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Risk & Protective Factors

Suicide and suicidal behaviours (including suicide attempts, plans and thoughts) among adolescents are influenced by multiple, interacting risk factors that encompass biological, psychological, familial, interpersonal, social and cultural dimensions. A few key points are worth keeping in mind regarding the role of risk factors in understanding and assessing risk for youth suicide.

First, risk factors interact in complex ways making it impossible to describe a singular profile of a “typical” suicidal youth. Second, it is important to keep in mind that risk factors for suicide are dynamic, often fluctuating, and they vary in their severity, which means that certain combinations of risk factors may elevate risk in some individuals but not in others. Third, our knowledge of risk factors is typically based on statistical summaries and generalizations, which can often conceal the unique and particular circumstances of individual lives and deaths. Nonetheless, systematic reviews of the research literature do provide us with valuable information upon which to base our youth suicide prevention, intervention and postvention strategies.

Recent reviews of the empirical literature confirm that there are a number of factors that have been strongly linked to suicide and suicidal behaviours among youth. 3 4 5 6 7 8 Specifically, research confirms that suicide and suicidal behaviours among youth are strongly associated with certain mental health conditions, particularly mood disorders, anxiety disorders, substance use disorders, eating disorders and disruptive disorders. Co-occurring disorders are also very common among suicidal youth. Previous suicidal behaviour, including prior attempts and behavioural rehearsal are significant risk factors for further suicidal behaviour. Hopelessness, aggression, recklessness and impulsivity are individual characteristics that have been linked to suicidal behaviour. Family factors, including high levels of conflict, parental mental illness and a family history of suicidal behaviour can elevate the risk for suicide among youth. Many youth who die by suicide have a history of childhood physical and/or sexual abuse. Stressful life events, which typically precipitate suicidal acts, further contribute to suicide risk among youth, especially in combination with existing vulnerabilities. These commonly include: interpersonal conflict, rejection, failure, humiliation, and loss. In addition to the well-documented individual and family-level risk factors for youth suicide, it is important to consider other less visible forms of risk, including the effects of oppressive social practices and historical relations of power on certain groups and populations in western society. These include for example, the negative historical effects of colonization on Indigenous youth 9 or the damaging effects of homophobia and heterosexist biases on sexual minority youth.10

A focus on risk reduction alone is inadequate. We also need to understand the role of protective factors, which include “reasons for living” and those hope-activating circumstances that might tilt a young person towards choosing life over suicide. Protective factors refer to those factors and experiences that appear to reduce risks for suicide. They are important focal points in any youth suicide prevention strategy. Actively cultivating experiences and relationships that enhance youth resilience, creating opportunities for belonging and acceptance, facilitating experiences of competence and effectiveness, and strengthening social support among youth are all practical examples of a strengths-based approach to practice. While protective factors are less well-established through research, preliminary evidence suggests that the following factors may serve to protect youth against a range of social problems: strong individual coping and problem-solving skills, experience with success and feelings of effectiveness, strong sense of belonging and connection, interpersonal competence, family warmth, support and acceptance, success at school, strong cultural identity, and community self-determination

Table 1 summarizes the risk and protective factors for suicide among youth.