Female Teenagers Who Have Attempted Suicide

Introduction

Existing research evidence (e.g. Daniel & Goldston 2009) indicate that teenager suicidal behaviour is developmentally mediated. Consequently, interventions for such suicidal behaviours have existed in varied forms, most of them being developmentally tailored (Daniel & Goldstone). In this paper, we review existing evidence of the interventions that can be applied to a female teenager who has attempted suicide.

The Intervention

Faced by such a scenario, one appropriate intervention would be a standard emergency room care followed by a motivational-educational emergency room (ED) intervention. In doing so, the child would be admitted in the emergency department, attended to by a physician, and then assigned to a rapid-response outpatient team to undertake post-ED care. According to Rotheram-Borus et al (2000), the outpatient care team would educate the teenager, together with her family on various aspects of suicidal behaviour such as the benefits of treatment, dangers of suicidal behaviour; and undertake the family through a therapy session.

Post-ED care intervention has been identified to have the capability of providing a window of opportunity to expose suicidal youths to several other useful interventions but worryingly, existing research by Ibrahim et al (2017) indicate that sometimes there is a low uptake of such interventions after ED discharge.

Nonetheless, existing research evidence has shown the effectiveness of the post-ED intervention in reducing suicidal behaviour among teenagers, including the study by Rotheram-Borus et al (2000) which found that teenagers who attended post-ED therapy experienced a decrease in suicidal intentions, although no significant changes in such idealization were observed after an 18-month follow-up.

Social Determinants of Health

One social determinant of health in relation to the case is age. According to Ibrahim et al (2017), adolescence age is associated with various social factors bordering community, family, and personal issues that may affect the health of the youth. Moreover, adolescence age is a determinant of health because there is a strong correspondence between health and health behaviours from adolescence into adulthood (Ibrahim et al, 2017). Against this backdrop, Centre for Disease Control and Prevention ( CDC, 2008b) point out that whereas suicidal behaviours have different burdens on individuals as they grow through their lifespan, suicidal behaviour in adolescence is a major public health issue because the adolescence developmental stage has been associated by numerous suicidal attempts. Besides, Goldstein et al (2008) observe that adolescence suicidal behaviour as one of the primary causes of hospitalization and emergency room visits as well as one of the predictors of future suicidal behaviour and deaths. In addition, CDC (2008a) indicate that whereas deaths by suicide at adolescence are at a relatively lower rate compared to those experience in adulthood, suicide is considered among the most common causes of death among adolescence age group.

From age and developmental perspective, adolescents differ from adults and younger youths in ways that may increase their exposure to the risk of suicidal ideation. For example, according to Reyna & Farley (2006), adolescents may have different time perspectives and more impulsive than adults hence may have their focus on more short-term consequences of their actions than adults when making decisions. Furthermore, there is a contextual differential between suicidal ideation in adolescents and suicidal ideation in adults. For example, adolescents may develop suicidal behaviour in the context of various forms of family conflicts, academics, or peer relationships (Ibrahim et al, 2017). This indicates the developmental nature of suicidal thoughts among adolescents, calling for developmentally oriented interventions.

Having understood the context of teenage suicidal behaviour, it is possible to extrapolate that developmental nuances can be incorporated as part of the strategies and interventions for suicidal behaviour among teenagers. This assumption corroborates with the assertions of Kwok & Shek (2010) that there is a need to developmentally tailor interventions aimed at addressing mental health problems associated with suicidal behaviours among the youth. Worryingly though, Weisz & Hawley (2002) observe that rather than developmentally tailoring the interventions for youth, it is common to find that youths are often subjected to interventions tailored for adults.

When individuals are at the adolescence stage of life, the developmental factors related to brain and puberty development results into new capacities and behaviours that contribute to transitions in peer, educational and familial domains as well as transitions in health behaviours (Nguyeng et al, 2013). According to Reyna & Farley ( 2006), these transitions lead to childhood changes towards health and well-being and are also affected by social and economic factors within communities and countries, leading to inequalities.

Kwok & Shek (2010) argues that the most prominent determinants of health inequalities among adolescents are structural factors such as income inequalities, national wealth, as well as access to education. Moreover, Reyna & Farley (2006) argue that better schools, supportive and safe families, as well as supportive peers are important ingredients to a youth’s ability to achieve their full potential, and subsequently, health and well-being, as they transit into adulthood.

Against this backdrop, we can point out that in order to address age as a determinant of health among the youth, it is important to consider improving their daily lives with their peers and families by addressing protective and risk factors within their social environment while focusing on protective factors across all factors of health (Kwok & Shek, 2010). Thus, perhaps structural changes are the most effective interventions because they aim at improving access to education and job opportunities to reduce the risk of suicidal ideation.

Gender impacts on health in different ways. According to Groholt et al (1999), the disproportionate access to resources such as education, healthcare, and food around the world has been found to be sources of disadvantage to the female gender. In a social context, men and women are often stereotyped to have opposite and fixed characteristics i.e. men often perceived to be active while women perceived as passive and emotional (Gili-Planas, 2001). Nonetheless, both female and male behavioural and occupational roles, guided by social norms can contribute to serious health hazards especially through different exposure to illness. This defines gender as a social determinant of health.

An important area of research is the understanding of gender differential in suicidal behaviours and ideation. In a study conducted by Befrienders Worldwide (2016), it was found that whereas males are more likely to die of suicide, females are more likely to conduct suicidal attempts. Moreover, Groholt et al (1999) found that female teenagers were more likely to have suicidal thoughts than male teenagers. Other studies focusing on the timing of suicidal thoughts (e.g. Lewinsohn et al 2001) have found that the risk of suicidal ideation among boys and girls peaked at adolescence.

During the teenage stage, females and males undergo different developmental stages with different life coping skills at different times (Berk, 2010). Besides, according to Perry & Pauletti (2011), this stage of life is characterised by changes in the actual levels of turbulence believed to occur at this stage of concepts and emotions, and one phenomenon that distinguishes males from females is how to deal with life problems. Hence, while teenagers might have similar goals of solving the problems that they encounter at this developmental stage of life, they attempt to find such solutions in different manners. A possible implication of this insight is that when implementing a post-ED intervention for the girl, it is important to consider the male-female differentials in approaching problems because the way the girl might approach her problems is not the same way a boy might approach the same problem.

Nonetheless, existing statistics indicate that there is a gender differential among women and men, 62% of women conducting successful having attempted suicide before, while 62% of men dying from suicide having not attempted suicide before (Schimelpfening, 2019). Schimelpfening (2019) goes ahead to discuss the fallacies associated with the differential suicidal attempts between males and females by asserting that the differences in completed and attempted suicides have erroneously deceived many people to believe that females do attempt suicide to get attention, yet this is not true and instead, it is apparent that failed suicide attempts are the greatest risk factors to suicide in the future, hence all suicide attempts among males and females should be taken seriously. This ties back to the case study because having attempted to commit suicide; the girl is at a greater risk to reattempt suicide – thus the need to develop an effective intervention to address the behaviour.

Continue your exploration of Factors Influencing the Implementation of Evidence with our related content.

References

• Befrienders Worldwide (2016) [webpage on the Internet]. Suicide statistics. Available from:
• Centers for Disease Control and Prevention, CDC (2008b) Youth risk behavior surveillance—
• United States, 2007. Morbidity and Mortality Weekly Report, 57(SS–4).
• Daniel, S., & Goldston B., (2009) Interventions for Suicidal Youth: A Review of the Literature
• Gili-Planas, M., Roca-Bennasar, M., Ferrer-Perez, V., Bernardo-Arroyo, M. (2001) Suicidal
• ideation, psychiatric disorder, and medical illness in a community epidemiological study. Suicide Life Threat Behav, 31(2):207–213.
• Goldstein, B., Frosch, E., Davarya, S., Leaf, J., (2007) Factors associated with a six-month return
• to emergency services among child and adolescent psychiatric patients. Psychiatr, 58(11):1489-92.
• to emergency services among child and adolescent psychiatric patients. Psychiatr, 58(11):1489-92. Grøholt, B., Ekeberg, Ø., Wichstrøm, L., Haldorsen, T. (1999) Sex differences in adolescent
• suicides in Norway, 1990–1992. Suicide Life Threat Behav, 29(4):295–308.
• Kwok, S., & Shek D. (2010). Hopelessness, parent-adolescent communication, and suicidal
• ideation among Chinese adolescents in Hong Kong. Suicide Life Threat Behaviour, 40(3):224–233.
• Lewinsohn, M., Rohde. P., Seeley, J., Baldwin, L. (2001) Gender differences in suicide attempts
• from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry, 40(4):427–434.
• Nguyen, T., Dedding, C., Pham, T., Wright, P., & Bunders J. (2013). Depression, anxiety, and
• suicidal ideation among Vietnamese secondary school students and proposed solutions: a cross-sectional study. BMC Public Health;13(1):1.
• Perry , G., & Pauletti, E. (2011). Gender and adolescent development. J Res Adolesc, 21(1),
• Rotheram-Boru, M., Piacentini, J., Cantwell C., Belin, T., Song, J. (2000). The 18-month impact
• of an emergency room intervention for adolescent female suicide attempters. Journal of Consulting and Clinical Psychology. 2000;68:1081–1093.
• Schimelpfening, N. (2019, March. 8). Differences in suicide among men and women, VeryWellMind. Retrieved from
• Weisz, J., & Hawley, K. (2002) Developmental factors in the treatment of adolescents. J Consult Clin Psychol. 2002 Feb; 70(1):21-43.