Risk and Protective Factors

If we are aware of the factors that might contribute to someone becoming at risk of suicide and how this might show, we have a chance of offering our support.

Risk Factors

Anything can be a risk factor depending on how the person sees it and this depends partly on the:

• ways in which the person has learned to think about themselves and cope with problems, eg. their level of confidence in their ability to bring about changes in their life;
• person's ability and opportunity to cope, and
• availability of good support from family, friends, carers and professionals.

The factors linked to youth suicide are numerous and complex. However, current thinking suggests that a combination of biological, psychological and social factors may make a person more at risk of suicide. It is important to recognise that there is not one single cause of suicide, but rather, there are many interacting factors that increase suicide risk.

It is thought that adolescents today are under more and different types of stress, compared with young people from previous generations. The types of stressors young people may face can include:

• Increased pressures of modern society and technological change;
• High youth unemployment;
• Denial of educational opportunities;
• Increased social and family disruption;
• Decreased resources for family support (neighbours and extended families);
• Isolation of family units;
• Increased access to means of self-harm (for example, firearms, drugs, and cars);
• Increased recognition of youth suicide, creating greater acceptability of it as an option;
• Culture of violence in the media;
• Increased use of alcohol, drugs and medication 1.

However, these things alone do not "cause" suicide. Rather, suicidal behaviour can arise when young people are exposed to a number of risk factors. Everyone has a limit at which they can no longer cope. Imagine juggling one, then two, then three, then four tennis balls... Now imagine that each tennis ball represents a risk factor. As we are exposed to more and more risks there comes a time when we can no longer function normally.

Some of the main risk factors are listed below 1.

Social and cultural factors

Social and cultural factors may heavily impact on a young person's experiences and perception of themselves. They can include:

• Increased rates of violence in society, accompanied by decreased levels of concern;
• Marriage dissolution, remarriage and changes in family structure;
• Increased mobility, with disruption of friendships and social networks;
• Changing roles of men and women;
• Larger and less personal communities;
• Socio-economic disadvantage, including low educational achievement and unemployment, economic depression and sudden economic change.

Family stresses

If a young person has had a particularly difficult childhood, there is an increased risk that they will attempt or complete suicide. Family risk factors include:

• Death of a parent, caregiver or another family member;
• Divorce of parents or separation;
• Problems with friendships;
• Physical or psychiatric illness within the family;
• Family violence and sexual abuse;
• Suicidal behaviour within the family;
• Poverty.

Mental illness

Not everyone who is suicidal has a mental illness, and not everyone who has a mental illness is suicidal. However, there is a strong link between mental illness and suicide. Mental health problems commonly associated with suicide include alcohol and drug misuse, depression, anxiety and stress, personality disorders and psychosis.

Prior suicidal behaviour

People who have previously attempted suicide are at risk of making further attempts. Although it cannot be assumed that everyone who makes a suicide attempt will make further attempts or complete suicide, prior suicidal behaviour is a major risk for completed suicide.

Biochemical and genetic factors

Some research suggests that changes in brain chemistry are related to violent suicidal behaviour. There is no evidence to suggest that suicide is genetic. However, suicide can be over represented in families. This is because families share the same environment and the completed suicide of one family member may well raise the awareness of suicide as an option for other family members.

Exposure to attempted or completed suicide

Exposure to attempted or completed suicide tends to affect young people who are already vulnerable to suicide and can occur in a number of ways:

• Seeing the person who completed suicide and being involved in the aftermath;
• Having talked with or seen the person on the day of the suicide;
• Belonging to the family of the person;
• Being a close friend of the person;
• Being in the same class or group;
• Being a friend of the family;
• The attempted or completed suicide of a role model;
• Reading or hearing about the death in the media.

Personal and individual factors

Personal and individual factors tend to affect young people who are already vulnerable to suicide and can occur in a number of ways:

• Situations that result in feelings of rejection, humiliation, rage, shame or a desire to get even, including sexual and physical abuse;
• Conflict over sexual identity or same-sex attraction, including questioning sexual identity and fear of "coming out";
• Harmful use of alcohol or other drugs;
• History of child abuse - sexual, physical and emotional;
• The availability of lethal methods of suicide, particularly easy access to guns;
• Losses, including death and loss of physical health;
• Exposure to attempted or completed suicide;
• Legal problems, imprisonment or behaviour that brings the young person into conflict with the law or society;
• Patterns of poor communication with others, especially family or friends;
• Financial problems.

In short, there are many risk factors that can have an influence on an individual's behaviour, therefore, what may be a risk factor for one person may not be a risk factor for someone else.

Exposure to a number of risk factors may lead to a person feeling unloved, unwanted, powerless and hopeless 3. Over time, a person's thinking may become more and more constricted - or tunnel- visioned - so that suicide seems like the best and only way to eliminate their pain. Increasing feelings of hopelessness and helplessness may prevent the person from seeking help and so help needs to be offered in an active and assertive manner. By connecting with a suicidal person, we may be able to assist them to see alternative solutions and encourage them to get help 1.

Protective factors

It is important to stress that risk factors do not establish or identify cause. An event such as failing exams may have been "the last straw" but that factor alone does not cause a person to attempt suicide. If that were true, then all people who failed exams would be suicidal 1. Anything can be a risk factor depending on how the person sees it and this depends partly on the:

• Ways in which the person has learned to think about themselves and cope with problems, e.g. their level of confidence in their ability to bring about changes in their life;
• Person's ability and opportunity to cope; and
• Availability of good support from family, friends, carers and professionals.

There are certain things that can protect people from suicidal behaviour, such as:

• Strong spiritual or religious faith, or a sense of meaning and purpose to life;
• Community and social integration;
• Early identification and appropriate treatment of psychiatric illness;
• Belief that suicide is wrong;
• Lack of access to means of self harm (for example firearms, drugs) in the house 2.
• Connectedness to family and school;
• Responsibility for children;
• The presence of a significant other, an adult for a young person, a spouse or partner;
• Personal resilience and problem-solving skills;
• Good physical and mental health;

References

Commonwealth Department of Health and Aged Care (2000). LIFE. Living Is For Everyone. A framework for prevention of suicide and self-harm in Australia. Canberra: Mental Health and Special Programs Branch.

Jeanneret, O. (1992). A tentative epidemiologic approach to suicide prevention in adolescence. Journal of Adolescent Health. 13; pp 409-414.

Ministerial Council for Suicide Prevention (2005). Coroners database 1986-2002. Unpublished data.

Silburn, S. Hypothesised risk pathways.