Youth Suicide: Recommendations from the Argentine Society of Pediatrics

Within the framework of World Suicide Prevention Day, which is commemorated on September 10, the Argentine Society of Pediatrics (SAP) issued a document that invites us to talk about this topic with children and adolescents and pay attention to those signs that could be warning about the risks of its occurrence.

Under the title “Suicide, talking about it is preventing it” , the Committees for Permanent Studies of Adolescents and Mental Health and Family of the SAP prepared a document in which they establish that suicide is a multi-causal phenomenon in which individual factors interact, family, community, social and political. “Suicidal behaviors encompass suicidal ideation, the development of a plan, obtaining the means to do so, and even the consummation of the act (with or without success) ,” the report states.

“When we are faced with a completed suicide or an attempted suicide, we find that the different actors close to the victim, such as parents, friends, teachers, doctors and psychologists, experience it with guilt and reproach themselves for not having been attentive to the signs of suicide.” alert,” said Dr. Nora Poggione , pediatrician, Secretary of the National Committee on Adolescence of the Argentine Society of Pediatrics (SAP).

“We must keep in mind that, at the slightest manifestation of suicidal ideation, the recommendation is to ask and promote a conversation. Talking about the topic does not activate the idea of ​​suicide, quite the opposite. That young people can freely express their feelings is one way to begin to solve the problem. Not speaking and keeping it hidden increases the risk,” said Dr. Hugo Gauto , Secretary of the Family and Mental Health Committee of the SAP.

In particular, the document encourages the health team to create a favorable environment so that, in simple and clear language, with respect and explicit confidentiality, they can ask direct questions to the patient, such as whether they have ever thought about harming themselves, how often, if it is suicidal thoughts or if you thought about how to carry it out, among others.

“Once the professional has achieved this level of dialogue, the clinical task has just begun, but this progress is very important,” stated Dr. Juan Pablo Mouesca , child and adolescent psychiatrist, Prosecretary of the Family and Mental Health Committee of the Argentine Society of Pediatrics. “On the other hand, human, therapeutic, family and friend contact is essential to approach adolescents at risk,” he insisted.

“In the face of a suicidal gesture, any individual involved, whether in the health or school, sports or social field, must internalize that a suicide attempt is a potentially serious act, which in no way should be downplayed,” the work describes. of the SAP. “Once under treatment, the essential objective of therapy is to calm, contain and protect.”

The document reports that “there are 20 attempts for each completed suicide” , that “ suicide attempts are more frequent in women than in men in a ratio of 4 to 1” , although “men are more effective in their lethality” and that “suicide represents a third of deaths from external causes in adolescents between 15 and 19 years old, with a higher prevalence in males than females.”

“When analyzing the evolution of the suicide rate in the adolescent population, in recent years there has been a relatively sustained increasing trend in mortality from suicide due to the decrease in accidents and deaths on public roads, probably related to social isolation during the pandemic, although in absolute numbers suicides are decreasing. For the same reason, consultations regarding violence, self-harm and suicide have increased relatively,” highlighted Dr. Fabio Bastide , Pro-Secretary of the SAP Adolescence Committee.

Another theme that stands out in the work is self-harm , which represents a temporary and subjective resolution to the individual’s suffering and conflicts. “Adolescents who self-harm experience negative and intense feelings triggered, mostly, by family conflicts. Although the cuts are made, especially in solitude, they are then shared with peers, which creates strong ties of belonging and identity. They function as symbolic marks of personal suffering; They are organized in opposition to the adult world and allow them to obtain recognition from their peers,” they describe from the SAP.

“It is important to take this type of behavior very seriously and not minimize it, since it refers to a condition, but timely intervention can modify future behavior. It is ideal, of course, to ask for professional help, who are the most qualified to face and resolve this type of situation,” said Dr. Poggione.

Among the factors that could predispose to suicidal behavior , the Argentine Society of Pediatrics mentioned the existence of a family or personal history of suicide attempts; domestic violence, including physical and sexual abuse; little or poor communication between family members; frequent changes of address; authoritarianism, loss of authority between parents or persistent mutual disavowals between both; inconsistency of authority, allowing conduct that has previously been disapproved; difficulties showing affection; identification and idealization of adolescent figures or icons who have committed suicide or who have died, and overcrowding, with coexistence in small spaces that affects the privacy of family members.

On the other hand, the following are listed as triggering factors : divorce-separation of parents; death of loved ones; prolonged/pathological grief; serious school behavior problems or learning difficulties; bullying and discrimination of any kind. From the age of 6, death begins to be considered an inevitable and universal event, with the boy or girl coming to the conclusion that all people, including him/her, have to die; In parallel with the concept of death, that of suicide is developed. Other triggers may be suicide, mental illness, alcoholism, addictions, psychosis or severe personality or mood disorders of one of the parents or cohabitants. In these cases, lack of care, the transmission of hopelessness, pessimism and lack of motivation can trigger suicidal behavior.

"A greater frequency of suicidal events was also found in those boys, girls and adolescents exposed to moves, departure of a family member, death of a loved one, school changes, breakups in relationships or a group of friends, and changes in life." family life, such as the retirement or illness of one of its members,” added Dr. Mouesca.

The SAP was also responsible for highlighting the existence of some myths that affect prevention actions and also those interventions in grieving a death due to suicide. Among others, they demystified the veracity of statements such as “whoever says or threatens that he is going to kill himself does not do it”, “he who commits suicide is going through depression”, “talking about suicide increases the risk”, “he who attempts suicide is a coward or a brave person”, “children do not commit suicide” or “the tendency to commit suicide is hereditary”.

“It is imperative that the health team work with the patient’s family and environment on these fallacious statements to achieve a better approach and a better treatment result,” said Dr. Bastide.

On the other hand, specialists highlight that there are also protective factors , such as that the basic needs of the family group are satisfied, that there is good communication between its members, with exchange of feelings and affections, religiosity and/or spirituality, personal fulfillment, ability to accept reality, positive coping and problem-solving strategies and family, school, peer, community, social and political support.

“An element to consider is postvention , that is, intervention in the environment in which an adolescent or child commits suicide (close relatives, school and peers, and the treating medical team). The idea is to be able to talk about what happened so that it does not spread and to try to grieve. From the point of view of communication, among other recommendations, it is suggested not to delve into the details of the method used, not to resort to religious or cultural stereotypes, and to avoid publishing photographs or suicide notes,” completed doctor Mouesca.

Finally, the document states that “suicide in adolescence is a complex problem that requires an interdisciplinary approach. It requires support from the family and the community from the various institutions that are in contact with adolescents and which in most cases is preventable, so it is important to know and not minimize the possible alarm signals that could give rise. adolescents.”