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Senior High School Department
S. Y. 2019 – 2020

The Perception of Selected of Psychologist toward

Treating Suicidal Person

CHAPTER II

Research of Related Literature

Suicidal behavior is clearly developmentally mediated. For example, according to the Center

for Disease Control and Prevention (CDC) data for 1999 to 2005, there were no suicides among

children ages 4 and younger (Centers for Disease Control and Prevention, 2008a). The rate of

suicide for children ages 5 to 9 was quite low, 0.02 deaths per 100,000. In contrast, the rate of

death by suicide for 10- to 14-year-olds, 15- to 19-year-olds, and 20- to 24-year-olds was 1.28,

7.79, and 12.27 per 100,000, respectively (Centers for Disease Control and Prevention, 2008a).

The rates were higher through adulthood (e.g., 13.76 and 14.61 per 100,000 for 25- to 44-, and

45- to 64-year-olds, respectively) and were particularly high for men over the age of 65 (28.64

and 4.03 per 100,000 for 65-to 84-year-old men and women, and 50.32 and 3.76 per 100,000

for 85+ year-old men and women, respectively; CDC, 2008a). Likewise, rates of suicide

attempts change as a function of age. In studies of both clinical and community-based samples,

youth show increased rates of suicide attempts from early-to mid-adolescence (Angle, O’Brien,

& McIntire, 1983; Kovacs, Goldston, & Gatsonis, 1993; Lewinsohn, Rohde, Seeley, & Baldwin,

2001). Results of at least one epidemiologic study have suggested that rates of suicide attempts
may then decline after adolescence, especially among females (Lewinsohn et al., 2001). Among

older adults, the rates of nonlethal suicide attempts to death by suicide are much lower than

they are for younger populations (Conwell & Thompson, 2008; Friedmann & Kohn, 2008).

Suicidal behaviors may have different characteristics and pose different burdens as individuals

develop across the lifespan. Nonetheless, nonlethal suicidal behavior in adolescence is a

particular public health problem because of the high rates of suicide attempts during this

developmental period (Centers for Disease Control and Prevention, 2008b), and because

nonlethal suicidal behavior is one of the primary reasons for child psychiatric emergency room

visits and hospitalizations (Goldstein, Frosch, Davarya, & Leaf, 2008; Peterson, Zhang, Saint

Lucia, King, & Lewis, 1996) and one of the best predictors of future attempts and deaths by

suicide (e.g., Joiner et al., 2005). In addition, despite the fact that deaths by suicide are

relatively low during this period compared to the rates for older men in particular, suicide is

nonetheless the third leading cause of death in this age group (Centers for Disease Control and

Prevention, 2008a). While an extensive discussion of the developmental nuances and

considerations for interventions for suicidal behavior across the lifespan is beyond the scope of

the current review and paper, it could be argued that interventions for mental health problems at

different points in the lifespan should be developmentally tailored, and yet they often are not.

For example, interventions for suicidal behaviors and risk among elders need to consider the

fact that older individuals, especially older males, do not as readily disclose mental health

difficulties or seek mental health services relative to individuals at other ages (Conwell &

Thompson, 2008). It particularly is the case that interventions for the mental health problems of

youths, including suicidality, are not developmentally tailored (Weisz & Hawley, 2002). Rather, it

is often the case that adolescents are treated with variations of interventions originally

developed for adults (Weisz & Hawley, 2002).

Developmentally, adolescents differ from younger youth and from adults in ways that may

increase their risk for suicidal behaviors. For example, adolescents may be more impulsive and

may have a different time perspective than adults, and may focus more on proximal

consequences of behavior than more distant goals when making decisions (Nurmi, 1991; Reyna

& Farley, 2006). Suicidal behavior of adolescents also occurs in different contexts than the

suicidal behavior of older individuals. For example, adolescent suicidal behavior often occurs in

the context of family conflict, including strivings for autonomy, in the context of academic and

disciplinary difficulties, or as a consequence of disruptions in peer relationships that are

increasing in importance as youth get older.

In sum, suicidal behavior is increasingly prevalent during adolescence and needs to be

considered in a developmental context. Likewise, intervention efforts for adolescent suicidal

behavior need to be appropriate to the developmental level, and to the peer, family, and school

contexts within which suicidal behavior of adolescents occurs. The purposes of this paper are

therefore twofold. First, we review the literature regarding controlled studies of psychosocial

treatment interventions for reducing or preventing the recurrence of adolescent suicidal

behavior. Although there have been other reviews of some of the studies described

(e.g., Macgowan, 2004), this particular review is focused primarily on the developmental

nuances of these interventions. Second, for future intervention development and refinement, we

discuss developmental considerations important in the treatment of suicidal adolescents.

Research of Related Studies

Suicide is the taking of one’s own life. It is a universal concept and happens all over the

world. Ahrens, Linden, Zaske and Berzewski (2000) define suicidal behaviour as ranging from

feeling that life is not worth living to thoughts of suicide and suicidal acts. According to Durkheim

(as cited in Williams, 1997) there are three types of suicide. In other words three categories,
which reflect a breakdown in the relationship between the individual and society. Egoistic

suicide incorporates the notion that an individual has no concern for their community and no

interest in being involved in it. There is a lack of meaningful social interactions and therefore a

low level of social integration, as exemplified in urban areas, as opposed to rural areas. Madu

and Matla (2003) studied the prevalence of suicidal behaviours among secondary school

adolescents in the Limpopo province and found that rates of attempted suicide were highest in

urban areas. This fits with the above theory as urban areas and townships are known for low

adherence to cultural and traditional values. This causes acculturation, which is the breakdown

of family ties and an increase in social misconduct, leading to egoistic suicide. However, this

study found no significant relationship between place of residence and plans to commit suicide

or attempted suicide. In systems (families) 10 where the boundaries between the system and

the surrounding community are impervious, the family becomes isolated from the social

environment in which they exist (Barker, 1992). This has potentially negative effects on the

adolescent, who is struggling to develop an independent autonomy.

Synthesis of Related Literature

Suicide and attempted suicide are major public health concerns. At least 804,000 people

take their own lives annually and 25 times that number attempt suicide (WHO, 2014). In recent

decades, there have been many welcome developments in understanding and preventing

suicide, as well as good progress in intervening with those who have attempted suicide. Despite

these developments, though, many challenges remain. In this article, we explore both the recent

developments and the challenges ahead for the field of suicide research and prevention.

Instead of relying solely on our individual perspectives, we consulted experts in suicide research

and prevention from across the globe. To this end, we contacted all of the contributors to the
2nd edition of the International Handbook of Suicide Prevention (O’Connor and Pirkis, 2016)

and asked them to nominate, in their view (i) the top 3 most exciting new developments in

suicide research and prevention in recent years, and (ii) the top 3 challenges in the field of

suicide research and prevention. We were fortunate to receive responses from about one third

of the authors representing 12 countries and spanning four continents (see section

“Acknowledgments”). We reviewed their nominations, combined them where they described an

overarching theme and then classified them into whether they referred to research or practice 1.

We also expanded upon their brief comments and added supporting references (largely in the

new developments sections) to elucidate the specific development or challenge. Needless to

say, these are fuzzy boundaries and some of the entries could be classified into more than one

category. It is important to highlight that this Perspective article is not a review of the literature,

although we did draw from the suicide research literature to obtain evidence to elucidate the

responses from the contributors. Given the nature of the task, some of the new

developments/challenges are very specific and others are more general. The interpretations of

the contributors’ submissions are ours and do not necessarily reflect those of the individual

contributors. It is also important to emphasize that this appraisal of the developments and

challenges within the field is not exhaustive and it reflects our biases and those of the

contributors; it is our combined view (together with our international experts’ views) of the recent

past within the field and our thoughts about the future. It could also be argued that, as the

contributors all wrote chapters for a single handbook, they are all like-minded individuals with a

particular view on suicide prevention. Nonetheless, we believe that this synthesis will be helpful

to guide those involved in suicide research and prevention as it highlights hot topics in the field.

We also highlight at the outset that despite the developments in understanding suicide risk, our

ability to predict suicide remains no better than chance and in many countries across the globe

suicide rates continue to increase (O’Connor and Pirkis, 2016; Franklin et al., 2017).
Synthesis of Related Studies

The use of new technologies (including social media and naturalistic real-time monitoring via

smartphones) to increase understanding of suicidal behavior and to better identify suicide risk

were the most frequently cited new research developments nominated by our contributors (see

Panel Panel1).1). With the proliferation of smartphone ownership globally, in low- and middle-

income countries (James, 2014) as well as in high-income countries, the growth in interest is not

surprising (de Beurs et al., 2015). Given the field’s continued inability to predict suicidal behavior

with sufficient sensitivity/specificity (O’Connor and Nock, 2014; de Beurs et al., 2015; Franklin et

al., 2017), the use of smartphone technologies affords the opportunity to assess risk factors

repeatedly, in real-time and in naturalistic settings (de Beurs et al., 2015; Michaels et al., 2015).

It is hoped that the use of such technologies will better capture the ‘waxing and waning’ nature

of suicidal ideation (Joiner and Rudd, 2000; Zisook et al., 2009) and account for the complex

interaction between the risk factors which predict the transition to suicide attempts (de Beurs et

al., 2015; O’Connor and Kirtley, 2018). If the promise of new technologies is realized, individuals

or clinicians may be able to better identify windows of acute risk in real-time (based, in part, on

social media and moment-to-moment monitoring), alert others and hopefully receive

interventions to alleviate that risk. Needless to say, there are many practical and ethical barriers

that have yet to be overcome, but they are not insurmountable.