Motivation and emotion/Book/2016/Youth suicide motivation

Overview
This book chapter explores what motivates youth to commit suicide. From reading the chapter, you should be able to grasp knowledge on suicide, including a definition, current statistics, risk factors, psychological tests and further. From there, the chapter delves into what motivates youth (a young person) to commit suicide, addressing certain factors and groups at risk. The last section will focus on psychological theories of suicide.

Definition
Suicide is the term used when a person dies as a result of a deliberate act to cause his or her own death (LIFE, 2007). For a death to be considered a suicide three criteria must be met (Responseability, 2015):
 * 1) The death must be due to unnatural causes (e.g. poisoning) rather than illness
 * 2) The actions which result in death must be self-inflicted; and
 * 3) The person who injures himself or herself must have had the intention to die.

Prevalence
The World Health Organization (WHO) estimates that approximately 800,000 people around the world die due to suicide every year (2016). The WHO reports that suicide is the second leading cause of death among 15 to 29 year olds. Young people who attempt suicide have significantly higher rates of mental illness compared with the general population. Those who have attempted suicide have an increased risk of making further attempts and thus increased chance of death from suicide (Headspace, 2012).

In Australia, suicide accounts for 35.9% of all deaths amongst young men aged 15-19, 25% of female deaths aged 10-14 years, and 27.1% of female deaths aged 15-19 years (ABS, 2014). According to the Australian Bureau of Statistics (ABS, 2014), the leading causes of death for those aged 15-44 years is suicide, accidental poisonings (including drug overdoses) and land transport accidents. In 2014, 2,864 deaths by suicide were registered in Australia; this included 2,160 males and 704 females.



Risk factors
Young people with elevated risk factors are more likely to engage in suicidal behaviour. In the youth population, groups identified as high risk include people with a mental illness, people with substance use problems, people in contact with the justice system, people who attempt suicide, youth identifying as homosexual or transgender, and those bereaved by suicide. Adolescents with a history of non-suicidal self-injury and major depression are also considered an at-risk population as well as when domestic violence is apparent in a home (Wilkinson, et al., 2011). Aboriginal and Torres Strait Islander persons, particularly males, are a high risk population for completing suicide as well asp people with a previous history of attempted suicide (ABS, 2014).

Protective factors
Youth with elevated protective factors – also known as coping resources/strategies – are less likely to attempt suicide (WHO, 2000). Protective factors reduce the likelihood of suicidal behaviour and work to improve a person’s ability to cope with difficult circumstances. Protective factors can occur at an individual, social and contextual level (LIFE, 2007).

Individual protective factors include mental and physical health, self-esteem and the ability of the individual to deal with difficult circumstances, manage emotions, or cope with stress. The social level includes relationships and involvement with others such as family, friends, workmates, the wider community and the person’s sense of belonging. The contextual level includes the social, political, environmental, cultural and economic factors that contribute to available options and quality of life (LIFE, 2007).

Suicide and non-suicidal self-injury (NSSI)
The relationship between suicide and self-harm is complex (see Table 1). Often the motivation for self-harming behaviour is to cope with, or to gain a sense of relief from, painful emotions and distressing personal experiences, not to result in death (Mindframe, 2016). Any action that is deliberately intended to cause death is best regarded as a suicide attempt (Mindframe, 2016). Self-harm and suicide are distinct and separate acts. Self injury and suicide attempts can be performed by the same individual – and in some cases the intent may not be completely clear. People who self-injure have a 50- to 100-fold higher likelihood of dying by suicide in the 12-month period after an episode than people who do not self-harm (NICE, 2013). There is also the risk of accidental death.

Table 1. Differentiating between suicidal and self-injurious acts (QLD Dept. of Communities, 2008).

Case Study Example

Sarah is a 15 year old girl who has just recently gone through the divorce of her parents. She has been feeling extremely sad lately, cannot concentrate on school and does not want to leave her house. Her mother took her to see a doctor, who believes she has depression and referred her to see a psychologist. Sarah does not want to feel down anymore and feels like she is a burden to her family and everyone around her, making statements such as "I don't want to be here" and "it would be easier if I wasn't here anymore". Sarah has constant thought's about how being alive is no longer "easy". Sarah feels as though she has no control over her life, and thinks its easier for her to not be alive anymore.

Referring to the above case study, can you list behaviours of suicidality that Sarah is experiencing?

Kessler Psychological Distress Scale (K10)
The K10 is a self report measure used to identify need for treatment and is widely recommended as a simple measure of psychological distress and as a measure of outcomes following treatment for common mental health disorders (Andrews & Slade, 2001).

The Modified Scale for Suicidal Ideation (MSSI)
The Modified Scale for Suicide Ideation provides more comprehensive suicide-specific instruments. The purpose of this scale is to assess the presence or absence of suicide ideation and the degree of severity of suicidal ideas (Miller, Norman, Bishop, Dow, 2004).

Beck Scale for Suicide Ideation
The scale of suicidal ideation consists of 19 items which can be used to evaluate a patient's suicidal intentions and is designed to quantify and assess suicidal intention. It can also be used to monitor a patient's response to interventions over time (Beck, Kovacs & Weissman, 1979).

What is motivation?
The word 'Motivation' comes from the Latin term movere which means "to move" and forces acting either on or within a person to initiate behaviour (Bong, Conradi, McKenna & Jones, 2015; Petri, 1991). Studies of motivation help to explain observed changes in behaviour that occur in an individual (Petri, 1991). Motivation is not typically measured directly, but through behavioural changes in reaction to internal or external stimuli (Petri, 1991).

What motivates youth suicide?
What motivates an adolescent to commit suicide is often complex and can be difficult to understand. Below is a list of reasons as to why youth feel inclined and motivated to commit the act of suicide. Individuals who are experiencing the below reasons are generally experiencing a combination of these, resulting in them feeling overwhelmed and unable to cope (Headspace, 2012).

Table 2. Reasons as to why young person's and adolescents commit suicide from WHO (2000):

{| cellpadding="10" cellspacing="5" style="float: right; width: 40%; background-color: LightSkyBlue; margin-left: auto; margin-right: auto"
 * style="width: 40%; background-color: yellow; border: 1px solid #777777; vertical-align: top; -moz-border-radius-topleft: 8px; -moz-border-radius-bottomleft: 8px; -moz-border-radius-topright: 8px; -moz-border-radius-bottomright: 8px; height: 10px;" |

If you know someone who is experiencing suicidal symptoms, please let them know you support them. Guide the person to seek help, and where possible help them in any way you can.

Common motivators
Below is a list of the most common factors, which include risk factors, as to why youth commit suicide (Headspace, 2012):
 * Having a mental illness. Depression, anxiety, Bipolar, psychotic disorders, and substance abuse increase the risk of suicide.
 * Difficulty coping with distressing life events. For example: parental divorce, relationship break-ups, bullying, and difficulties at school. If a few issues are being dealt with at the same time, it can be very overwhelming for the individual to cope.
 * Not having the skills to manage feeling overwhelmed and stressed.
 * Feeling like there is no where to go for help and that the individual does not have access to support.
 * Feeling isolated, alone or not belonging. This is a large contributor as youth are experiencing different social groups and feeling like they do not belong can be extremely harmful to the individual.

Social isolation
Feeling socially isolated and alone is a major motivational factor that accounts toward youth suicide. Van Orden et al (2010) noted in their research on the interpersonal theory of suicide that a suicide can be decreased if one has a strong social structure. Therefore, if one has a low or weak sense of social structure, whereby they do not experience social interactions and do not have a social group, a link exists between this isolation and increasing the risk of suicide. Especially in adolescence, a time where an individual is finding out about themselves and experiencing different situations, it is important to interact socially.

Bullying


Bullying is a major cause for concern and a significant issue; findings between 20% and 56% of young people are involved in bullying (Hertz, Donato & Wright, 2013). For a young person who is involved in bullying – as a victim, perpetrator or both – such involvement has been correlated with poor mental health and physical health (Hertz, Donato & Wright, 2013). Young people who are the victim to bullying are more like to be anxious, depressed, have lower academic achievement, report feelings of not belonging, greater loneliness and have poor emotional and social skills, including relationships with friends and classmates (Hertz, Donato & Wright, 2013). Suicide ideation and attempts were more prevalent among victims who were bullied at schools (Espelage & Holt, 2013). Further to this, Rivers and Noret (2013) found that students who observed bullying, but did not partake, were more likely to develop greater helplessness and report symptoms of feeling inferior.

Psychodynamic theories
Psychodynamic theories propose that motivation to commit suicide is caused by unconscious drives, intense affective states, desire for escape from psychological pain, existential drives for meaning, and disturbed attachment (Van Orden, et al., 2010).

The psychodynamic perspective asserts that the cause of suicide may be due to the individual being in a depressive state, experiencing feelings of sadness, and may also have a narcissistic view on the act of suicide (Kaslow, et al. 1998). The psychodynamic theory is that suicide is an aggressive act and to understand suicide, one must address this aggression within the human mind (Kaslow, et al. 1998).

Freud’s research into psychoanalysis postulated that aggression is part of the individual’s self-preservative instinct (Kaslow, et al. 1998). He further viewed suicide as an aggressive and murderous act in which the individual wishes towards another person back onto the self; and this aggression was mostly derived and directed towards others. For a person to attempt the act of suicide they must have been ‘overwhelmed by the object’, for example, the mental representation the person has of other people in the world (Freud, 1915). Object relations theory focuses on this aspect Freud explained suicide as an act to destroy bad internal objects or unwanted aspects of the self (Kaslow, et al. 1998). A study by Chance et al, (1996) found that higher levels of suicidal intent were associated with less differentiated self- and object representations and a lower level of emotional investment in relationships. The individual who wants to attempt suicide is said to want to gain relief from traumatic experiences, especially unresolved trauma from childhood experiences, as explained by Freud. Freud further suggested a life instinct and a death instinct. The death instinct, explained by Freud (1938), has a suicidal aim, “its final aim is to lead what is living into an inorganic state”.

Another psychodynamic perspective on suicide is of Fenichel (1945) who viewed suicide in individuals as an outcome of the relations between the ego and a harsh superego. These relations caused guilt arising from the superego in which the individual sought escape. Laufer and Laufer (1989) saw suicide as separating from the object, or as an attempt to control distance from the object; whereby the act of suicide is seen as abandoning, or an attack, on the object.

The interpersonal-psychological theory of suicidal behaviour
The interpersonal-psychological theory of suicidal behaviour proposes that an individual will not die by suicide unless he/she has both the desire to die by suicide and the ability to do so (Joiner, 2005). The theory asserts that when people hold two specific psychological states in their minds at the same time for a lengthened amount of time, they can develop the desire for death (Joiner, et al. 2009). The two psychological states are perceived burdensomeness and a low sense of belongingness or social alienation.



Perceived burdensomeness
This is the view when an individual believes their existence is a burden to family, friends or society. This view produces the idea that “everyone would be better off if I wasn’t alive” or “it would be so much easier for everyone if I wasn’t here”. A study by DeCatanzaro (1995) found a correlation between perceived burdensomeness toward family and suicidal ideation among community participants and high-suicide-risk groups.

Low belonging/social alienation
When an individual experiences a low sense of belonging, they feel alienated from others, unimportant, not part of the group (family, friends) and do not feel valued (Joiner, et al. 2009). It has been found that suicide rates go down during times of celebration and during times of hardship or tragedy (when people pull together to commiserate) (Joiner, Hollar, & Van Orden, 2006)

The theory also proposes a third element that must be present; this is the acquired ability for lethal self-injury. While feelings of burdensomeness and low belongingness may instill a desire for suicide, without the third element, they are not sufficient enough to ensure that the desire will lead to an actual suicide attempt (Joiner, et al. 2009). The individual will not act on the desire for death unless they have developed the capability to do so. This capability develops through exposure and habituation through painful or fearsome experiences (Joiner, et al. 2009).

Psychache
The term “psychache” is used to describe unbearable psychological pain leading to suicide – hurt, anguish, soreness, and aching. Risk factors operate by increasing psychache which predisposes one to suicidality (Shneidman, 1993). Shneidman theorised that unresolved psychache results in suicidal behaviour and stems from distorted psychological needs, whereby every suicidal act reflects an unfulfilled psychological need (Shneidman, 1993).

''“Pain is the core of suicide. Suicide is an exclusively human response to extreme psychological pain.”'' - Edwin Shneidman, 1993.

As Shneidman (1993) pointed out, suicide is understood as the individual does not want to deal with the consciousness and unendurable pain they are suffering, and by therefore stopping this pain, they do not have to deal with life's painful and pressing problems. He further maintained that suicide is usually always triggered by the failure to fulfill some need, and the intensity of that need determines the degree of worry, which leads to suicide.

Escape theory
According to the escape theory of suicide, Baechler (1979), the first suicidologist to propose the theory, stated that escaping a situation that feels unbearable is the motivating factor behind suicide. Escape also refers to escaping from the self (Neustadter, 2010). According to the theory, people use the method of ‘cognitive deconstruction’ to escape from their negative affect. This method creates a distorted view of emotion, and person’s under this process are incapable of thinking openly about their lives as well as finding solutions to their problems (Neustadter, 2010). Escape theory does not address why the individual initially feels compelled to escape life. Moreover, the question arises as to why the individual chooses death as the means to escape versus other means of escape such as running away to a tropical destination or quitting one’s job (Neustadter, 2010).

Quiz


{Suicide is the second leading cause of death amongst which age group? + 15-19 year olds - 12-14 year olds - 20-23 year olds
 * type=""}

{What are common symptoms of youth suicidality? - Feeling alone - Depression - Substance use + All of the above
 * type=""}

{Who created the term "psychache"? - Sigmund Freud + Edward Shneidman - Thomas Joiner
 * type=""}

Conclusion
The chapter provided an overview of what motivates youth to commit suicide. There are many motivators as to why a young person has committed suicide, with social isolation, feeling alone and bullying as major motivators. Theoretical explanations include escaping from a depressive state, wanting to be less of a burden, and no longer wishing to deal with pain they are suffering. Encourage others to seek help if they show signs that might suggest risk of suicide.