FOR half a century, America's young people have been felled by a seemingly unlikely killer: themselves. The suicide rate for Americans aged between 15 and 24 tripled between 1950 and 1994, from 4.5 to 13.7 per 100,000. Over the same period, the suicide rate for adults and the elderly actually went down. Since then, the youngsters' rate has drifted down to 11.1. Still, the number who die by their own hand remains strikingly high. Why?
In 1998, the last year for which government data are available, suicide was the third commonest cause of death for young Americans, after accidents and murder. More adolescents and young adults killed themselves than died from all the next seven main causes of death.
Young women try to commit suicide more often than young men, but the males are nearly six times likelier to finish the job. The teenage rate for girls of 3.3 per 100,000 is nearly identical to that in Europe; but the rate for boys (18.6) is much higher than the European figure (12).
Young whites are more likely to kill themselves than blacks (though the rate for black males has increased sharply since 1980). The highest rate of all is among young Native American males: more than 40 per 100,000. There is no obvious link between suicide and income or education. Things seem worst in rural areas and the western states.
There is also, alas, a copycat factor. When suicides are reported in the press, the local suicide rate increases in proportion to the prominence of the coverage. There is, oddly, no similar effect among adults and the elderly. This is hardly new. Goethe's novel of love lost, “The Sorrows of Young Werther” (1774), was banned in parts of Europe because of a suspicion that it would encourage suicides. The American Foundation for Suicide Prevention now has guidelines warning the media not to glorify the victim, give details of the method of suicide, or make the death seem unavoidable.
Guns matter. A study has compared suicide rates in Seattle, in Washington state, with those across the Canadian border in demographically similar but less well-armed Vancouver, British Columbia. Older people in Vancouver found other ways to do themselves in; younger ones did not. Among 15-to-24-year-olds in Seattle, the total suicide rate was 40% higher, mainly because more youngsters killed themselves with guns. A coming article in the cheerful-sounding Journal of Suicide and Life-Threatening Behaviour suggests that one in five young people who set out to kill themselves do so impulsively, without warning. The less lethal the weapon at hand, the less likely death will follow.
But when it comes to working out why young people end their lives, much of the clarity of the research disappears. There seem to be five main factors: depression or other mental disorder; alcohol and/or drug abuse; a crisis in one's life, such as trouble at school or with the law; schizophrenia; and previous attempts at suicide.
The list helps to identify troubled individuals by focusing on visible symptoms; but it does not address the deeper causes of unhappiness. Many psychiatrists argue that the root causes lie deep in the past. Those who commit suicide, at any age, are likelier than non-suicides to have suffered abuse as children, or been exposed to domestic violence. Chemistry may also play a part. Suicide victims often have low levels of serotonin, a brain chemical that helps to regulate mood, says Morton Silverman, a professor of psychiatry at the University of Chicago and editor of the Journal of Suicide. Low levels of serotonin are associated with depression; they seem to be genetically caused, though childhood abuse and other forms of trauma may also cause neurobiological changes.
None of this, however, explains why young Americans are more at risk of suicide these days than they were in 1950. “We don't know very much,” admits Alex Crosby, an epidemiologist for the Division of Violence Prevention at the Centres for Disease Control and Prevention (CDC). Lloyd Potter, a former CDC official who now works on suicide-prevention programmes, thinks that two social changes have had the greatest effect on the suicide rate: the withering of the nuclear family, and more exposure to drugs and alcohol. But, again, the evidence is not conclusive.
A recent county-by-county study by three Harvard economists, David Cutler, Edward Glaeser and Karen Norberg, found that a 2% rise in the divorce rate seems to be matched by a 2-per-100,000 increase in the youth-suicide rate. In theory, that could explain as much as two-thirds of the rise in the youth-suicide rate since 1950; but the Harvard trio advise taking such a conclusion with “numerous shakers of salt”. Other studies have found divorce to have little or no impact on suicide risk.
The use of drugs and alcohol among American youths has also increased over time, but has dipped slightly in the past few years. Many youths are drunk or high when they kill themselves; yet it would be hard to demonstrate that the suicide rate has been driven by drugs and drink.
Other variables may affect the numbers. The murder rate, to which the suicide rate tends to be related, has fallen. Since the mid-1990s, there has also been a slight decline in gun-related violence. More recently, better treatment for depression has become available; Dr Silverman speculates that the “Prozac generation” may prove less suicidal than previous ones.
Still, something can be done
For all the uncertainty, the lack of hard evidence about what causes young people to kill themselves does not mean that suicide cannot be prevented. Most suicides are preceded by two distinct developments: a set of predisposing psychological conditions (low self-esteem, for instance) and a precipitating event (such as the loss of a loved one). A successful suicide-prevention programme, argues Dr Silverman, must treat the former and control the latter.
Some recent attempts to do so have been quite successful. New Jersey and Florida have run school programmes that appear to have reduced suicide rates by half. These involve training adults—parents and teachers, but also bus drivers and cafeteria workers—to identify pupils who are at risk; educating students about how to find help for troubled friends; and looking for students who may be “quietly disturbed”. The American air force has a similar programme, which helped cut the suicide rate in its ranks from 16 per 100,000 in 1994 to 5.6 in 1999.
Just as there are factors which seem to increase the risk of suicide, so there are “protective factors” which make it less likely. These include making sure that troubled youngsters stay in contact with their families and friends, and have access to health-care services where psychological disorders and addictions can be treated. Mr Potter says that, as a rule of thumb, any programme that promotes the healthy development of children will improve the suicide rate. Everything from smoking to skipping school may be associated with a higher suicide risk. But Mr Potter adds: “Most kids who attempt suicide really do want to live.” May the wish to live tip the balance.