Challenging Dogma


...Using social sciences to improve the practice of public health

Wednesday, April 25, 2007

Public Health’s Remissness on Preventable Public Health Problem, Suicide – SatByul Kim

At the critical and sensitive period of individual identity formation and development, many teenagers in United States are especially vulnerable to the cues given by their environments and outside information such as media. According to the US Centers for Disease Control and Prevention, “suicide is the third leading cause of death among young adults, second among college students” (5), with only the rates of unintentional injury and homicide surpassing the rate of suicide. Public health practitioners can work to prevent teenage suicide. Although the causes of suicide vary among individuals, the predisposition of the person in combination with the social expectations and other risk factors contribute to the suicidal behaviors in teenagers. While the stresses from the teenagers’ community, school, and family perpetuate the suicidal behavior, the risk of suicide increases in individuals with mental illnesses and/or substance abuse (10). Media also plays an important role in publicizing suicidal behaviors to the public. With these numerous individual and environmental risk factors impacting the lives of the teenagers today, public health practitioners should pay closer attention to the confused and overwhelmed young people’s risk factors and search for the best prevention method to protect the youth. However, today’s public health intervention programs are focused on either individual and social factors.

Impacts of Mental Illnesses
Aside from the environmental factors that can increase the risk of suicide, researchers show that some individuals are innately more susceptible to commit suicide than others (11). Individual predisposition toward depressive illness, character disorder, aggressive-impulsive personality, and/or perfectionistic-rigid personality increases the predictability of suicidal behavior (12). Especially youth with major depression or other mood disorders are likely to develop suicidal behaviors (13). According to Surgeon General Satcher, 90 percent of all suicides are related to mental health and substance abuse problems among teenagers in United State (14). For the best results for the preventions programs, studies found that the program needs to focus “on identification and treatment of mental illness and substance abuse, coping with stress, and controlling aggressive behaviors” (6). This highlights the significance of mental illness and substance abuse in preventing suicide and shows that the problematic behavior, suicide, is deeply rooted in mental health. It is also noted that impulsive characters of a person have high risks for engaging in harmful activity. Young people tend to act more impulsively than adults; thus, teenagers carry greater risk for uncontrolled self-destroying actions and addiction to harmful substances.

Impacts of substance abuse
When this mental illness is accompanied by the teenager’s problem of substance abuse, the chance of suicide increases: “Younger persons who kill themselves often have a substance abuse disorder in addition to being depressed” (2). Since younger people have less skills and resources to cope with their strong feelings and overwhelming stresses, these individuals may turn their attention to substance use or simply hide their feelings in depression. The problem with these “solutions” is that they are temporary relief and lead to a need for a greater solution – suicide. Young people with substance use and abuse have greater risk factors for suicide. Dependency on substance increases the probability of having other risk factors: "In addition to being depressed, they are also likely to have social and financial problems" (2).

Media Influences on Teenager Suicide
Among many outwardly forces influencing a typical teenager’s behavior, the media has one the greatest powers in everyday activities of a young person. An average teenager is largely exposed to mass media daily – including TV, video games, advertisements, etc. – that can be detrimental to the mental health of a vulnerable teenager. Many media programs show violence and life-threatening behaviors that may suggest ideas of self-abusive behaviors or suicide.

The influence media has on teenager suicidal rates can be explained by social contagion, which is like a contagious disease. When an individual directly or indirectly comes in contact with the idea of suicide, it is more likely for the individual to act out the behavior (2). It has been found in one psychological study that “known suicides, as well as fatal auto accidents and private airplane crashes (which sometimes disguise suicides), increase after well-publicized suicides” (1). Also called “copy cat suicide,” this phenomenon has been shown in many occasions involving a suicide of a famous celebrity or other publicly announced information of suicide occurrence. As a form of norm formation, this suggestibility of behavior particularly attracts the teenagers who have not fully developed their sense of identity (1). For the teenagers, aligning themselves with the norm is essential – to be a part of the group. Teenagers tend to show expected behavior of their peer groups, and they seek to find their sense of being by modeling the behaviors of others.

To effectively reduce the suicide rates among the teenagers, the public health practitioner should censor the information transferred by the media, using Agenda Setting Theory or the Framing Theories. Agenda Setting Theory, explaining the relationship between the coverage of a story in media and the importance of the story, can be used to reduce the attention the media focuses on the suicide related stories (4). If the public health practitioners can limit the coverage of suicidal behaviors, then suicide will not be a popularized issue for the teenagers as well as the adults. The three Framing theories – gatekeeping, priming and framing – also work in similar way to Agenda Setting Theory; controlling the output information to the public will change the perspective of groups of people, thereby preventing the social contagion of suicidal behaviors (4). Less exposure to the suicidal contents will reduce the teenagers’ likelihood of ending their lives by choice.

Problems with Existing Suicide Prevention Programs
Much of the existing suicide prevention program is based on Social Norm Theory which influences the perceptions of youth about the problematic behavior. When young people are placed in a social group that perceives an incorrect belief to be the standard, "the social urge to conform will negatively affect overall behavior of group members" (9). Using this knowledge of social psychology, many of the previous suicide prevention programs are developed to educate and train the group about healthy behavior by screening, hotlines, peer support, and gatekeeping. Screening and gatekeeping are prevention programs in which a group selects few representatives to train and to educate about suicide and its prevention methods. Hotlines and peer supports are programs that are mostly one-on-one and help the person at individual level. These methods of prevention are well implemented and programmed, but there generally has been few focuses on using media and family as prevention method.

Although some attention has been shown by public health towards youth suicide prevention, in relation to the importance and immediacy of the matter there has been insufficient effort for modification for better methods of prevention. The existing prevention programs offer help for limited aspects of suicide risk factors; each program focuses on either environmental or personal level but rarely both. According to Social Cognitive Theory, an individual's behavior is affected by both personal/cognitive aspects and environmental aspects (8). Behavior, environment, and cognition work reciprocally, meaning that the programs should consider the combined effects of environment and cognition when designing a program for prevention of a particular behavior.

Discussion
To prevent the risk factors - mental illness and substance abuse - for suicide in young people, each individual's family has a crucial responsibility. In one teenage substance abuse study, it has been found that drug use among teenagers strongly declined when more parents and guardians talked about the risks of drug use (7). Parental involvement in prevention is more than necessary in the healthy development of a young person. Although mental illness and substance abuse are individual risk factors, a family based prevention program for the youth will bring together individual and social factors to effectively reduce teenage suicide.

Community and peers are important sources of influence for a young person since he or she is directly exposed to them on a daily basis, but the subtle yet strong messages that a person indirectly contacts in large amount such as media and family cannot be ignored. On top of what the existing programs offer, the programs should consider having more emphasis on the media works as well as family support. The programs should work to bring families together to reduce the risk factors such as depression and substance abuse. The better the communication between parents and teenager, better it will be for a teenager to cope with stress when he or she meets a crisis. Also, family support for the prevention of suicide will form healthy mental state in teenagers, together with the media framing its contents and coverage. Making individual and social factors work together to prevent suicidal behaviors in teenagers, this combined approach will create a stronger suicide intervention program.

Conclusion
Today, as much as the family ties that are easily broken and as much as suicidal information is prevalent in the communities, many teenagers choose to end their lives in hopelessness. Having to cope with many changes in their lives, many adolescents today strive to find the solutions for their struggles, sometimes leading to suicide. Suicidal behavior is a form of desperate cry for help, a silent struggle to live. The public health practitioners need to readily help those in this struggle and prevent such action from taking place by attending to the needs of the young people. More prevention programs aimed at teenagers should be enforced and the public health should continue to work with greater effort to identify and provide the lost teenagers with what they want - a healthy life.

REFERENCE
1. Myers, David G. Social Psychology. 2005. New York: McGraw Hill. (pp. 174-175, 213)
2. National Institute of Mental Health: Frequently Asked Questions about Suicide. http://www.nimh.nih.gov/SuicidePrevention/suicidefaq.cfm (4/5/07)
3. CDC Youth Suicide Prevention Program. http://aepo-xdv-www.epo.cdc.gov/wonder/prevguid/p0000024/P0000024.asp#Figure_1 (4/5/07)
4. Agenda-setting theory - Wikipedia. http://en.wikipedia.org/wiki/Agenda-setting_theory (4/5/07)
5. Coroner: High level of legal drug in body Stanford student found dead. http://209.85.165.104/search?q=cache:4BewwW7kwpoJ:www.topix.net/content/kri/0058887348260086628832144593341737007428%3Fthreadid%3DKASMRBH8RUQ3NDFJ+US+Centers+for+Disease+Control+and+Prevention,+%E2%80%9Csuicide+is+the+third+leading+cause+of+death+among+young+adults,+second+among+college+students%E2%80%9D&hl=en&ct=clnk&cd=1&gl=us (4/5/07)
6. Mental Health Disorders, Teen Suicide. http://www.healthsystem.virginia.edu/uvahealth/adult_mentalhealth/teensuic.cfm (4/5/07)
7. ASK - Adolescent Substance Abuse Knowledge Base - Teenage Drug Abuse. http://www.adolescent-substance-abuse.com/ (4/5/07)
8. Santrock, John W. Life-Span Development. 2004. New York: McGraw Hill. (p. 52)
9. Best Practices: Social Norms. http://wch.uhs.wisc.edu/13-Eval/Tools/Resources/Social%20Norms.pdf (4/5/07)
10. National Strategy for Suicide Prevention. http://mentalhealth.samhsa.gov/suicideprevention/suicidefacts.asp (4/5/07)
11. Emotional Well-Being. http://www.sportsdoctor.com/chg/emotional.html (4/5/07)
12. Suicide and mental illness explained. http://www.betterhealthchannel.com.au/bhcv2/bhcarticles.nsf/pages/Suicide_and_mental_illness_explained (4/5/07)
13. Teen Suicide. http://www.safeyouth.org/scripts/teens/suicide.asp (4/5/07)
14. More Efforts Need to Curb Suicide Rate Among Teenagers. http://pn.psychiatryonline.org/cgi/content/full/36/20/2 (4/5/07)

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