Other than murder, suicide is probably the most painful loss experienced by the families and friends of the deceased. This is especially so when the deceased was young, appeared to be healthy, and any signs of depression or suicidal intent were absent, overlooked, or minimized.
Since 1958. the suicide rate among teenagers in the United States has tripled. The rate may be even higher because some accidental deaths may actually be suicides. The nation's concern about teenage suicide has been heightened, as illustrated by the number o\' national conferences, films made for television, and national news coverage about the subject.1 Congress has also enacted legislation concerning teenage suicide, including designating June 1985 as "Youth Suicide Prevention Month." appropriating funds for grants for the development of prevention programs, and establishing a commission to conduct a study of the problem of youth suicide. Since 1985, at least 10 books on the subject have been published.2,11
In view of the reported increase in suicide - both attempts and completions - among minority youth, this issue of Psychiatric Annals focuses on these populations, especially as. with few exceptions, they have been given limited attention by researchers. In the introductory article. Husain highlights psychological factors that play a significant role in adolescent suicide. He calls attention to the important roles that racial and cultural variables play. A number of his observations, coupled with statistical findings from other sources, warrant in-depth studies. For example, we know that black children and adolescents with disordered behaviors are overrepresenled in the diagnostic category o\ conduct , disorder. Might a sizable percentage of these youngsters be among those Husain describes? "Depression in adolescents frequently may be manifested as conduct disorder and therefore may be missed as a suicide risk factor." In his reference to an earlier studv, Husain underscores familvrelated conflicts as a significant psychosocial factor in triggering suicidal behavior of adolescents.
Each of the contributors provides a literature review that is of particular significance to the focal point of their specific sections. The need for research in each of the topic areas also is addressed.
Thompson and Walker fulfill their stated goal to "assess the present state of knowledge about Indian adolescent suicide and evaluate progress or lack of progress during the 1980s." They question the validity oi reports that identify alcoholism and depression as primary causal factors of the high suicide rate among American Indians and point to the paucity of scientific studies of these populations as (he basis for their question. Thompson and Walker also call lor a "refocusing oi' efforts toward the provision of effective clinical interventions" and away from education and health promotion programs, which have not been effective.
Drawing from findings in a lileraI me search and from a study conducted in the South Bronx. Heacock highlights several significant factors:
* black males are overrepresented in the overall increase in young adult suicide.
* the incidence of suicide is much lower in the black female population than in any other racial group, and
* hispanic females have the highest suicide attempt rate of any ethnic minority group.
He also addresses the multiple psychosocial factors that put poor black and Hispanic youngsters at risk and calls for targeting adolescents with specific problems (eg. depression, acting-out behaviors, substance abuse) in research studies and intensive service programs.
Pfeffers topic, treatment of suicidal behavior, is certainly applicable to adolescents across cultures. Treatment is discussed in terms of criteria for hospitalization, intervention planning, and specific treatment. Emphasis is given to the need lor a multifocal approach in order to address specific risk factors. Three specific types of treatment formats are underscored as most potent in limiting suicidal behavior: psyehotherapeutic-cognitive approach, environmental-stabilizing, and psychopharmacotherapy. Pfeffer cautions against polypharmacy and recommends repeated assessments during medication trials.
It is regrettable, to say the least, that most youngsters in need lack access to quality clinical services. As Heacock points out, segments of the population in the community in which he practices do not make use of the services available. On the other hand, limited funding creates barriers to service for many. These matters must be addressed as we pursue our work as advocates for children and youth, as clinicians, and as researchers.
1. Evans C. Farberow NL. The Encyclopedia of Suicide. New York. NY: Facts on File: 1988.
2. Capuzzi D. Golden Z. Preventing Ado leseen A Snidile. Muncie, Inch Accelerated Development Ine: 1988.
5. Coleman L. Suicide Clusters. Boston. Mass: Faber & Pdber; 1987.
4. Crow GA. Craw I.I. Crisis Inten-ention and Suicide Prevention: Working with Children and Adolescents. Springfield. Ill: CC Thomas: 1987.
5. Griffin MK. relsenthal C. A Cry for Help. Garden City. NY: Doubleday: 198").
6. Husain SA. Vandiver S. Suicide in Children and Adolescents. New York. NY: SI' Medical & Scientific Books; 1484.
7. Kierman CL. Suicide and Depression Among Adolescents and Young Ailults. Washington. I)C: American Psvchiatric Cress: 1 98b.
8. Orbach I. Children Who Don't Want to Live: Understanding and Treating the Suicidal Child. San Francisco. Calif: Jossey-Bass; 1988.
4. Pfeffer CR. The Suicidal Child. New York. NY: Guilford Press: 1 48b.
10. Pfeffer CR. Suicide Among Youth: Perspectives on Risk and Prevention. Washington. DC: American Psvchiatric Press: 1 988.
11. Sudak HS. Ford AB. Rushforth NR. eds. Suicide in the Young. Stoncham. Mass: Butterworth; 1984.