Suicide ain’t painless: report reveals the most effective killer of European teens

A recent report by the World Health Organization revealed that suicide has quietly crept up the ladder and become the leading killer of teenage girls worldwide. The estimates, largely based on the WHO mortality database (a global vital registration and cause-of-death registry that is created from data provided by its member states), reveal data across 172 member states for 2012. 

Although the absolute number of suicides has fallen by about 9% around the world since 2000 – despite an increase in the global population – the figures glaringly show that more girls aged between 15 and 19 die from self-harm than from road accidents, diseases or complications from pregnancy around the world.

The difference might be a result of the developments in medicines and health services in many regions of the world, which is resulting in less fatalities, but this drop has finally shed light on one of the greatest taboos of our time: teen suicides.

Local experts who spoke to this newspaper emphasised how a frank and non-stigmaitising discussion on suicide and its causes would be the healthiest step forward, ensuring that the many psychological factors that lead to young suicides are nipped in the bud, and placed in the appropriate context. 

Head of the crisis team at Mater Dei University hospital Dr Mark Xuereb pointed out that suicide rates varied according to the location in question, but that shockingly suicide retained the top spot as a killer for teenage girls even in Europe. He explained that suicides in teenage girls were more common in Asia, where women were traditionally submissive to men.

“In these countries suicide is often a response to overwhelmingly restricting changes that the girls can’t handle. Some girls are pushed into marriages at a very young age, or they suffer sexual and physical abuse in complete and expected silence,” Xuereb said.

Self-harm and social media

Xuereb – a suicidology specialist – pointed out that self-harm had also become an almost ‘in-trend’ thing to do for girls, whether it was attempted to end life or not.

“Girls, who often tend to be more reflective than boys, often suffer in silence and find solace on social media pages on Tumblr or Facebook. Social media can sometimes be helpful as people find like minds to share their troubles with, but the truth is there are also groups that encourage things like self-harm, saying it can be cathartic.”

Xuereb added that related issues like body image could also play a part: the constant bombardment of Photoshopped celebrities could dent girls’ self-esteem, while boys are known to be cruel to girls that don’t necessarily conform to the established beauty standard.

“There seems to be a sense of universality and of group therapy that seems to take over teenage girls’ virtual selves, which means they look for help in the wrong places,” he stressed.

Chairman of Fondazzjoni ghal Sahhtek and psychiatrist Dr Anton Grech added that the role of the media and social media could not be forgotten. 

“The copycat suicide phenomenon has become harder to control given user-controlled media, like videos posted on-line that go viral,” he said explaining that some news was spreading despite the sensitivity employed by the media. 

Xuereb explained that although statistics for Malta showed that the bulk of suicides locally were committed by males in the 36-59 age group, self-harm among teenage girls was becoming increasingly common. According to police statistics, 74 suicides of the total of 128 between 2000 and 2014 had been committed by men in the 36-59 age group, as opposed to five suicides for people under 18, in the same period.

He also explained that self-harm was not always intended as a way to kill themselves and that on average, for every girl that committed suicide, an estimated 100 other girls would resort to cutting themselves.

“Suicide can sometimes be rational; a response to bullying or perhaps even some form of depression,” he said, adding that the taboo surrounding psychological problems often made matters worse.

Breaking the taboo

Clinical psychologist and trainee sexologist Dr Nicholas Briffa agreed that in Maltese society, most people are uncomfortable with the topic of suicide, especially that of teen suicide.

“Too often, victims are blamed, and their families and friends are left stigmatized. As a result, people do not communicate openly about suicide,” Briffa said adding that an important public health problem is therefore left shrouded in secrecy, which limits the amount of information available to those working to prevent suicide.

Briffa added that an important preventive factor for teen suicide is that of stimulating the education and discussions about suicide. 

Xuereb further explained that all too often, suicide, at whatever age, was a result of self-disenchantment.

“People sometimes feel like they have run out of options, but that’s never the case, and Crisis Centres are there for that reason,” he said, emphasising the role of private lines like Crisis Resolution Malta. 

“There are whole teams of people who are ready to offer people other options, and that’s something people can only know if they engage in an active discussion of their negative thoughts or tendencies rather than treating them like a taboo,” he said.

“Going by my experience as a psychiatrist, many survivors of suicide have admitted that they ultimately decide to kill themselves because they feel they have run out of options.”

Xuereb said that one of the ways to battle this would be through a nationwide effort both to identify people suffering from depression or other issues early, and to create more groups where people with suicidal tendencies feel safe, citing international examples such as the particularly suicide-afflicted Japan, where workplaces are come equipped with suicide prevention facilities.

 Suicide triggers

Pointing out how the majority of young people who commit suicide are believed to have had a mental disorder – such as depression – which would have tragically gone undiagnosed or untreated, Briffa explained that three factors could trigger serious suicidal attempt among young people.

“The first is an acute event, such as a disciplinary crisis. An example would be a humiliating event or breaking up with a girl- or boyfriend. The second trigger is any factor that alters the adolescent’s state of mind, which includes marked hopelessness, an obsession with looking good, rage, or intoxication with drugs or alcohol. The third proximate factor is the opportunity for suicide.” 

Briffa also observed that the method that young people use to kill themselves varies according to where they live, suggesting that it is, in part, determined by practical matters. Xuereb also made mention of the latter fact, explaining that the higher the means and access to weaponry there is, the more frequent suicides become. However, he stressed that it’s easy to talk about numbers and forget the human beings behind it all.

“People who understand that there is help at hand early on in life would hopefully not resort to it again later on in life,” Xuereb said, emphasizing that the best way to tackle such a tragic issue was creating a nationwide prevention strategy.