Suicide is the second leading
cause of death among adolescents in Canada and globally. The purpose of our
study was to calculate what proportion of adolescent suicide attempts could be
prevented in the absence of verbal, physical and sexual violence. Using the
province-wide 2008 British Columbia Adolescent Health Survey (N=29,315) we
calculated population-attributable fractions for each type of violence, as well
as exposure to any violence, separately by gender, among adolescents age 12–19.
We found violence victimization is implicated in the majority of suicide
attempts. Focusing on violence prevention may be an important strategy for
reducing suicide among young people.
… This study of
adolescent students in British Columbia shows that violence exposure is not
only linked to suicide attempt, it is strongly implicated among the majority of
adolescents in school who attempt suicide. For both boys and girls, whether
that violence is verbal harassment and taunting, physical assaults and abuse,
or sexual assaults, we can partially attribute to violence exposure between
one-third to two-thirds of those youth who attempt suicide. We also considered
the exposure to any form of violence as compared to no violence at all, and
that comparison offers an even more sobering finding: the majority of the
prevalence of suicide attempts could be attributed, in part, to experiencing
some form of violence.
Our results are similar to rates found by one
large-scale study of suicide attempts and various childhood adverse events among
adults (Dube et al., 2001),
but much higher than those reported in the other adult studies. However, since
the attributable fraction is a function of the prevalence of various types of
violence, as well as the strength of the relationship between the violence
exposure and suicide attempt, it is possible that underreporting of both
violence exposure and prior suicide attempts due to recall bias among older
adults, or the limited types of violence included (usually limited to more
severe forms of violence exposure) may help explain differences between our
results and those among adults in other countries. The high prevalence of any
violence victimization in our study was similar to that found in a study of
peer-to-peer violence in one school district in the same region (Trach, et al., 2010), and is much higher than
the rates of violence retrospectively reported by adults in other countries,
when the questions did not also include exposure to bullying in school or
sexual harassment. At the same time, several studies have documented the link
between bullying at school and suicidal ideation and attempts, so it is clear
these forms of violence should be included in considering global exposures to
violence as a contributor to suicide among adolescents.
Exposure to violence victimization, whether in school,
at home, or in the community, is an important social determinant of health for
adolescents, even in a country like Canada, which is not experiencing armed
conflicts at home, and where firearms and similar weapons are not easily
accessible to the general population. This suggests that violence prevention
initiatives may have further value as a strategy for suicide prevention for
adolescents, especially as primary prevention. This perspective, however, does
not appear to be widely considered by public health policy makers and others involved
in suicide prevention initiatives. International reviews of suicide prevention
strategies suggest most strategies are focused on secondary or tertiary
prevention, i.e., improving screening to identify those at higher risk for
suicide, means restriction for who are actively suicidal, reducing stigma and
promoting help-seeking behaviours among those who are depressed, or
pharmacological and therapeutic treatments for those who have already
experienced a suicide attempt (Mann, et al., 2005; Buus Florentine & Crane, 2010; Cusimamo & Sameem, 2011). While these may
be important strategies for suicide prevention when they are effective, they
are downstream approaches, and many are not population-based strategies. At the
same time, many population-based suicide prevention strategies have focused on
social media campaigns or psycho-educational approaches designed to raise
awareness of signs of depression and suicidality, sources of help for those at
risk, and occasionally problem coping skills; such strategies have been
targeted to the general population (Mann et al.,), or to students in schools
(Buus Florentine & Crane; Miller, Eckert & Mazza, 2009).
Unfortunately, these population-based prevention strategies offer limited to no
evidence of effective prevention of suicidal behaviour, primarily documenting
changes in awareness, attitudes, and knowledge of sources for referral and
help-seeking (Buus Florentine & Crane; Miller, et al.), or offering some
promising results but weak evaluation methods. None of them focus on preventing
upstream risk factors for suicide.
Full article at: http://goo.gl/IEZUd6
By:
University of
British Columbia School of Nursing, Vancouver, British Columbia
Author Contact: Dr. Elizabeth M. Saewyc, UBC School of
Nursing, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Tel: 604-822-7505,
Fax: 604-822-7466, Email: ac.cbu.gnisrun@cyweas.htebazile
More at: https://twitter.com/hiv_insight
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