# data[].attributes.body
There are many forms of stress teenagers are experiencing from grades to relationships they have many constant weights on their shoulders which may cause them to feel like suicide is the only option.

# data[].attributes.body
A study on teen suicide from Johns Hopkins Medicine states "suicide is the third leading cause of death in young people. For youth ages 10-14, suicide is the second leading cause of death" (Medicine)

# data[].attributes.body
It is likely teenagers who feel suicidal have a difficult home situation creating stress and other mental effects.

# data[].attributes.body
Schools and teachers can have a large impact on teenagers since so much of their time is spent in a learning environment. It must be safe.

# data[].attributes.attachment_link.description
Several years ago, American surgeon, author, and public health researcher Atul Gawande experimented with using a two-minute checklist in operating rooms in eight different hospitals. One unexpected result was that a round of team-member introductions before surgery lowered the average number of surgical complications by 35%.

# data[].attributes.attachment_link.title
Creating an Emotionally Supportive Home Environment | Parenting Tips…

# data[].attributes.attachment_link.description
Children need a safe space to share and a calming guide to listen and empathize. Follow these tips for how you can build an emotionally supportive home for…

# data[].attributes.body
There are many ways to tell if a teenager is feeling suicidal, even if they don't verbally express it.

# data[].attributes.body
How can we tell a teenager is suicidal?

# data[].attributes.attachment_link.description
What parents and loved ones can do to recognize suicide warning signs and take action.

# data[].attributes.body
"Hostile family environment, faulty interactions between family members, and lack of perceived family support may contribute to suicidal behavior among adolescents and young adults." (A Qualitative Study)

# data[].attributes.attachment_link.readable_text
Abstract

Background:

Suicides are among the leading cause of death among adolescents and young adults worldwide, including India. Suicide attempts are about 20 times more common than completed suicides. Teenagers and youth who attempt suicide belong to a heterogeneous group. Various biological and psychosocial factors, including family factors, contribute to such behavior. Quality of family functioning and relationships may act as an important contextual factor in deciding suicidal behavior. Hence, this study was done to explore the family factors contributing to suicide attempts.

Methods:

Qualitative exploratory study design and purposive sampling were used. Data were collected from 22 adolescents and young adults using an in-depth interview method. All audio recordings were transcribed in Malayalam, and then translated to English. Codes were developed using the qualitative data analysis software. Thematic analysis was done. Themes and relationships were identified and synthesized to a framework that represents the summary of the data.

Results:

Most of the participants perceived the home environment as hostile. Problems within the family included parental conflicts and separation, conflict with a sibling or other members of the family, and marital disharmony. Most of them perceived low family support. Socioeconomic factors such as financial issues, superstitious beliefs, disturbing neighborhoods, interpersonal issues, and the stigma of having a mental illness, in a family member, were also noted.

Conclusion:

Hostile family environment, faulty interactions between family members, and lack of perceived family support may contribute to suicidal behavior among adolescents and young adults. Hence, it is imperative to consider these factors while treating them or planning any suicide prevention program for them.

Keywords: Suicide attempts, adolescent, young adults, family factors

Key Messages:

Emotional distress due to faulty interactions with family members and other socioeconomic factors within the family may precipitate suicide attempts among adolescents and young adults. Early identification and family level intervention may help prevent such behavior

Globally, suicide is one of the leading causes of death and considered a public health and social issue. According to the World Health Organization, almost 800,000 people die from suicide every year; this roughly corresponds to one death every 40 seconds. These figures do not include suicide attempts, which can be more than 20 times frequent than completed acts. Worldwide, suicide is the second leading cause of death among those aged 15-29 years.1 India's contribution to global suicide rates has increased over the years 1990-2016.2

According to the National Crime Records Bureau, the official agency responsible for suicide data collection in India, more than one lakh (139,123) persons committed suicide in the year 2019, and the National average was 10.4 per one lakh population. Kerala recorded a rate of 24.3 per one lakh population, which is more than twice the national average. Around 35.1 percent of suicide victims were youths in the age group of 18-30 years, and this was the main age group that committed suicide.3 In India, for suicide deaths at ages ≥15 years, Patel et al. estimated that 56% of women and 40% of men belong to the age group 15-29 years.4 Clinical studies have shown that the youth who attempt suicides belong to a heterogenous group in terms of gender, intent and lethality of attempt, impulsivity, previous attempts, presence of psychiatric disorders, family history of mental illness/suicide, and various other social factors.5-7

Suicidal behavior is a complex behavior. Its causes consists of a constellation of components that act together and include a variety of biological, psychological, and social factors, including familial and other contextual factors.6-9 Though suicide is regarded as a public health problem, it is a very personal decision that the individual makes. Hence, it is vital to understand the personal distress and the contextual factors. Perceived family functioning and relationships are important contextual factors deciding suicidal behavior among adolescents and young adults.10 Perceived criticisms from parents, invalidation from family members, and low levels of perceived family support may contribute to such behavior.11-13 Though many family factors have been identified, qualitative research is scanty in this area.

In Indian culture, family plays an important role in an individual's life experiences and decisions. Though it largely acts as a protective factor providing vital support for the individual, sometimes it may act as a risk factor in precipitating suicide attempts.

Hence, a qualitative study was planned to explore the individual experiences and family factors that contribute to suicide attempts so that this will help us understand this complex phenomenon. It will also provide the clinician with a deeper understanding of the individual's distress and help in making appropriate interventions at the family level. This study is part of a larger study conducted among adolescents and young adults in a tertiary care center in South India to assess the predictors of attempted suicide among them.

Materials and Methods

Study Setting

The study was conducted in the in-patient wards of a tertiary care medical hospital. The study was conducted in 2014, after clearance from the Human Ethics Committee.

Study Design

Qualitative exploratory study14 to explore the individual experiences and perceptions regarding the family factors associated with the suicide attempt among adolescents and young adults.

Sample Selection

Inclusion criteria: Participants were selected from adolescents and young adults (13-29 years of age) admitted with a suicide attempt. They were part of the larger quantitative study that looks at the predictors of attempted suicide among adolescents and young adults. Purposive sampling was used, allowing maximum variation in age, sex, geographical location, level of education, income, family history of suicide, and intent of the present attempt.

Exclusion criteria: Those with serious medical complications related to the attempt, those with known mental illness, and those not willing to give consent were excluded.

Data were collected from 22 subjects. After each interview, data analysis was done completely, and a decision about the subsequent interview was made by constant comparison method. This process continued until data saturation was reached, with no new themes coming from subsequent interviews.

Method

Patients admitted after suicide attempts and meeting the selection criteria were approached. In-depth face-to-face interviews were done after they became medically stable. Most of them were interviewed within one week of the attempt. Each interview lasted about 30 minutes and was conducted in Malayalam, the regional language. Sociodemographic data and relevant clinical details, such as family history and suicide intent, were collected. Suicide intent was assessed clinically, based on the person's response to the questions on whether he/she wanted to die, the method of attempt, and the circumstances (whether rescue measures were taken or not).

Interviewer: The first author, a consultant lady psychiatrist with an MD degree in psychiatry, who has attended training workshops on qualitative research techniques, conducted the interviews. The interviewer has an interest in suicidology and public health and has been working with suicidal patients for the last 10 years. Possible assumptions/bias regarding the study topic was addressed by a constant discussion with other members of the team.

Relationship with participants: Rapport was established before the in-depth interviews. Details regarding the research and the interviewer were explained to the participants, and the participant information sheet was provided. Two patients were excluded as they did not want to participate. Informed consent was taken from young adults who agreed to participate in the study. Informed assent was taken from adolescent participants, and informed consent from their parents was also taken for the study. Privacy and confidentiality were ensured at all stages.

Data collection: Semistructured format was used, with open-ended questions initially, followed by questions focusing on the participant's experiences and perception about the family environment and interaction, communication between the family members, decision-making and problem-solving within the families, and their socioeconomic background. The semistructured interview schedule was prepared by operationalizing the previous knowledge about family factors contributing to attempted suicide among adolescents and young adults. This preliminary interview schedule was pilot tested in four patients to confirm the coverage and relevance. Modifications were made accordingly, and the final interview schedule was formed. Probes and prompts were used when needed. An audio recording of the interviews was done. Field notes were made during and after the interview. All audio recordings were transcribed verbatim in Malayalam and translated to English. The transcripts were shown to six randomly selected participants for comments and corrections.

Figure 1. Framework Depicting Risk Factors.

Data Analysis

After each interview, data were entered and analyzed completely using the Web Embedding Fonts Tool Qualitative Data Analysis (Weft QDA 1.0.1)software. The decision regarding the next interview was made based on this. Data collection ended when data saturation was reached with no new themes coming from subsequent interviews.

Two data coders, familiar with the process, independently did the data analysis. After the first three interviews, they discussed the codes and revised when needed. This process of discussion and revision was done in between, using random transcripts. Participant feedback was taken in between.

From the available narratives, codes were developed using Weft QDA 1.0.1 software. Thematic analysis was done.15 Themes and relationships were identified. Themes were derived inductively from the data, using the process of open coding, creating categories and finding the inner meaning. Data were synthesized to form a framework that represents the summary of the data (Figure1).

Results

A total of 22 participants were interviewed. The characteristics of the study participants are shown in Table 1. The perceived home environment was hostile for most of the study participants. This was due to many factors within the family, like parental conflicts, conflict with a sibling or other members of family, unsupportive spouse, or difference of opinions between the family members living in the same home. Socioeconomic and cultural factors, like financial issues, superstitious beliefs, the stigma of having a family member with mental illness, and disturbing neighborhoods also contributed to suicidal behavior. Themes, subthemes, and illustrative quotes are summarized in Table 2.

Table 1.

Characteristics

Adolescents (13-19 Years) n = 7

Young Adults (20-29 Years) n = 15

Frequency

Percentage
(%)

Frequency

Percentage
(%)

Family history of mental illness/suicide

Present

4

18.2

10

45.5

Suicide intent

Low

5

22.7

9

40.9

Table 2.

Theme: Parental Issues

S. No.

Subthemes a

Quotes b

Theme: Problems with Siblings and Other Family Members

Theme: Marital Disharmony

Theme: Socioeconomic and Cultural Issues

1

Financial issues (5)

"Once the money is lost, everything is lost. Now I have no business, no friends, no support from family. No point in living this way." (P9)

Parental Issues

Parental factors included parental conflicts or separation, victimization as mentally ill, parents who are not open for friendly conversations, paternal addiction to alcohol, and a parent being mentally ill.

Parental conflicts disturbing the home environment was reported by many participants. Narrative from a young lady, aged 20 years (Participant number 12 [P12]], about her family environment is included in Table 2. Another participant, a 15-year-old girl [P8], expressed that her mother frequently called her "mad," and she was used to it. But, when her father said the same for the first time, she could not control her thoughts ( Table 2). The critical comments from her parents (being addressed as "mad") caused sadness, impulsive anger, and, finally, suicidal thoughts. Her perception, "nobody loves me," was echoed by many of the participants, which makes it clear that the dynamic interaction between family factors and the individual factors (how the individual perceives, interprets, and reacts) are important in determining the suicidal attempt. Among adolescents, a teenage girl (16 years, P15) had a relationship with a boy that raised issues at home, leading to suicidal attempt. Although she was open to her mother, her mother often become angry and critical towards her, and this prevented her from admitting the truth that she had received a mobile phone from her boyfriend. Her mother's critical comments made her feel helpless, and the perceived lack of family support led to the attempt. Illustrative quotes are included in Table 2. Another participant, a 26-year-old lady (P6), had a family history of mental illness in her mother who was taking treatment from the same hospital. The participant eloped with a man whom she married later on, but then, after delivering a female baby, she came to know that he is in a relationship with another woman. This made her leave him and stay with her mentally ill mother and grandmother who always fight with each other. She had never enjoyed parental affection and now feels that she and her child are a burden to her ill mother. Hostile family environment, lack of perceived family support, and probably, her inability to handle the stressful situation may have led to the attempt ( Table 2).

Problems with Siblings and Other Family Members

Many of them had difficulty interacting with siblings and others in the family. There was an adolescent girl, 14 years old (P19), who complained about her younger sister. She was talking of sibling rivalry, which led to disrespect, miscommunication, and the suicide attempt ( Table 2).

Family dysfunction owing to frequent quarrels, poor communication, and lack of collective decision-making was evident from some excerpts. Illustrative quotes from a 16-year-old boy (P7) and 20-year-old young lady (P3) are given in Table 2.

Marital Disharmony

Marital dysfunction due to alcohol abuse of the spouse, insecurity about children, or the spouse being manipulative and unsupportive was evident among young adults. Consistent blaming by the partner, feeling less valued by the partner and separation from a partner were also observed in young adults with marital disharmony ( Table 2).

Socioeconomic and Cultural Issues

Financial issues, superstitious beliefs, disturbing neighborhoods, and the stigma of having a mental health issue, in a family member, were also noted.

Families of many of them have bank loans and debts, which contributed to conflicts and dissatisfaction within the family. One of the participants, a 26-year-old male (P9), who had sustained a failure in business, felt helpless and suicidal when the financial resources were lost ( Table 2) Another participant (18-year-old boy, P11) was consistently complaining about the neighborhoods as disturbing. Disturbances were caused by drunkards, the filthy language used by neighbors, and frequent interference by police. He also feels that these neighbors cause all their misfortunes through black magic ( Table 2). The stigma of having a mental illness in a family member was evident from few excerpts. Appropriate quote from a 14-year-old boy is included in Table 2. Among the few who feel that their home was peaceful, both their parents were employed, and in most of the cases, it was their father who was the decision-maker. In other cases, it was the mother or own spouse who was the decision-maker. There was only one study subject who mentioned that decisions were taken by both parents. Except in a couple of instances where the family members collectively solved the problems, it was the mother who used to try to solve the problems within the family.

Discussion

Our study looked into the family context of adolescents and young adults belonging to the age group of 13-29 years. Family-level factors like a negative relationship with either or both the parents, family discord, whether the parents are living together or not, parental substance abuse, parental psychiatric disorder, and singleparent households are proven factors for suicidal risk among adolescents and young adults across the globe.5,16 Female gender, not attending school or college, lack of independent decision-making, physical abuse at home, psychological distress, and probable common mental disorders were associated with suicidal behavior in Indian youth.17,18

The decision to attempt suicide is a highly personal one, largely influenced by the individual's perception of his/her environment, relationships, and sociocultural milieu.19 Studies have shown that perceived family factors such as hostile family environment, critical comments and invalidation from parents, and lack of emotional support from family members influence suicidal behavior among adolescents and young adults.10-13 All these family-level risk factors emerged in this study as well.

Though nuclear families have increased, Indian culture still holds the tradition of joint families. An interesting finding that came from this study was that adolescents and young adults are at risk when cordial relationships and integration are absent between members of a joint family. This appears to limit and complicate the information-sharing space available for adolescents and young adults and, thus, results in a lack of collective decision-making and a problem-solving environment at home.

Other factors affecting adolescents and young adults, as found in the literature, are socioeconomic status or financial loss, education, relationships, status within the family, childhood adversities, a recent change in family roles, infertility, and family stability.20,21 In this study, young adult men attempted suicide due to factors like socioeconomic status and status in the family, whereas young adult women were more concerned about family roles and stability. As per the strain theory of suicide, sources of psychological strain are differential value conflicts, discrepancies between aspirations and reality, relative deprivation, and lack of coping skills. It is safe to assume that young adults would have experienced more sources of a psychological strain than adolescents.22

Parenting styles influence suicidal behavior. Studies have shown that "affectionless control," yielding to low levels of emotional warmth and high levels of parental control or overprotection, is associated with a threefold increase in the risk of suicide attempts.23

It is widely acknowledged that the stigma associated with mental health issues prevents people from disclosing their problems to others.24 This was evident from this study, as there were subjects who had a family history of mental illness. These family members did not receive proper treatment and follow-up care, and this might have led to inadequate family support in those who attempted suicide, when compared to others.

Strengths and Limitations

The strengths of the study are that the in-depth interviews were conducted by a consultant psychiatrist, ensuring privacy, confidentiality, comfort, and support to the patient. Purposive sampling helped to select persons with diverse sociodemographic and clinical variables. Credibility was ensured by prolonged engagement and persistent observation by the researcher. Coding analysis and interpretations were done and verified by two researchers. A member check was done by feeding back data and findings to some participants. Transferability was ensured by describing the individual's experiences and context. Attempts were made to describe the research steps transparently, to improve dependability and confirmability.

Limitations include the restricted generalizability of the study findings to other contexts or settings. Method and data triangulation was not attempted. Non-assessment of temperament/personality attributes and coping skills is another limitation.

Conclusion

This study explored the family factors that contribute to suicidal attempts among adolescents and young adults. The findings suggest that perceived family context, including disruptive family environment, faulty interactions between family members, and lack of perceived family support, plays an important role in determining suicidal behavior among adolescents and young adults. Hence, it is imperative to explore these factors in clinical practice while treating a person with a recent suicide attempt and while planning any suicide prevention strategies for them. Context-specific understanding of the individual distress, early identification of youth at risk, and family interventions involving multidisciplinary teams may help prevent suicide attempts.

Future research may include quantitative studies to systematically look at these risk factors and find the effectiveness of family-level intervention strategies. Further steps may include incorporating such successful interventions in suicide prevention programs for adolescents and young adults.

Footnotes

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author received no financial support for the research, authorship and/or publication of this article.

References

1. World Health Organization Suicide data, https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ (2019, accessed March12, 2020).

3. National Crime Records Bureau Accidental deaths and suicides in India. Report, Ministry of Home Affairs. New Delhi: Government of India, 2019. [Google Scholar]

14. Reiter B. Theory and methodology of exploratory social science research. Int J Sci Res Methodol, 2017; 5(4): 129-150. [Google Scholar]

15. Braun V and Clarke V. Using thematic analysis in psychology. Qual Res Psychol, 2006; 3(2): 77-101. [Google Scholar]

24. World Health Organization Preventing suicide: A global imperative, https://www.who.int/mental_health/suicide-prevention/world_report_2014/en/ (2014, accessed March12, 2020).

Articles from Indian Journal of Psychological Medicine are provided here courtesy of Indian Psychiatric Society South Zonal Branch

# data[].attributes.attachment_link.title
Exploring the Family factors associated with Suicide Attempts among Adolescents and Young Adults: A Qualitative Study

# data[].attributes.attachment_link.description
Suicides are among the leading cause of death among adolescents and young adults worldwide, including India. Suicide attempts are about 20 times more common than completed suicides. Teenagers and youth who attempt suicide belong to a heterogeneous ...

# data[].attributes.body
Teenagers with one or more mental or substance abuse problems are at risk for suicide.

# data[].attributes.attachment_link.readable_text
What is teen suicide?

Suicide is when a teen causes his or her own death on purpose. Before attempting to take his or her own life, a teen may have thoughts of wanting to die. This is called suicidal ideation. He or she may also have suicidal behavior. That's when a teen is focused on doing things that cause his or her own death.

Suicide is the third leading cause of death in young people ages 15 to 24. The CDC reports that:

Boys are 4 times more likely to die from suicide than girls.

Girls are more likely to attempt suicide than boys.

Guns are used in more than half of youth suicides.

What causes a teen to attempt suicide?

The teen years are a stressful time. They are filled with major changes. These include body changes, changes in thoughts, and changes in feelings. Strong feelings of stress, confusion, fear, and doubt may influence a teen's problem-solving and decision-making. He or she may also feel a pressure to succeed.

For some teens, normal developmental changes can be very unsettling when combined with other events, such as:

Changes in their families, such as divorce or moving to a new town

Changes in friendships

Problems in school

Other losses

These problems may seem too hard or embarrassing to overcome. For some, suicide may seem like a solution.

Which teens are at risk for suicide?

A teen's risk for suicide varies with age, gender, and cultural and social influences. Risk factors may change over time. They are:

One or more mental health conditions, including substance use disorder

Impulsive behaviors

Undesirable life events or recent losses, such as the death of a parent

Family history of mental or substance use disorder

Family history of suicide

Family violence, including physical, sexual, or verbal or emotional abuse

Past suicide attempt

Gun in the home

Imprisonment

Exposure to the suicidal behavior of others, such as from family or peers, in the news, or in fiction stories

What are the warning signs of teen suicide?

Many of the warning signs of suicide are also symptoms of depression. They are:

Changes in eating and sleeping habits

Loss of interest in usual activities

Withdrawal from friends and family members

Acting-out behaviors and running away

Alcohol and drug use

Neglecting one's personal appearance

Unnecessary risk-taking

Obsession with death and dying

More physical complaints often linked to emotional distress, such as stomachaches, headaches, and extreme tiredness (fatigue)

Loss of interest in school or schoolwork

Feeling bored

Problems focusing

Feeling he or she wants to die

Lack of response to praise

Another warning sign is making plans or efforts toward committing suicide:

Says "I want to kill myself," or "I'm going to commit suicide."

Gives verbal hints, such as "I won't be a problem much longer," or "If anything happens to me, I want you to know ...."

Gives away favorite possessions or throws away important belongings

Becomes suddenly cheerful after a period of depression

May express weird thoughts

Writes 1 or more suicide notes

These signs may look like other health problems. Make sure your teen sees his or her healthcare provider for a diagnosis.

How is a teen diagnosed as being suicidal?

Threats of suicide are a cry for help. Always take such statements, thoughts, behaviors, or plans very seriously. Any teen who expresses thoughts of suicide should be evaluated right away. Talk with your teen's healthcare provider.

Any teen who has tried to commit suicide needs a physical checkup first to rule out life-threatening health problems. He or she should then get a mental health evaluation and treatment until he or she is stable. This often will take place at an inpatient facility to make sure of the child's safety.

How is a teen treated for suicidal behavior?

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment starts with a detailed evaluation of events in your teen's life during the 2 to 3 days before the suicidal behaviors. Treatment may include:

Individual therapy

Family therapy. Parents play a vital role in treatment.

An extended hospital stay, if needed. This gives the child a supervised and safe environment.

How can I help prevent my teen from attempting suicide?

Learning the warning signs of teen suicide can prevent an attempt. Keeping open communication with your teen and his or her friends gives you an opportunity to help when needed. Also take these steps:

Keep medicines and guns away from children and teens.

Get your teen help for any mental or substance use problems.

Support your teen. Listen, try not to offer undue criticism, and stay connected.

Become informed about teen suicide. Resources include the public library, local support group, and the internet.

Know the warning signs for depression:

Feelings of sadness, hopelessness, or loneliness

Declining school performance

Loss of interest in social and sports activities

Sleeping too little or too much

Changes in weight or appetite

Nervousness, agitation, or irritability

Teens can take these steps to help prevent suicide if they see warning signs in a friend:

Take their friend's behavior and talk of suicide seriously.

Encourage their friend to seek expert help. Go with the friend, if needed.

Talk with an adult they trust about their friend.

When should I call my teen's healthcare provider?

Call your teen's healthcare provider right away if your teen:

Feels extreme depression, fear, anxiety, or anger toward him or herself or others

Feels out of control

Hears voices that others don't hear

Sees things that others don't see

Can't sleep or eat for 3 days in a row

Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your teen has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Key points about teen suicide

Suicide is when a teen causes his or her own death on purpose.

Suicidal ideation is when a teen has thoughts of wanting to die.

Suicidal behavior is when a teen is focused on doing things that cause his or her own death.

Normal developmental changes combined with stressful life events may cause a teen to think about suicide.

Many of the warning signs of suicide are also symptoms of depression.

Any teen who expresses suicidal thoughts should be evaluated right away.

Next steps

Tips to help you get the most from a visit to your child's healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child's condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child's provider after office hours. This is important if your child becomes ill and you have questions or need advice.

# data[].attributes.attachment_link.description
Suicide is when a teen causes their own death on purpose. Before attempting to take their own life, a teen may have thoughts of wanting to die. This is called suicidal ideation. They may also have suicidal behavior. That's when a teen is focused on doing things that cause their own death.

# data[].attributes.body
"Suicide is a leading cause of adolescent death (McLoughlin et al. 2015), and suicidal thoughts and behaviors (STBs) contribute to disability among youth worldwide (Gore et al. 2011)."

# data[].attributes.attachment_link.description
Stress exposure is central to theories of suicide. To advance understanding of the relation between stress and suicide, we examined whether specific, theoretically-pertinent life stressors were differentially related to suicidal thinking versus…

# data[].attributes.body
Divorced parents, family deaths, and unhealthy sibling relationships are some examples of how a home can be unstable.

# data[].attributes.body
There are many warning signs that a teenager is feeling suicidal. A study by Johns Hopkins Medicine lists examples including "changes in eating and sleeping habits, loss of interest in normal activities, withdrawal from friends and family members, acting-out behaviors and running away, alcohol or drug use" etc. (Medicine). Looking out for these signs can help prevent suicide in teenagers.

# data[].attributes.body
Not only does your child need you to create a stable home, but also a good communication system. The Johns Hopkins Medical study on teen suicide points out "the important piece is the fact your child knows you are approachable and nonjudgmental when help is critically needed" (Medicine).

# data[].attributes.body
If a teen shows threats of suicide must be well supported by the family and friends around them. As reiterated by Johns Hopkins Medical in the study on teen suicide, "any young person who expresses thoughts of suicide should not be left alone and should be assessed right away" (Medical).

# data[].attributes.body
Substance abuse may lead teenager's brains not to function correctly and bring thoughts of self-harm.

# data[].attributes.body
Suicide is one of the most heartbreaking causes of death for the ones committing to the families and friends experiencing losing their loved ones for reasons they feel they could have prevented. It is important to catch when someone we love is feeling this way to avoid this from happening.