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While case numbers are small, there is a chance many suicides go unreported, known as the “iceberg phenomenon.”

Generic teenager head in hands : Stocksnap via Pixabay Pixabay Licence Generic teenager head in hands : Stocksnap via Pixabay Pixabay Licence

While case numbers are small, there is a chance many suicides go unreported, known as the “iceberg phenomenon.”

Youth suicide stories like those portrayed in the Netflix series 13 Reasons Why are not unheard of in the real world.

In April 2024, an 18-year-old teen from Gresik, Indonesia, killed himself after breaking up with his girlfriend. This month, a high school student took his own life because his parents confiscated his smartphone, ostensibly to prevent him playing online games.

These cases have sparked the attention of activists about how prevalent this issue is among young people and what motivates them.

According to the World Health Organization (WHO), youth suicide is the fourth leading cause of death in people aged 15-29. Most cases were reported in low to middle-income countries.

In the United States, suicide is the second most common cause of death in young adults aged 15-24. The annual rate has been increasing at an alarming rate. From 1999 to 2020, there were about 47,000 American adolescent deaths. There were differences in suicide method by gender, age, and ethnicity.

In Indonesia, there were 2,112 suicides in the past 11 years, and 985 of them (46.63 percent) were young people.

Despite the seemingly “low” number of youth suicides compared with the total population,  there could have been  undetected cases and the possibility of an “iceberg phenomenon.”

The data did not show the actual number of those with suicidal thoughts  and those who had already made plans or attempts.

An in-depth Indonesia National Adolescent Mental Health Survey for the last 12 months revealed  that 1.4 percent of young people have thought of ending their lives, 0.5 percent had planned suicide, and 0.2 percent had tried. These figures did not include those who were hesitant or did not seek help from professionals or close ones.

There are numerous risk factors for suicide in children and adolescents. Depression, substance abuse, bipolar disorder, post-traumatic stress disorder (PTSD), and psychotic symptoms are all individual risk factors.

Bullying is also a significant factor. Physical neglect or abuse by family, violence by an intimate partner, and experiencing life crises such fights with parents, receiving low grades at school, or parting ways with a romantic  partner are  other risk factors. High debt and low income, unemployment, social isolation, and exposure to news of other suicides could also act as the triggers.

In Western countries ,the LGBT community experiences an elevated risk of suicide due to  discrimination.

Examples of suicide among young LGBT populations in Indonesia are rare, but that does not mean it doesn’t happen. Strict societal norms and stigma mean studies of the LGBT population is difficult.

Cyberbullying is also shown to  increase risk of youth suicide. There is also an association between pathological use of the Internet/social media and suicide attempts in young people, although the causality is yet to be discovered.

The phenomenon of “sextortion”, where a victim is lured into sending sexually explicit images or videos and then blackmailed into paying their tormentor, has been rampant in the US, UK, and Australia.

While  still uncommon in Indonesian youths, the phenomenon has begun to affect adults, so there is a possibility it  could happen to minors.

An urgent problem


Preventing youth suicide is urgent. Prevention and intervention strategies may be categorised into three levels: universal, selective, and indicated strategies.

Universal strategies are targeted at the entire population and aim to improve awareness and promote protective factors. Selective strategies are directed at children and adolescents with a history of substance abuse and those with mental health problems. Indicated strategies target individuals displaying signs of suicidal tendencies.

These efforts should involve family, relatives, close friends, educators, primary care physicians, psychiatrists, governments and youth groups. Public training to recognise depression and sudden behavioral changes is the first step to preventing suicide.

At-risk young people can be screened by physicians to detect depression, and if appropriate, they could consult psychiatrists. Adolescent stress-reduction programs may be developed to improve coping strategies on difficult days. Adolescent mental health programs are usually conducted at schools  although this program may also be conducted online.

Intervention programs that promote effective coping strategies to manage stress such as active solution-orientation, stress resolution, conflict with stress, mindfulness, and building a positive attitude may be designed to ensure adequate emotional adjustment. This may reduce suicide risk.

Psychoeducation programs may also be developed in a small group of adolescents in a “safe-haven” environment to enhance coping strategies and emotional regulation toward stress to detect earlier of the suicide risk.

The government could also provide hotline numbers dedicated to those on the brink of suicide crisis and requiring immediate mental health assistance.

With correct implementation of these programs, it could be expected that young people may have better access, adequate support and treatment, as well as develop and strengthen their  defence mechanisms, ultimately reducing the incidence of suicide.

Tjhin Wiguna is a Professor in Child and Adolescent Psychiatry at the Department of Psychiatry, Dr. Cipto Mangunkusumo Hospital – Faculty of Medicine, Universitas Indonesia.

Valdi Ven Japranata is a medical practitioner at Pondok Indah Hospital, graduated from the Faculty of Medicine, University of Indonesia.

Originally published under Creative Commons by 360info™.

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