CHEARS

Suicide occurs more often in older than in younger people but is still one of the leading causes of death in late childhood and adolescence worldwide. This not only results in a direct loss of many young lives, but also has disruptive psychosocial and adverse socio-economic effects. From the perspective of public mental health, suicide among young people is a main issue to address. Suicide is as a fatal self-injurious act with some evidence of intent to die. Worldwide, more than 800,000 people die due to suicide each year.

Many more men than women die by suicide. The male-to-female ratio varies between 4 to 1 (Europe and Americas) and 1.5 to 1 (Eastern Mediterranean and Western Pacific region) and is highest in richer countries. These suicide figures are probably still an underestimation of the real cases. Registering a suicide is a complicated process, often involving judicial authorities. Suicide deaths may not be recognized or may be misclassified as an accident or another cause of death. Sometimes suicide is not acknowledged or reported, due to its sensitive nature and the taboo that still surrounds it. Suicide attempts, i.e., non-fatal suicidal behaviour, are much more frequent, and are estimated to be about 10–20 times more frequent than actual suicide. The estimated global annual prevalence of self-reported suicide attempts is approximately 3 per 1,000 adults. About 2.5% of the population makes at least one suicide attempt during their lifetime.

There is also an increasing awareness in the general population about the tremendous negative consequences of youth suicidality, not only because of the direct loss of many young lives but also in the disruptive psychosocial and adverse socio-economic effects on a large societal scale. From the perspective of public mental health, suicide among young people is one of the main issues to address through effective preventive measures. Therefore, it is important to gain as much insight as possible in the risk factors contributing to suicidal behaviour in youth.

Youth in terms of strict age ranges is rather arbitrary and varies by country and over time. Suicide under the age of 5 is hard to find. Most literature (including this mini review) on youth suicide refers to school-age children (7–12 years) and adolescents (13–20 years). These young people are by nature vulnerable to mental health problems, especially during the years of adolescence. This period in life is characterized by movement, changes and transitions from one state into another, in several domains at the same time. Young people must make decisions about important concrete directions in life, for example school, living situation, peer group etc. They must also address new challenges regarding building their own identity, developing self-esteem, acquiring increasing independence and responsibility, building new intimate relationships, etc. In the meantime, they are subject to ongoing, changing psychological and physical processes themselves. And besides that, they are often confronted with high expectations, sometimes too high, from significant relatives and peers. Such situations inevitably provoke a certain degree of helplessness, insecurity, stress and a sense of losing control. To address these challenges and successfully cope with these emotions, young people must have access to significant supporting resources such as a stable living situation, intimate friendships, a structural framework and economic resources. Risk factors can be seen as factors that undermine this support or hinder access to these resources, while protective factors strengthen and protect these resources, or serve as a buffer against risk factors.

In recent decades, several population-based psychological autopsy studies of suicides have been conducted, involving interviews with key informants and examination of records, as well as follow-up studies of people who have attempted suicide, revealing important information about the risk factors for youth suicide. Everyone agrees that numerous factors can contribute to suicide, and that ultimately each suicide is caused by a highly unique, dynamic and complex interplay of genetic, biological, psychological and social factors. Nevertheless, it is possible to identify different types of factors that are clearly associated with an increased risk of youth suicide, so this is highly relevant regarding prevention.