report scales such as the suicide probability scale (SPS) developed by Cull and Gill (1982), the reasons for living inventory for young adults (RFL-YA-II) developed by Gutierrez et al., (2002) and the suicidal ideation questionnaire (SIQ) by Reynolds et al., (1999) can be utilised to predict suicidal ideation and behaviour in adolescents aged from 13 to 18. These instruments assess the risk of suicide as well as evaluate beliefs and expectations of living as well as suicide attempts. They can be administered in a cost-effective way and give clinicians a quick and accurate measure of suicide risk in adolescents (Baek et al., 2021). As part of the formal assessment, assessing the presence of some or all suicidal thoughts in a patient’s history will help to give a clearer indication as to their risk of acting on suicidal thoughts (First, 2008). It is also important to consider that the use of a structured interview in addition to a self-report scale will help to yield a more accurate and valid diagnosis of SI. This is particularly relevant for adolescents who display internalising problems or observable behaviours.

Impact on the Individual and Interactions

Particular groups such as the LGBTQ+ community, ethnic minority or those that come from a low socioeconomic background are more prone to suffer from SI. According to SAMHSA (2020), lesbian, transgender, gay and bisexual adolescents are four times more likely to report SI. These statistics demonstrate how this group of adolescents are affected by experiencing stressors in school by peers or in the community such as violence, bullying and discrimination relating to their identity. In addition, risk factors such as academic difficulties, low self-esteem, bullying and mental health issues can also trigger SI. Peers begin to have more of an influence during adolescence and therefore may become the primary source for sharing SI or attempts as opposed to family. However, this becomes problematic when adolescents seek support from their peers who are not appropriately equipped thus creating a bidirectional effect, or may have attempted suicide themselves (Boyd et al., 2021).

The familial microsystem also plays a vital role in influencing SI and suicidal behaviour. Boyd et al. (2021) state that lower levels of parental support and communication are linked to a higher risk of SI. Parents’ beliefs surrounding sex, relationships and life choices can also heavily influence an adolescent’s attitude towards life. This becomes an issue when an adolescent may not conform to their parent’s beliefs, which may affect the relationship and the ability for an adolescent to confide in their parents about life choices. Without parental support adolescents may begin to despair and experience SI.

Suggested Interventions

Schools are the most effective settings and provide the best opportunities to identify children and adolescents at risk of SI. In order to successfully prevent future suicidal behaviour, it is essential that guidance counsellors identify at risk children early by utilising formal suicide risk assessments (SRAs) such as questionnaires and interviews. Literature has demonstrated that SI is an initial stage on a continuum of suicidality and thus a predictor or future suicidal behaviour (Reynolds & Mazza, 1999). In fact, according to SAMHSA (2020) over one third of adolescents who experience SI will go on to attempt suicide. If guidance counsellors are able to identify at-risk students early, this will allow for referrals to external agencies and more effective intervention.

In order for intervention to be effective, a holistic approach needs to be adopted. Instead of solely focusing on students that are displaying signs of SI, at risk students also need to be targeted. Guidance counsellors can use the school curriculum and classroom time to aid in the prevention of SI by providing education to students on recognising the signs and risk factors of suicidal thoughts and behaviours. It is also important that guidance counsellors teach the difference between normal versus abnormal behaviour as well as information on where to seek help (Schiro, 2020). In addition, Guidance Counsellors could run workshops for school staff in recognising at risk students to increase knowledge and confidence in early identification and referral. This approach will enable a more collaborative and effective approach to the early identification and prevention of suicidal behaviour.  These tools can be particularly helpful for adolescents as this is the period in which they spend more time with peers, and will therefore be able to identify warning signs not just for themselves but for others.