Warning signs and behavioural changes
While suicide is, by its nature, a terminal act, one must be vigilant for the tell-tale signs of a lowering of mood or of other at-risk behaviours. Unfortunately, not every incident of suicide can be predicted, as, even with the benefit of hindsight, it appears clear that some young people tragically kill themselves in an impulsive manner which could not have been foreseen, even by their nearest and dearest. However, it makes it all the more important that we pay very close attention to signs of depression or increasing impulsivity which can lead to timely interventions where appropriate.
Depression is a condition which previously had been considered unusual in teenagers and vanishingly rare in pre-teens. We now know that the incidence of depression, while uncommon, is very much a concern in pre-teens, and rising through adolescence. It is more common in girls than boys, and its incidence increases with age, until it reaches adult levels.
Depression is characterised by low mood, increasing irritability, social withdrawal, poor concentration, and is often accompanied by alterations in sleep pattern and appetite. The thinking patterns which are common in depression are self-critical, finding fault with many things, pessimistic regarding the future and discounting anything which may appear to be of value or benefit to the person. Essentially, it is the very opposite of “rose tinted glasses”.
While most cases of depression are mild to moderate, and resolve within a month or two, some cases become more serious. Teenagers with depression create difficulties for themselves by virtue of their irritability, their deteriorating school performance, their social withdrawal and their resultant behavioural difficulties and lack the flexibility to get themselves out of such situations, because of their low mood. Therefore they can become alienated from family, and sometimes from their friends.
For teenagers, who take so many of their values and their points of reference from their peer group, to fall out with friends, particularly when they have already fallen out with their families, causes huge difficulties, thereby perpetuating and indeed deepening the cycle. In such cases, particularly when teenagers become agitated and angry, self-harm is often an accompanying concern.
One can see, for such teenagers, how drugs or alcohol might offer a temporary reprieve. Nonetheless, it remains that most episodes of drink and drug use by teenagers is of an experimental type, at least initially, and then often part of a peer activity. It is certainly not the intention to make excuses for it, but merely to point out that it is common, and it is usually not associated with mental illness.
Many teenagers, especially boys, are quite impulsive by nature. This can often be seen in the context of young people with ADHD (Attention Deficit Hyperactivity Disorder) but is not restricted to this. For such teenagers, who struggle with deferred gratification, the likelihood of an impulsive act of self-harm is greater than for the general teenage population.
While in some ways such acts are more easily excused, and indeed occasionally explained away because of the impulsivity, when one thinks further about it, one realises that the level of impulsivity actually makes it more difficult to plan prevention strategies compared to those whose acts of self-harm are the result of the more protracted planning.