Although people of all ages may try to kill themselves, the likelihood of committing suicide steadily increases with age up through middle age, then decreases during the early stages of old age, and then increases again beginning at age 85 (see Figure 9-2). Currently, 1 of every 100,000 people under 15 years of age in the United States kills himself or herself each year, compared with 11 of every 100,000 people between 15 and 24 years old, 19 of every 100,000 between 45 and 64 years old, 15 of every 100,000 between 65 and 84, and 18 of every 100,000 people over age 85 (AFSP, 2014; CDC, 2013). The exceptional rate of suicide among those who are middle-aged is a recent phenomenon and is not fully understood. Up until 2006, that rate had been considerably lower than the current rate and always lower than that of elderly people.

Clinicians have paid particular attention to self-destructive behavior in three age groups: children, adolescents, and the elderly. Although the features and theories of suicide discussed throughout this chapter apply to all age groups, each group faces unique problems that may play key roles in the suicidal acts of its members.

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Although suicide is infrequent among children, it has been increasing over the past several decades (Dervic, Brent, & Oquendo, 2008). Indeed, more than 6 percent of all deaths among children between the ages of 10 and 14 years are caused by suicide (Arias et al., 2003). Boys outnumber girls by as much as 5 to 1. In addition, it has been estimated that 1 of every 100 children tries to harm himself or herself, and many thousands of children are hospitalized each year for deliberately self-destructive acts, such as stabbing, cutting, burning, or shooting themselves; overdosing; or jumping from high places (Fortune & Hawton, 2007; Cytryn & McKnew, 1996).

Researchers have found that suicide attempts by the very young are commonly preceded by such behavioral patterns as running away from home; accident-proneness; aggressive acting out; temper tantrums; self-criticism; social withdrawal and loneliness; extreme sensitivity to criticism by others; low tolerance of frustration; sleep problems; dark fantasies, daydreams, or hallucinations; marked personality change; and overwhelming interest in death and suicide (Wong et al., 2011; Dervic et al., 2008). Studies further have linked child suicides to the recent or anticipated loss of a loved one, family stress and a parent’s unemployment, abuse by parents, victimization by peers (for example, bullying), and a clinical level of depression (van Geel, Vedder, & Tanilon, 2014; Renaud et al., 2008; Van Orden et al., 2008).

Most people find it hard to believe that children fully comprehend the meaning of a suicidal act. They argue that because a child’s thinking is so limited, children who attempt suicide fall into Shneidman’s category of “death ignorers,” like Demaine, who sought to join his mother in heaven. Many child suicides, however, appear to be based on a clear understanding of death and on a clear wish to die (Pfeffer, 2003). In addition, suicidal thinking among even normal children is apparently more common than most people once believed. Clinical interviews with schoolchildren have revealed that between 6 and 33 percent have thought about suicide (Riesch et al., 2008; Culp, Clyman, & Culp, 1995). Small wonder that many of today’s elementary schools have tried to develop tools and procedures for better identifying and assessing suicide risk among their students (Miller, 2011; Whitney et al., 2011).

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The suicide of John, age 17, was not an unusual occurrence. Suicidal actions become much more common after the age of 13 than at any earlier age. According to official records, approximately 1,400 teenagers (age 13 to 18), or 7 of every 100,000, commit suicide in the United States each year (Nock et al., 2013). In addition, at least 12 percent of teenagers have persistent suicidal thoughts and 4 percent make suicide attempts (Nock et al., 2013). Because fatal illnesses are uncommon among the young, suicide has become the third leading cause of death in this age group, after accidents and homicides. Around 10 percent of all adolescent deaths are the result of suicide (Pompili et al, 2011; Shain, 2007).

About half of teenage suicides, like those of people in other age groups, have been tied to clinical depression (see PsychWatch below), low self-esteem, and feelings of hopelessness, but many teenagers who try to kill themselves also appear to struggle with anger and impulsiveness or to have serious alcohol or drug problems (Orri et al., 2014; Renaud et al., 2008; Witte et al., 2008). Some also have deficiencies in their ability to sort out and solve problems.

Teenagers who consider or attempt suicide are often under great stress. They may be dealing with long-term pressures such as poor (or missing) relationships with parents, family conflict, inadequate peer relationships, and social isolation (Orri et al., 2014; Capuzzi & Gross, 2008; Apter & Wasserman, 2007). Alternatively, their actions also may be triggered by more immediate stress, such as a parent’s unemployment or medical illness, financial setbacks for the family, or a social loss such as a breakup with a boyfriend or girlfriend (Orbach & Iohan, 2007). Stress at school seems to be a particularly common problem for teenagers who attempt suicide. Some have trouble keeping up at school, while others may be high achievers who feel pressured to be perfect and to stay at the top of the class (Frazier & Cross, 2011). In many high schools, psychologists and teachers are now trained to look for these and other risk factors in students (Miller, 2011; Whitney et al., 2011).

Some theorists believe that the period of adolescence itself produces a stressful climate in which suicidal actions are more likely. Adolescence is a period of rapid growth that is often marked by conflicts, depressed feelings, tensions, and difficulties at home and school. Adolescents tend to react to events more sensitively, angrily, dramatically, and impulsively than individuals in other age groups; thus the likelihood of their engaging in suicidal acts during times of stress is higher (Greening et al., 2008). Finally, the suggestibility of adolescents and their eagerness to imitate others, including others who attempt suicide, may set the stage for suicidal action (Apter & Wasserman, 2007). One pioneering study found that 93 percent of adolescent suicide attempters had known someone who had attempted suicide (Conrad, 1992).

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Teen Suicides: Attempts Versus CompletionsFar more teenagers attempt suicide than actually kill themselves—most experts believe that the ratio is 25 to 1 (AFSP, 2014), although estimates range as high as 200 to 1. In contrast, the ratio is thought to be 4 to 1 among the elderly. The unusually large number of unsuccessful teenage suicides may mean that adolescents are less certain than middle-age and elderly people who make such attempts. While some do indeed wish to die, many may simply want to make others understand how desperate they are, or they may want to get help or teach others a lesson (Apter & Wasserman, 2007). Up to half of teenagers who make a suicide attempt try again in the future, and as many as 14 percent eventually die by suicide (Horwitz, Czyz, & King, 2014; Wong et al., 2008; Borowsky et al., 2001).

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Why is the rate of suicide attempts so high among teenagers (as well as among young adults)? Several explanations, most pointing to societal factors, have been proposed. First, as the number and proportion of teenagers and young adults in the general population have risen, the competition for jobs, college positions, and academic and athletic honors has intensified for them, leading increasingly to shattered dreams and ambitions (Holinger & Offer, 1993, 1991, 1982). Other explanations point to weakening ties in the family (which may produce feelings of alienation and rejection in many of today’s young people) and to the easy availability of alcohol and other drugs and the pressure to use them among teenagers and young adults (Brent, 2001; Cutler et al., 2001).

The mass media coverage of suicides by teenagers and young adults may also contribute to the high rate of suicide attempts among the young (Gould et al., 2007). The detailed descriptions of teenage suicide that the media and the arts often offer may serve as models for young people who are contemplating suicide (Cheng et al., 2007). In one of the most famous examples of this phenomenon, just days after the highly publicized suicides of four adolescents in a New Jersey town in 1987, dozens of teenagers across the United States took similar actions (at least 12 of them fatal)—two in the same garage just one week later. Similarly, one study found that the rate of adolescent suicide rose about 7 percent in New York City during the week following a television film on suicide, in contrast to a 0.5 percent increase in the adult suicide rate during the same week (Maris, 2001).

It is worth noting here that a number of pro-suicide forums and chat rooms have popped up on the Internet in recent years. Some pro-suicide Web sites celebrate former users who have committed suicide; others help set up appointments for joint or partner suicides; and several offer specific instructions about suicide methods and locations and writing suicide notes (Davey, 2010; Becker & Schmidt, 2004). During a two-month period in 2008, for example, 30 people committed suicide across Japan, all of them involving the use of detergent mixtures that produce a deadly hydrogen sulfide gas—a technique repeatedly described and encouraged on Internet suicide sites (CNN, 2008).

Although such sites are growing in number and influence, they do not appear to be a major factor in the rise of teenage suicide attempts—at least not yet. One study used a strategy called “hyperlink network analysis” to determine which Web sites are visited by suicidal people (Kemp & Collings, 2011). The investigators found that pro-suicide sites were not readily accessible and in fact were visited relatively infrequently, whereas sites dedicated to suicide-related information, prevention, or treatment were very accessible and often visited.

Teen Suicides: Multicultural IssuesTeenage suicide rates vary by ethnicity in the United States. Around 7.5 of every 100,000 white American teenagers commit suicide each year, compared with 5 of every 100,000 African American teens and 5 of every 100,000 Hispanic American teens (Goldston et al., 2008; NAHIC, 2006). Although these numbers certainly indicate that white American teens are more prone to suicide, the rates of the three groups are in fact becoming closer (Baca-Garcia et al., 2011). The white American rate was 150 percent greater than the African American and Hispanic American rates in 1980; today it is only 50 percent greater. This trend may reflect increasingly similar pressures on young African, Hispanic, and white Americans—competition for grades and college opportunities, for example, is now intense for all three groups (Barnes, 2010). The growing suicide rates for young African and Hispanic Americans may also be linked to their rising unemployment, the many anxieties and economic pressures of inner-city life, and the rage many feel over racial inequities and discrimination in our society (Baca-Garcia et al., 2011; Barnes, 2010; Goldston et al., 2008). Recent studies further indicate that 4.5 of every 100,000 Asian American teens now commit suicide each year.

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The highest teenage suicide rate of all is displayed by American Indians. Currently, more than 15 of every 100,000 American Indian teenagers commit suicide each year, double the rate of white American teenagers and triple that of other minority teenagers. Clinical theorists attribute this extraordinarily high rate to factors such as the extreme poverty faced by most American Indian teens, their limited educational and employment opportunities, their particularly high rate of alcohol abuse, and the geographical isolation of those who live on reservations (Alcántara & Gone, 2008; Goldston et al., 2008). In addition, it appears that certain American Indian reservations have extreme suicide rates—called cluster suicides—and that teenagers who live in such communities are unusually likely to be exposed to suicide, to have their lives disrupted, to observe suicidal models, and to be at risk for suicide contagion (Bender, 2006; Chekki, 2004).

More than 15 of every 100,000 people over the age of 65 in the United States commit suicide, a rate that rises to 18 per 100,000 among the very elderly, as you read earlier (AFSD, 2014). Elderly people commit over 19 percent of all suicides in the United States, yet they account for only 14 percent of the total population (U.S. Census Bureau, 2014).

Many factors contribute to this high suicide rate. As people grow older, all too often they become ill, lose close friends and relatives, lose control over their lives, and lose status in our society (Draper, 2014; O’Riley et al, 2014). Such experiences may result in feelings of hopelessness, loneliness, depression, “burdensomeness,” or inevitability among aged persons and so increase the likelihood that they will attempt suicide (Kim et al., 2014; Cukrowicz et al., 2011; Jahn et al., 2011). One study found that two-thirds of particularly elderly individuals (those over 80 years old) who committed suicide had been hospitalized for medical reasons within 2 years preceding the suicide (Erlangsen et al., 2005), and another found a heightened rate of vascular or respiratory illnesses among elderly people who attempted suicide (Levy et al., 2011). Still other research has shown that the suicide rate of elderly people who have recently lost a spouse is particularly high (Ajdacic-Gross et al., 2008). The risk is greatest during the first weeks of bereavement, but it remains high in later months and years as well.

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Elderly people are typically more determined than younger people in their decision to die and give fewer warnings, so their success rate is much higher (Dennis & Brown, 2011). As you read earlier, an estimated one of every four elderly persons who attempts suicide succeeds (AFSD, 2014). Given the resolve of aged persons and their physical decline, some people argue that older persons who want to die are clear in their thinking and should be allowed to carry out their wishes (see InfoCentral below). However, clinical depression appears to play an important role in as many as 60 percent of suicides by the elderly, suggesting that more elderly people who are suicidal should be receiving treatment for their depressive disorders (Levy et al., 2011; Hirsch et al., 2009). In fact, research suggests that treating depression in older persons helps reduce their risk of suicide markedly (Draper, 2014; Lapierre et al., 2011).

The suicide rate among the elderly in the United States is lower in some minority groups (Joe et al., 2014; Alcántara & Gone, 2008; Leach & Leong, 2008). Although American Indians have the highest overall suicide rate, for example, the rate among elderly American Indians is relatively low. The aged are held in high esteem by American Indians and are looked to for the wisdom and experience they have acquired over the years, and this may help account for their low suicide rate. Such high regard is in sharp contrast to the loss of status often experienced by elderly white Americans.

Similarly, the suicide rate is only one-third as high among elderly African Americans as among elderly white Americans (Joe et al., 2014; Barnes, 2010). One reason for this low suicide rate may be the pressures faced by African Americans, of whom it is sometimes said: “only the strongest survive” (Seiden, 1981). Those who reach an advanced age often have overcome significant adversity, and many feel proud of what they have accomplished. Because reaching old age is not in itself a form of success for white Americans, their attitude toward aging may be more negative. Another possible explanation is that aged African Americans have successfully overcome the rage that prompts many suicides in younger African Americans.