Why Do Adolescents Attempt Suicide?

BACKGROUND: 

A suicide attempt is defined as “a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die” (Silverman, Berman, Sanddal et al., 2007, p. 273). Fortunately, suicide among teenagers is infrequent. However, teens have a relatively higher rate of suicide attempts than adults.

Much of suicide research is concerned with who attempts suicide rather than why they do so. For both researchers and clinicians to gain a better understanding of what contributes to an individual’s suicide attempt, Dr. David Klonsky of the University of British Columbia, along with Dr. Alexis May now at Wesleyan University, developed the Inventory of Motivations for Suicide Attempts (IMSA), based on several widely accepted theories of suicide.

QUESTION

Why do adolescents attempt suicide?

STUDY

In the present study, Dr. Klonsky utilized the IMSA to assess suicide attempt motivations of 52 adolescents ages 12-17 years (mean age 14.8 years) who were hospitalized at a psychiatric inpatient unit after a suicide attempt. Eighty-five percent of the sample were female. The average age of the initiation of suicidal ideation was 12 years old. The percentage of participants reporting only one suicide attempt was 67.

The IMSA includes 10 five-item scales plus four additional items. The scales are based around feelings of:

• Hopelessness – the belief that things cannot get better, or one’s situation cannot improve
• Psychache – extreme emotional or psychological pain
• Escape – the desire to escape from one’s own thoughts, feelings, or actions
• Burdensomeness – the feeling that one is a burden to those around him or her
• Low Belongingness – the feeling that one is not accepted by his or her community
• Fearlessness – the absence of fear which had prevented a suicide attempt at an earlier time
• Problem-solving – the belief that suicide or suicide alone will solve one’s problems
• Impulsivity – acting in an unplanned way, often without reasoned thinking
• Interpersonal Influence – direct social pressures promoting suicide
• Help Seeking – the desire for help or care, from others

The first six of these scales reflect internal factors (intrapersonal) while the final two scales reflect factors associated with communication (interpersonal). The middle two scales, Impulsivity and Problem-Solving, aren’t strongly associated with either factor and are considered separately. Participants were asked to identify feelings they’ve experienced, based on a series of statements, each beginning with the phrase, “I attempted suicide because…” For instance, “I attempted suicide because I wanted to die,” which highlights the intent behind the attempt; or “I attempted suicide because… I felt overwhelmed and in too much pain from humiliation,” which implicates psychache as a driving factor.

The study participants then rated their agreement with four additional general statements about suicide on a scale of zero (not at all important) to four (most important), based on how they felt leading up to their suicide attempt.

To assess if adolescents’ reports of suicide attempts were accurate, another suicide scale, the Columbia-Suicide Severity Rating Scale, was also administered.

RESULTS

Describing their motivations at the time of their attempt, 98 percent of participants endorsed the item “I attempted suicide because I wanted to die,” though there were varying levels of degree of intent to die. The three strongest motivators for suicide attempts in this teen sample were Psychache, Hopelessness, and Escape. The weakest motivator was Interpersonal Influence.  These results were similar to those of Klonsky’s previous study of adult suicide attempt survivors, which used the IMSA to assess motivations for attempts.

Burdensomeness was found to be a stronger motivator for adolescents than for adults. Interpersonal Influence, the least important motivator for adults, perhaps surprisingly, appears to be even less important to adolescents.

Internal motivators, for teens, were more strongly associated with suicidal behaviors than external motivators. This means that at the time of the suicide attempt most people perceived that suicide was the only way to end their own emotional or psychological struggles. These results oppose the idea that youth attempt suicide solely for attention or to obtain the help of others. Rather than engaging in suicidal behavior to gain the help of others, the study made evident that teens more often attempt suicide because they are in emotional pain, feel hopeless, and do not believe there can be any resolution to their problems.

TAKEAWAYS

• The strongest motivations for suicide attempts in both adults and adolescents using the IMSA were emotional pain, hopelessness and wanting to get rid of the pain. (i.e., Psychache, Hopelessness, and Escape)
• Individual’s internal feelings of pain were stronger motivators for suicide attempts than interpersonal factors, even for adolescents.
• The Inventory of Motivations for Suicide Attempts (IMSA) has demonstrated reliability and validity across the age span
• Adolescents and adults experience a variety of motivations for suicide, and understanding these motivations can inform clinicians and families about how to intervene to prevent suicide attempts

Reference

Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE. Rebuilding the Tower of Babel: A Revised Nomenclature for the Study of Suicide and Suicidal Behaviors Part 2: Suicide-Related Ideations, Communications, and Behaviors. Suicide and Life-Threatening Behavior. 2007; 37(3):264–277.

David Klonsky, Ph.D.
Professor, Department of Psychology
University of British Columbia
Grant Title: Assessing Motivations for Attempted Suicide
2014 Pilot Research Grant

Grant-Related Publications:

Klonsky, E. D., Qiu, T., & Saffer, B. Y. (2017). Recent advances in differentiating suicide attempters from suicide ideators. Current Opinion In Psychiatry, 30(1), 15-20.

May, A. M., O'Brien, K. M., Liu, R. T., & Klonsky, E. D. (2016). Descriptive and Psychometric Properties of the Inventory of Motivations for Suicide Attempts (IMSA) in an Inpatient Adolescent Sample. Archives Of Suicide Research: Official Journal Of The International Academy For Suicide Research, 20(3), 476-482.

Click here to read more about Dr. Klonsky's Pilot Research Grant.