TEEN SUICIDE IS ON THE INCREASE AND THE QUESTION IS WHY Parents, caregivers, educators and friends are warned to take suicide signs and threats seriously and seek professional help. With youngsters across the country having received their exam results, it is natural for them to be experiencing stress and anxiety as exam time and receiving results are amongst the most significant stressors of growing up. On top of this, they have to deal with overwhelming societal pressure to be successful. At the start of the new academic year, adolescents and young adults also find themselves heading for new grades, possible class and school changes, or heading to university, college, or in the case of those not continuing their studies, looking for employment. For those who have written Grade 12 exams, years of studying, hard work and dedication were devoted to one last set of exams which can dictate their future. “Young people with an underlying mental illness may experience depression in the time leading up to exams, and also if they achieved lower than expected results that may make them feel they have let themselves and others down,” says Tegan Rix, occupational therapist at Akeso Milnerton. “This depression, often accompanied by social isolation and loneliness, can lead to suicide.” What causes youngsters to feel hopeless? Research suggests that the main reported causes of depression, suicidal ideation and associated hopelessness, are due to difficulty with meeting expected university standards, loneliness, relationship difficulties and strained relationships with parents, Rix says. “At times, the size of the institution may add to these feelings of hopelessness, as the individual may struggle to become part of a new community and find good support structures. It is helpful to acknowledge that you are not alone, and that negative thoughts and thinking patterns increased anxiety, stress and change in physiological patterns are all normal during this time.” “Many young people are highly motivated to avoid failing – not because they cannot manage emotional reactions such as disappointment and frustration – but because failing makes them feel a deep sense of shame,” she explains. “Failing represents a significant psychological threat, in which their motivation to avoid failure far outweighs the motivation to succeed in any identified task or challenge. A deep sense of shame can be a toxic emotional reaction for some as it does not target our actions, but instead targets who we are as a person. This is why some people will actively avoid the psychological threat of failure.” When moving to a higher grade, or from school to university, young people may be exposed to other students who perform better than them, increased workloads, and different academic expectations. If young people can learn to be resilient, and refrain from negative comparisons to others, they may experience less negative emotions. Fear of failure looks different for every individual, she adds. Examples may include a reluctance to try challenging tasks or projects, self-sabotaging behaviour such as procrastinating or failing to follow through with goals, negative self-talk such as ‘I’m not smart enough’, or a willingness to only try things they know they will succeed at. “It is important to be able to identify this pattern of behaviour and work to overcome it,” Rix says. “There are many tools which can help to manage fear of failure. We help adolescents break down an often overwhelming goal into smaller, realistic and achievable outcomes. SMART principles help to ensure success at the end of each week. To make a goal SMART, it needs to be Specific, Measurable, Attainable, Relevant and Timely. It is important that we do not set ourselves up for failure, ultimately creating painful emotions. Goals do not have to be complex, they just need to be a step in the right direction. Other skills include positive self-talk, affirmations and decision analysis.” Look out for warning signs While some suicides may occur without any outward warning, most do not. Rix explains. The most effective way to prevent suicide is to learn to recognise the signs of someone at risk, take these signs seriously and know how to respond to them. It can be difficult to predict suicide. Warning signs may present differently for individual young persons. These include behavioural changes, thoughts or feelings which may give clues about the increased risk of suicidal behaviour. “Some adolescents verbalise that they want to kill themselves or they speak about their own death often. It is important to take these comments seriously,” she says. “Parents, friends and healthcare professionals should take each suicidal ideation or plan to potentially end one’s life seriously, and to ensure that we keep young people safe, even if they are using this language as a way to express intense emotional feelings.” Other signs are more difficult to identify, especially when adolescents internalise their feelings and emotions and keep them hidden from family and friends. “It’s advisable for caregivers and friends to be observant of changes in behaviour over a short period of time and to ask questions,” Rix says. “Communication is vital when attempting to form a safe and supportive structure for adolescents. If family and friends are not easily approachable, it may be a somewhat impossible task for adolescents to verbalise thoughts and feelings which they too are fearful of.” The main warning signs include: feelings of hopelessness or having no hope for the future increase in substance use isolation and loneliness irritability and aggression negative view of the self and their abilities expressing death through writing, talking or drawing self-harming behaviours such as cutting giving personal belongings of value away to others expressing the feeling of being a burden to others What can be done to help vulnerable youngsters? Although some youngsters would like to dedicate a large portion of their day to their books, it is equally important for them to ensure they maintain a healthy level of physical activity and engage in constructive hobbies during study time, Rix says. “It’s also important to ensure that any physical illness is treated, that they maintain a good level of self-care (like getting out of their pyjamas and getting ready for the day), having enough sleep, spending leisure time with company they value, and enjoying and maintaining a healthy and balanced diet. Some young people also thrive on routine to help settle the nerves. Learning how to manage stress and anxiety leading up to the D-Day of getting exam results is an invaluable and underused tool which is crucial, especially for students who may not achieve the grades expected.” How can parents and family help? We should not underestimate the impact caused by parental figures especially. It is of utmost importance that caregivers find a middle ground between what they expect their children to achieve and what is realistically attainable with regards to results from school or university, Rix says. “Having unreachable expectations increase the level of stress and anxiety, causing feelings of hopelessness. Supporting youngsters during this time means empathising with them. Empathising with your child means trying to ‘feel with them’. Try to put yourself in their shoes and understand that exams are a difficult time and they are under pressure to work towards the best possible results. The home environment should be one of minimal distraction during exam time. Try to encourage them to take breaks and do things that they enjoy, rather than what they are responsible for, even if this means relieving them off some chores during exam time.” If your child is away from home and you are not able to support them in person, send a message to ask how the studies are going and, most importantly, how they are feeling. Messages allow for your child to reply whenever they have the chance and when they have a break. You can also ask when would be the best time to call them throughout the day, so that they know when to expect the call. “During exam time and before receiving results, do not verbalise things such as, ‘you sound nervous’, or ‘this is your most difficult subject’ – facts of which they are well aware. Focus on them, and ask them if there is anything you can do to ensure their study and exam period is comfortable as possible and thereafter try to reduce the anxiety that they might feel during the period before their exam results arrive. Remind them that you are part of their support structure. Avoid saying ‘I know you will do well’ or ‘You have been studying really hard and I am sure you will pass’ as these statements add to the expectation. Sometimes it is better to talk about anything other than the upcoming exams. You could also help them to take a step back and regain some perspective so that they remember that exams can be retaken and that bad marks or failure do not define who they are.” If you believe someone you know is feeling suicidal and requires help, contact Akeso Clinics on 0861 435 787. Facts about teen suicide in South Africa1 9% of all teen deaths are due to suicide – and this figure is on the increase In the 15-24 age group, suicide is the second leading – and fastest growing – cause of death Children as young as 7 have committed suicide in South Africa Every day 22 people take their lives Research indicates that 75% of people who commit, or attempt, suicide have given some warning 90% of adolescents who die by suicide have an underlying mental illness. About the Akeso Group: Akeso is a group of private in-patient psychiatric hospitals, and is part of the Netcare Group. Akeso provides individual, integrated and family-oriented treatment in specialised in-patient treatment facilities, for a range of psychiatric, psychological and addictive conditions. Please visit www.akeso.co.za, email firstname.lastname@example.org, or contact us on 011 301 0369 for further information. In the event of a psychological crisis, please call 0861 435 787 for assistance. 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