Adolescents at risk: causes of youth suicide in New Zealand.

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Adolescents at risk: causes of youth suicide in New Zealand. Wilhelmina J. Drummond.

Adolescence, Winter 1997 v32 n128 p925(10)

The New Zealand suicide rate among 15- to 19-year-olds has almost trebled over the past 20 years - from 5.8 per 100,000 in 1970 to 15.7 in 1991 (UNICEF, 1994). New Zealand has one of the highest teenage suicide rates among industrialized countries. The aim of this paper is to shed light on the causes of this phenomenon by examining environmental-social factors. Some of the problems New Zealand youth face are noted and their risk-taking behaviors explored. Findings are linked to current theory on adolescent suicide. How governmental agencies are addressing this problem is discussed.

A United Nations report, The Progress of Nations (UNICEF, 1994), recently ranked New Zealand as having one of the highest teenage suicide rates among industrialized countries. The aim of this paper is to examine the environmental-social factors that could explain this phenomenon. First, demographic information on suicide, gender, bicultural differences, suicide attempts, and methods used is presented. Second, the literature on youth suicide in New Zealand is reviewed. Third, a psychosocial analysis considers the causes of suicide, specifically the developmental features of adolescence and changes in New Zealand society currently challenging its youth. Fourth, prevention, intervention, and treatment initiatives, adapted to the New Zealand situation, are examined.

DEMOGRAPHIC TRENDS

New Zealand is similar in size to Great Britain (270,500 square kilometers; New Zealand Official Yearbook, 1994) and consists mainly of two islands - North Island and South Island. It has a population of 3.5 million and is bicultural: 9.5% are Maori or of Maori descent, with the majority being mainly of European descent. However, the society is becoming increasingly multicultural with the immigration of Pacific Islanders and Asians (Public Health Commission, 1994). It is estimated that half a million are aged 15-24, the age group considered to be at greatest risk of committing suicide.

Suicide in the 15-19 age group has increased over the last twenty years, from 5.8 per 100,000 in 1970 to 15.7 in 1991. In 1991, the suicide rate for the 20-24 age group was 31.3 per 100,000, with the increase much higher among males than females (Aldridge, 1994). Thus the peak suicide rate occurs in the twenties, not in the teenage years (Joyce & associates, 1994). Nevertheless, for the joint 15-24 age group, the suicide rate is highest. Suicide is very rare under age 15 (Townsend, 1993; Joyce & associates, 1994). [ILLUSTRATION FOR FIGURES 1 AND 2 OMITTED.]

Suicide is the second most common cause of death for young people, the first being motor vehicle accidents (Joyce & associates, 1994). Of the leading causes of death in the total population, youth suicide was ranked tenth in 1989 (Townsend, 1993). Although official suicide rates are evidence of the magnitude of the problem, they do not give a complete picture of this phenomenon. For every teenager who is recorded as having completed suicide, many more have attempted it. Also, even though statistics show increasing rates of suicide among young people, they do not show that suicides are probably underreported, because coroners often have difficulty deciding whether a death was due to suicide and may not report it as such.

Males aged 15-19 commit suicide at the rate of 26.9 per 100,000, while the rate for teenage girls is only 3.6 (Aldridge, 1994). Youth suicide therefore remains a predominantly male problem (Townsend, 1993). But while young males tend to successfully kill themselves, Tan (1991) indicates that significantly more women attempt suicide, with those aged 17 and 18 being the most vulnerable. Women are more likely than men to be admitted to a hospital for a suicide attempt, and women in the 15-24 age group are more likely to attempt suicide than are women in other age groups (Tan, 1991; Disley, 1994).

Males are more successful in committing suicide because they use more irreversible means (Disley, 1994). Aldridge (1994) reported that between 1980 and 1990, there were clear gender differences in the methods chosen by young people. Males used hanging, strangulation, and suffocation, followed by firearms and explosives. Females chose hanging, strangulation, and suffocation, followed by poisoning.

In comparing the bicultural groups, since 1970 the suicide rate for non-Maori males aged 15-24 has generally been higher than that for Maori males (Public Health Commission, 1994). Both male groups show an increasing trend, with a dramatic increase beginning in 1985 (Disley, 1994). During 1985-1990, the suicide rate for non-Maori males aged 15-24 increased by 33%; the rate for Maori males in the same age group doubled during 1985-1989, but declined in 1990. The fluctuation in Maori suicide is largely due to the small number of cases involved (New Zealand Health Information Service, 1994). For females, both Maori and non-Maori suicide rates remained relatively stable from 1970 to 1990, with a slight increase in the last five years (Disley, 1994). For both Maori and non-Maori, the annual suicide rate for females aged 15-24 was consistently lower than for males in the same age group (Public Health Commission, 1994). Other minority group rates are still relatively insignificant compared with the rest of the population (New Zealand Health Information Service, 1994), but the cultural nature of their suicides must not be ignored.

REVIEW OF THE LITERATURE

This section focuses on the contemporary status of youth suicide in New Zealand, with research studies following along the lines of the three main foundations: sociological, in the tradition of Durkheim (1897/1951), psychoanalytic, in the tradition of Freud (1925/1961) and Blos (1976), and the ecological-contextual approach, as introduced by Erikson (1950), Bronfenbrenner (1977), and Vygotsky (1962).

The work of Antoniades (1988) marks a turning point in New Zealand's approach to suicide in that it points out cases where suicide could have been prevented by a shift in emphasis from treatment of potential suicide patients to prevention and early intervention. He is one of the few who considered the grieving survivors also to be at risk.

[Expanded Picture] The impetus to focus on adolescents at risk in New Zealand came from Porirua College, which in 1993 mounted the first national conference dealing with at-risk secondary school students, drawing skilled practitioners to participate in workshops. The Porirua College initiative marked the beginning of proactive identification of risk factors. Their survey of 350 state and integrated secondary schools (Indicative Survey of At-Risk Students in New Zealand Secondary Schools, 1993) identified the following: financial hardship, truancy, abuse, behavioral problems, involvement with police, and transience. One can add Morrell's indicators (1994): physical disorders, malnutrition, and illnesses.

Guidelines on the Management of Suicidal Patients was released by the Ministry of Health (1994) to establish minimum standards of care in the clinical management of suicidal patients. It was generally accepted that 94% of people who committed suicide were suffering from a mental illness, most commonly depression, alcohol-related disorders, or schizophrenia. It was recognized that the increase in suicide by young people probably reflected a number of social pressures, thus requiring a review of current health-management strategies. The move for active treatment to allow individuals to return to their families, homes, and jobs demonstrated an important shift from custodial care in large psychiatric institutions.

An overview of suicide research was provided by the journal Community Mental Health in New Zealand in May 1994. An update on suicide and parasuicide in the Auckland region was included (Fanslow & Norton, 1994). The Canterbury Suicide Project investigated individual histories of suicides and attempted suicides. Preliminary findings identified high rates of depression, antisocial behavior, and alcohol and drug problems. Sullivan (1994) also related high suicide risk to compulsive gambling. Cogan and Norton (1994) investigated ways of reducing self-directed harm.

The latest development is the "Mental Health Promotion Strategy for the Prevention of Youth Suicide," released by the Public Health Commission (1995), which seeks to promote mental health and reduce suicides through specific public-health initiatives. It has been distributed to institutions throughout New Zealand for review.

SOME CAUSES OF ADOLESCENT SUICIDE IN NEW ZEALAND

There are special features of adolescence that make young people particularly vulnerable. It is a relatively unstable period during which rapid changes in all domains of development take place, resulting in an identity crisis (Erikson, 1968). This may set the stage for suicide, especially when combined with particular social conditions.

Kiell (1964) has provided accounts from famous people in history who toyed with suicide in adolescence. These included Napoleon Bonaparte, Gandhi, and Anthony Trollope. He conjectured that their actions resulted from a revival of the oedipal conflict, leading to anxiety and precipitating morbid feelings of depression. He claimed that it is common for psychoneurotic depression and suicidal fantasies and impulses to appear during adolescence. Indeed, adolescence is the period when people start thinking about their own mortality. This results in ambivalent feelings about the gloriousness of life and the comforting fantasy of death as a simple answer to the problems of the human condition.

Adolescence is the period in which the individual must establish a sense of identity, overcoming role diffusion and identity confusion (Erikson, 1950). The search for identity involves establishing a meaningful self-concept in which past, present, and future are brought together to form a unified whole. The adolescent who fails in this task will be susceptible to indulging in a self-destructive activity, including suicide (Baumeister, 1986).

In many Western countries, career identity is dominant. Adolescents who do not establish a work or academic career fail to gain the identity required by adult standards. Khan (1986) has stressed that historically in New Zealand, schools socialized the young for adult roles and work, which are central to self-concept.

The identity crisis is greater for young people during this period in history in which the stable family and community traditions have been eroded or lost. For many developing and advanced countries, the present is characterized by social change, and the future has become much less predictable (Muuss, 1990). Durkheim (1897/1951) noted that at each moment of its history, each society has a definite aptitude for suicide. Could it be that New Zealand, Australia, and other advanced nations are at a crossroad where the tremendous social, economic and political changes make it too difficult for the young to find their place in society?

Disley (1994) has recognized that there is a paucity of research into the area of suicide prevention. Antoniades' study (1988) of suicide during 1961-1988 showed that for adolescents 15-19, mainly males, the following were high-risk indicators: having been born overseas, having parents who separated, being a sickness beneficiary or inpatient, having relationship problems, and having psychiatric problems. Joyce's research has pinpointed current New Zealand factors: high rates of depression, alcohol use, and drug use; family dysfunction; sexual abuse; and repeated serious suicide attempts. Townsend (1993) has added antisocial behavior and unemployment to this list. Adding the international findings to those from New Zealand, the list becomes more extensive: psychiatric disorder; stressful life events (e.g., breakdown of an