Since such a complex range of factors contribute to suicide, it cannot easily be predicted. A combination of underlying risk factors and recent events increase the likelihood of a suicide attempt. Four factors in particular stand out as precursors to suicide: prior attempts, mental illness, substance abuse, and social factors. When any one or a combination of these factors are present, an event perceived as devastating to the individual may precipitate an attempt.
Those with a history of mental illness are at increased risk for suicide. Suicide and suicide attempts are linked with depression, schizophrenia, bipolar disorder, conduct disorders, and personality disorders. Clinical depression is the most prevalent of these in completed suicides. "Hopelessness is a significant component of depression and emotional well-being. . . . Hopelessness . . . has been shown to be a key psychological factor in suicidal behaviors." (Page, Allen, Moore, & Hewitt, 1993) Too often depression in young people goes untreated, because it is not recognized or it is assumed to be a normal part of adolescence. Prolonged periods of sadness are not a normal part of growing up. Suicide risk should be assessed in anyone who is depressed.
Drug and Alcohol Abuse
"Drug involvement . . . has been linked with both depression and suicidal ideation . . . among adolescents." (Thompson, Eggert, & Moody, 1994) Young people who abuse alcohol and drugs are at higher risk of suicide. The reasons for this may be that substance abuse causes an increased impulsiveness effect and social problems. Such abuse is frequently a deliberate part of the attempt itself. "More than half of all adolescent suicides and suicide attempts are associated with alcohol. In other words, the person who attempts or commits suicide has often been drinking immediately prior to the attempt." (Marcus, 1996, p. 69) The social effects of substance abuse increase the likelihood of suicidal behavior. Substance abuse is known to cause problems with relationships, impairment of coping skills, increased impulsiveness, and depression. Substance abuse by itself does not cause people to want to take their own lives, but it does increase the risk for people with other vulnerabilities.
Since there is such a immense range of social factors contributing to suicidal behaviors, only two will be discussed here. Family instability and poor peer relationships appear to be the most important contributing factors in the lives of young people. Poor relationships with parents, divorce, and domestic violence have been associated with increased risk of youth suicide. Events that may precipitate an attempt may be a severe conflict with a parent, an episode of domestic violence, divorce, or the loss of an important family member.
Good peer relationships are an important part of a healthy adolescence. Garfinkel and Northrup (1989) report:
A powerful force in diminishing or enhancing future self-destructive impulses is peer support or pressure. The overwhelming response adolescents provide when asked who they would turn to when considering suicide is a 'friend.' If friends are dysthymic and flirt with death through drugs, . . . or careless . . . driving, risk of harm is enhanced. If friends chosen are supportive and have a number of coping skills themselves, such as use of friends and family when in trouble, seeking professional help when necessary, . . . risk of future harm is lessened (p. 37).
Loneliness and isolation, in the presence of depression, and substance abuse, can all increase the risk of suicide. When there have been previous attempts, this risk is even greater.
When these and other risk factors are present, an event perceived as devastating to an individual may precipitate an attempt. Most young people who commit suicide do so after experiencing some type of stressful event. "The breakdown of a current love relationship . . . is an important factor. . . . Not uncommonly vulnerable adolescents cling desperately to one single intense relationship which, upon failing, precipitates deep disappointment, depression and suicidal behavior." (Otto, 1972, as cited in Garfinkel & Northrup, 1989) Family disputes, school problems, pregnancy, legal problems, and sexual assault are other common precipitating events.
Young people with inadequate problem-solving and ineffective coping skills are believed to be more vulnerable to suicidal behaviors, especially when subjected to multiple stressors. "Precipitating stressful life events and circumstances have been linked with suicidal behaviors, particularly stressors related to interpersonal relationships, family and school performance problems." (Thompson et al., 1994) There is no single reason that can explain why a person would decide to commit suicide. Some individuals may endure many of the predisposing conditions that are linked with increased risk and experience no vulnerability. Others may experience only a few of these conditions and complete suicide. Therefore, identifying risk factors does not allow suicide to be predicted.