Adolescence

Adolescents as defined by the United Nations are people between the ages of 10 and 19.  There are 1.3 billion adolescents in the world, making up to 16% of the world’s population in the world today (UNICEF, 2022b). Adolescence is the transition period from childhood to adulthood; young people experience significant growth and development in physical, cognitive and psychological ways and it is a time for exploration of identity and learning independence to become an adult (Gerldard et al., 2019). In adolescence, young people may experience high levels of emotional intensity which lead to mood disruption in adolescence (Silvers et al., 2012). In the process of gaining their autonomy, adolescents may engage in risky behaviours or conflict with adults (Arnett, 1999). Most young people can go through adolescence smoothly; however some are struggling and facing certain psychological problems. According to the World Health Organisation (WHO; 2021a) one in seven adolescents experience mental health disorders, of which depression, anxiety and behavioural disorder are leading causes of the illness. It is important to appropriately address mental health concerns in adolescence to give people opportunities to have a fulfilling life as an adult.

Suicidal ideation

Suicidal ideation is defined as thinking about, considering or planning to take our own life or suicide (WHO, 2021e). Suicidal ideation can appear in various forms, from brief thoughts to detailed planning to die (WHO, 2021e). Adolescents are more disposed to experience suicidal thoughts than other groups (Rozanov & Rakhimkulova, 2017). Although not all people who have suicidal ideation conduct suicide attempts, suicidal ideations are considered a risk factor for proceeding to actual suicide (Franklin et al., 2017), given that suicide is the fourth leading cause of death in adolescents in the age group of 15 to19 years (WHO, 2021e). In a recent study of 397,299 adolescents from 90 countries, the prevalence of suicidal ideations was significantly higher in girls than boys, while there was no different by age or sex in suicidal attempts (Campisi et al., 2020).

Depression and other mood disorders are the strongest risk factors for suicidal ideations (Mandelli et al., 2015; Sekhon & Gupta, 2020). Gijzen et al. (2021) suggest that suicidal ideation seems suggestive or symptomatic of depressive disorder symptoms during adolescence. The major symptoms of depression are loneliness, sadness, low self-esteem, self-criticism and self-hatred, of which loneliness is the strongest contributing factor to suicidal ideations (Gijzen et al., 2021). From the perspective of another mood disorder, people with bipolar disorder experience both high and low emotions (depression and mania) and during their lows, people with bipolar are at greatest risk for suicide (Dome et al., 2019). More than half of children and adolescents experience suicidal ideation, and about 25% are at risk of suicidal attempts (Hauser et al., 2013). In addition, medical side effects from antidepressant medications which are commonly used for depression treatment might increase the risk of suicidal thoughts in some patients (Reeves & Ladner, 2010).

Suicidal ideation is also associated with many different life events, such as sexual trauma or other trauma and injury, being exposed or witnessed to violence (Liu & Miller, 2014; Gårdvik et al., 2021). In a short term follow up review Howarth et al. (2020) found that the association between stressful life events and suicidal ideation is stronger in young adults, especially for boys. Research also suggests there is strong link between family risk factors such as negative parent-child relationships, child maltreatment and family with antisocial disorders history and youth suicidal ideations and behaviours (Dardas, 2019). Of these, parental divorce and substance abuse and a family history of suicidal behaviours are more strongly associated with active suicidal ideation and fatal suicide, while low cohesion and adaptability in family, or insecure parent-child attachment are more associated with passive suicidal ideations and nonfatal suicidal symptoms (Wagner et al., 2003).

In addition, with the development of internet, media contamination is an important factor that triggers suicidal ideation in adolescents (Hawton et al., 2012). Peer relations are important in adolescents’ lives, in which peer rejection and having no close friends also creates suicidal ideation among adolescents, both boys and girls (Campisi et al., 2020). While bullying is a significant reason for suicidal ideation among young girls, fighting is for young boys ages 13 to 15 years old (Campisi et al., 2020).

Evidence of Symptoms 

Most people who are experiencing suicidal ideation give warning signs that they are intending to end their life by suicide. Different people experience suicidal ideation in various ways. However, suicide is preventable. Understanding the symptoms and signs of suicidal ideation is the best way to prevent the tragedy from happening (Campisi et al., 2020). The most common warning symptoms and signs of suicidal ideations could include the following areas.  

People who experience suicidal thoughts believe there is no way to solve their problems and the best and the only solution is ending their life. Their minds are preoccupied with death and dying. They may experience memory impairment, unable to concentrate and fulfil  tasks or responsibilities. Physically, they may experience insomnia or hypersomnia, as well as significant changes in their weight (Healthdirect, 2021; Beyond Blue, n.d.).

Psychological symptoms of suicidal ideations could be feelings of hopelessness, sadness, worthless and being trapped in their intense emotional pain. People may experience high levels of mood swings such as being emotionally high one day, and deeply depressed the next day. They may feel paranoid; have increased anxiety and poor hygiene (Healthdirect, 2021; Beyond Blue, n.d.).

Behaviourally speaking, those suffering from suicidal ideation may start talking about death, dying, using sign phases such as “when I am gone” or “I am going to kill myself”. Some may say goodbye to their loved ones or give away their prized or valued processions. People who experience suicidal thoughts may withdraw from social activities or activities that once pleasurable to them. They may increase use or abuse of drugs and/or alcohol and self-harm (Healthdirect, 2021; Beyond Blue, n.d.).

Impact on the Individual and Interactions

The impact of suicidal ideation can be catastrophic for everyone involved. Suicidal ideation sees not only an increased risk in suicidal attempts and deaths by suicide, but may also lead to serious traumatic experiences and other psychological problems, risky sexual behaviours, substance use and delinquency (Uddin et al., 2019). The effect of suicidal ideation can persist long into adulthood and cause serious damage, both physically and mentally. Physically, it could cause severe injury and damage to all organ systems, brain damage or death (Thompson et al., 2012). Mentally, suicidal ideation could cause serious mental health impairment in adolescents and adult life (APA, 2020c).

Suicidal ideation in adolescence is tremendously challenging, and often devastating to people around when the individual completes suicide (Young et al., 2022). Suicide survivors can suffer complicated grieving, extremely guilt, anger, shame and serious depression, and their experience can be worsened by societal stigma around suicide (Young et al., 2022). The negative emotions associated with grief in adolescence might cause an increasing risk for a copycat suicide among children and adolescence suicide survivors (Kim et al., 2020).

Suggested Interventions

Suicide ideation is a major concern for public health (Pistone et al., 2019). Educational intervention programs for preventing suicidal behaviours significantly contribute to reduction of suicidal ideation and suicide attempts in adolescents (Pistone et al., 2019). Youth Aware of Mental health (YAM) is a school-based mental health and suicide prevention program for young people ages 13 to 17 that build students’ knowledge about mental health through student-led interactive discussion and role-play (Mental Health in Mind International (MHiM), 2022). In the program, young people are encouraged to practice their sympathy, build up resilience, develop problem-solving skills and learn from each other. YAM invites young people to reflect on their emotions and discuss their approaches to the difficult challenges in their life, or their mental health concerns. Through the activities, YAM helps grow harmony among young people and promote positive mental health practices. YAM has trained more than 800 instructors and conducts intervention with more than 85,000 adolescents in 16 countries (MHiM, 2022). A recent study of the YAM program of 556 students in Australian secondary schools suggests YAM is a promising program for intervention for schools, especially for increasing help-seeing activities and reducing suicidal ideation and depression in adolescence (McGillivray et al., 2021).