Experts on adolescent behaviour say the apparent susceptibility of Canadian teens to the idea of suicide shows the need to change public discussion about this sensitive topic.
Among the suggestions being put forward are finding new ways to refer to the act, to put it in a more appropriate context and training crisis-intervention teams to be more aware of how young people can respond to a suicide in their midst.
A study published May 21 in the Canadian Medical Association Journal reported that teens who knew of schoolmates who took their own lives were more likely to consider it or attempt it themselves — a phenomenon the authors call "suicide contagion."
Given how vulnerable teens seem to be to the idea of suicide, there is probably a need to change counselling techniques and media coverage of the issue, says Nora Spinks, executive director of the Vanier Institute for the Family.
'We were really surprised how strong the effect was, especially among the younger adolescents.'— Dr. Ian Colman, co-author of study on 'suicide contagion'
"We’ve got a lot of experience with clusters of suicide, and this helps to explain why that happens and begins to change the conversation around prevention and treatment," says Spinks.
The study, which was co-authored by Dr. Ian Colman, Canada Research Chair in mental health epidemiology at the University of Ottawa, and Sonja Swanson from the Harvard School of Public Health in Boston, used data on 22,064 young people aged 12 to 17 from across Canada.
According to 2009 figures from Statistics Canada, the Canadian suicide rate is 11.5 in every 100,000. The rate is lower for people aged 10-14 (1.3 in every 100,000), but rises for the 15-19 cohort (nine in 100,000).
The contagion study found that by age 16 or 17, 24 per cent of teens had a schoolmate die by suicide, and 20 per cent personally knew someone who had taken his or her own life.
"There were a few things that we found really shocking — like just how many Canadian adolescents are reporting that somebody in their school has died of suicide," says Ian Colman.
"We were also really surprised how strong the effect was, especially among the younger adolescents."
The study says that 12-13 year olds who had experienced a suicide in their school were about five times more likely to contemplate suicide themselves.
"And this is after accounting for things like poverty, drug and alcohol use and a history of depression," Colman says.
Suicides in schools and communities tend to happen in clusters, says Amy Cheung, an adolescent psychiatrist and researcher at the Centre for Addiction and Mental Health in Toronto, largely because of copycat acts.
She points out that the fear of a suicide contagion is the reason why the Toronto Transit Commission, for example, doesn’t make an announcement every time an individual jumps in front of a subway train — something that happens once a month, on average.
Cheung says adolescents are especially susceptible to media coverage of suicides, whereby the mere suggestion of the act might compel them to consider it.
A young person who is already at risk of self-harm might also perceive some sort of "social desirability" in taking their own life, she says, offering the hypothetical example of a teen who has been bullied and was feeling hopeless when he learned that a classmate had died by suicide.
"So what's our response when that happens? Generally, people are devastated, even though they never cared for that person before they died," says Cheung.
"Now, everybody is their friend: 'So-and-so was so nice, she was so smart.' The person who died has been glorified, so then the kid who's at risk says, 'Geez, if I kill myself, people will say nice things about me.'"
Many schools now have crisis intervention teams to help kids cope with another student's suicide, Cheung points out.
But she says more has to be done in terms of prevention — for example, by linking schools to medical professionals who can help those who are at risk of suicide find the proper treatment.
"We need to intervene and identify kids that are at risk to prevent more suicides from happening," says Cheung.
"I think the media play a huge role in controlling that and how the message gets across to the kids."
The language of suicide
At the Vanier Institute, Spinks says that part of the solution is changing some of the terminology pertaining to suicide.
For example, by saying someone "committed" suicide, we criminalize the act, she says, and make it the sole responsibility of the person’s immediate family.
On the other hand, by saying someone was "successful" at suicide, we trivialize it, she adds.
Spinks prefers the expression "completing" suicide, because it looks at the problem holistically, where death is but the last stage of a longer process of mental stress or illness.
"If we talk about [someone] having 'completed' suicide, that means we’ve missed the signs and the cues and the opportunities as a community and a society to support that individual and their family to avoid or prevent suicide," says Spinks.
Colman says that for all the sensitivity around the handling of suicide, it is imperative to keep talking about it.
"We want to create a culture, whether that's in our schools, at home, our communities, where people feel comfortable talking about mental health, and especially children feel comfortable seeking help, coming forward, if they're struggling with their mental health. We should talk about suicide, but we should be careful."