Results from the YRBS paint a disturbing picture of unhappy youth; 22% had considered suicide (Figure 2). The data suggest an estimated 35,000 Oregon high school students considered suicide during the year preceding the survey. Of those, 14,000 attempted suicide and 2,500-3,500 were treated for their attempts. These figures may seem high, but they are what the students reported, and are consistent with YRBS results in other states (Table 1).
Most attempts are probably not made with death as the goal. Rather, they are cries for help motivated by a desire to resolve interpersonal conflicts — especially in the case of medically non-serious attempts. 10
An estimated one in five
Oregon high school students
Suicidal behavior is a consequence of a complex interaction of factors, not a single event, although a single event may act as a trigger. 11 YRBS data show that suicidal behavior is strongly linked to other forms of risky or potentially self-destructive behavior. Youth engaging in one risky behavior are likely to also engage in others, as well. For example, many teens who reported attempting suicide were using licit and illicit drugs, drinking and driving, and engaging in unsafe sex practices. Further, the larger the number of risk factors reported by the youth, the greater the risk of suicidal thought and behavior ( Figure 3).
"I think it's mainly family problems that make teens the way they are. Believe me, there's a lot of people out there with problems."
Although male adolescents are far more likely to make an attempt that results in death, females are more likely to make non-fatal attempts. 13 Five percent of males in the YRBS reported attempts compared to 12% of females ( Table 2).
A female student was
twice as likely to make a
suicide attempt than was a male.
Suicidal attempts were reported most often by freshman and least often by seniors. The proportion who attempted suicide declined from 11% to 5%, respectively. This trend, however, is the opposite of that seen among attempts that resulted in death; the number of deaths from self-inflicted injuries increases with age among teens. 13 (The youngest Oregon child to commit suicide was a seven year old boy who shot himself in 1990.)
Minority groups often bear the brunt of inequalities in Oregon society and these inequalities are too often mirrored in the risk of youth suicide. Non-white and Hispanic students were most apt to report attempting suicide, with American Indians twice as likely as non-Hispanic whites to report an attempt (16% vs. 8%). This elevated risk is apparent in the African American and American Indian youth suicide death rates, as well. 14
"I think many people close their eyes to the visible. Things that their children are screaming silently."
The socioeconomic status (SES) of the student's school showed a modest association with suicidal behavior. 14 Students attending a low SES school were 36% more likely to have attempted suicide (11% did so, compared to 7% of students at high SES schools). Measurement of the SES of individual students would probably yield more pronounced differences.
One in six students said
they did not have a caring
adult they could talk to.
One in six students (16%) do not have at least one caring adult that they can talk to about their problems ( Figure 4). (See Appendix B for a list of the questions and answers in the YRBS questionnaire.) These adolescents were three times more likely to attempt suicide than those with four or more caring adults (16% vs. 5%). Students who said they had no caring adult to talk to were more likely to have been physically and sexually abused, and to report emotional problems. (See Appendix C for further discussion of the relationship between the home environment and adolescent behavior.)
Physically abused youth
were five times more
likely to attempt suicide.
Over one-quarter (27%) of all high school students said they had been physically abused at some time, 26% of males and 29% of females. These youths were almost five times more likely to attempt suicide than those who had not been physically abused (19% vs. 4%). 20, 21 Although the effect of physical abuse was greatest when the abuse occurred during the previous year, the risk of attempting suicide persisted for many years. Students abused more than five years previously were still three times more apt to make an attempt within the year prior to the survey. The Third National Incidence Study of Child Abuse and Neglect (NIS-3) found that children from the lowest income families were 22 times more likely to be seriously injured from physical abuse than were those in the highest income families. 22
"If you want to find the real problem look at family values and bonds. Ask students how they feel about their family, how close they are to their family, and what do their parents teach them about the world. The kinds who aren't close to their family are going to be the ones with the most problems."
DROPOUTS AND HOMELESS YOUTH
The 1997 survey does not include information about Oregon high school dropouts—youth that are at elevated risk of engaging in self-destructive behaviors. During the 1996-1997 school year, about 10,500 students dropped out, representing a four-year dropout rate of 25%. 15 The suicide attempt rates are unknown for this group, but in a survey of Oregon students enrolled in alternative schools, 32% said they considered suicide, 17% said they attempted suicide, and 5% said they were treated by a doctor or nurse for the attempt. 16 A survey of incarcerated students yielded similar results: 30% considered suicide, 17% attempted suicide, and 7% were treated for an attempt. 17 Many drop-outs are, or become, homeless. In Multnomah County alone, an estimated 1,200 children (grades 7-12) were homeless during 1997; statewide, 3,700 were believed to be homeless. 18 Among Portland homeless youth, 57% reported that they had considered suicide at some time and 30% were currently considering suicide; 40% reported at least one past attempt. 19
Children both physically
and sexually abused were
ten times more likely to
try to kill themselves
than were non-abused children.
"I think moral values have decreased tramesly in society today. Almost to a point that I don't think there is any going back. That is sordof a sad thing to hear."
Fifteen percent of students (5% of males and 25% of females) reported that they were victims of sexual abuse. These young Oregonians were nearly four times more likely to make a suicide attempt than were those who were free from this type of abuse (22% vs. 6%), with the risk differential more pronounced among males ( Figure 5). As with physical abuse, the effect of sexual abuse was greatest within a year of the abuse, but the attempt rate was still three times higher for children abused more than five years prior to the survey. The NIS-3 found that children in the lowest income families were 18 times more likely to be sexually abused than those in the wealthiest families. 22
A child who is sexually abused is too often also physically abused; these doubly abused youth (9% of the respondents) were ten times more likely to try to kill themselves than those free of this abuse ( Table 3). 23 The cumulative effects of these, and other environmental factors, can be seen in Appendix C. Riggs et al concluded that "At the very least, psychologic difficulties stemming from abuse may serve as catalysts for problem behaviors during the vulnerable period of adolescence." 24 In a recent review of abuse studies, Silverman and her colleagues noted that young adults who were abused during childhood or adolescence were at greater risk of a variety of short- and long-term impairments including sexual disturbances, anxiety and fear, low self-esteem, depression, aggressive behavior, and interpersonal problems. 25
Six percent of students reported emotional problems, and, not surprisingly, were more apt to attempt suicide. While 7% of those who did not report emotional problems attempted suicide, 30% of those who reported problems said they had tried to kill themselves. In psychiatric studies of suicide completers, only a very small minority of adolescents were found to be free of discernible disorders. 26, 27
Only 67% of high school
students said they had been
neither physically nor sexually abused.
"I'm scared of the world, there are too many death traps amongst us. I can't avoid them my entire life. HELP ME."
Almost two of every five
students lived with someone who smoked.
Few questions on the YRBS relate directly to the home environment, but one that explicitly does so is a question about cigarette smoking in the home by a person other than the student. Because smoking is more common among persons with less education and lower household income, it can be considered a rough indicator of the socioeconomic status of the student's family. 28 Students with family members who smoked were twice as likely to attempt suicide (12% vs. 6%). In four in ten households, someone (besides the student) smoked; in half those households with a smoker, someone smoked inside the home. 29 Adolescents in homes with second-hand smoke attempted suicide more often (13% compared to 11% in homes where the smokers indulged their addiction elsewhere).
The number of students enrolled in a school is inversely related to the proportion of students who say they attempted suicide. Those in schools with fewer than 100 enrollees were more likely to say they attempted suicide compared to those in schools with over 1,200 enrollees (12% vs 8%).
Almost one-third (31%) of students reported being harassed at school during the previous 30 days; as a group, they were three times more likely to attempt suicide than those who were not victimized (15% vs. 5%). At greatest risk were those harassed for sexual reasons. ( Table 4).
"I think this school fails to meet the needs of the students. It's not only the school, but the whole community. I believe that [city name] is a disgrace of a town, because I don't feel that anyone cares about the kids or is willing to do anything for them. This is frustrating and incredibly discouraging."
During the month prior to the survey, 19% of students carried a gun, knife, and/or club for use as a weapon (12% at school). Six percent carried guns (2% at school). Weapon carriers were over twice as likely to report attempting suicide (16% vs. 7%); those carrying weapons at school were at somewhat greater risk (19% vs. 7%).
Seven percent of students said they had been threatened or injured with a weapon such as a gun, knife, or club on school property during the previous 12 months ( Table 2). One percent reported six or more incidents. Two-fifths (41%) of those in the latter group attempted suicide compared to just 7% of those who had not been threatened or injured, a six-fold difference ( Figure 6).
"I DON'T THINK THIS SCHOOL SHOULD BE WORRIED ABOUT DRUG USE. I MEAN YEAH DRUGS ARE ILLEGAL BUT IT'S OUR BODIES, OUR CHOICE, if WE AS STUDENTS WANT TO USE DRUGS ITS OUR BUSINESS."
Self-perceived bodyweight is associated with suicidal be-havior. While both very underweight (2% of all students) and very overweight students (3%) were more likely to attempt suicide, overweight students were at the greatest risk. There was a sexual dichotomy, however; obesity was associated with a greater risk than skinniness among females but the opposite was true for males. One in twenty students (5%) used extreme measures for weight control -- self-induced vomiting and/or laxative use. Those who did so were over four times more likely to attempt suicide (30% vs. 7%). 30
In an average high school classroomCigarette Smoking.
of 25 students, one student
began smoking when he or she was
no more than eight years old.
One-fourth of students (23%) reported smoking during the previous 30 days (Table 5). No greater risk differential was seen than that between heavy smokers (21+ cigarettes per day) and non-smokers; heavy smokers were nine times more likely to attempt suicide (45% vs. 5%).
Heavy cigarette smokers were
nine times more likely to
try to kill themselves
than were nonsmokers.
"I am a teenage girl and I do have an eating disorder along with about 80% of the other teenage girls, because of these druggie supermodles that we have to look up to. It is very depressing world for kids, life is verry confusing."
Cigarette smoking at an early age was associated with a greater risk of suicidal behavior; in fact, the younger the age of initiation, the greater the risk. Nine percent of high school youth began smoking before their eleventh birthday and those who did were five times more likely to attempt suicide than never-smokers (19% vs. 4%). Seven percent of the students thought smoking was "cool"; these adolescents were twice as likely to attempt suicide (15% vs. 8%). Alcohol Consumption. Frequent alcohol consumption is also associated with suicide attempts. While nearly half (46%) of students drank alcohol during the previous month, and were at greater risk of suicidal behavior, those who drank on 20 or more of the previous 30 days were at greatest risk, 29% compared to 4% of abstainers ( Figure 7).
Binge drinking (5+ drinks within a few hours) was popular with one-third (32%) of students, and the more often they binged, the greater the likelihood that they would also attempt suicide. Those who binged on 20 or more of the previous 30 days were six times more likely to say they tried to kill themselves (38% compared to 6% of those who did not binge). Both students who would drive after drinking, and those who did not use seatbelts, were more likely to say they attempted suicide ( Table 5).
Like cigarette smoking, alcohol consumption at an early age was associated with a greater risk of suicidal behavior; students who began drinking when they were 10 or younger were six times more likely to try to attempt suicide than those who did not drink (17% vs. 3%).
Students who began drinking
alcohol when they were 10
or younger were six times more
likely to attempt suicide
than were abstainers.
"I think teen's use drugs, alcohol & tobacco becouse they feel they have too much stress & no-one to talk to!"
Almost one-half of
abusers< br> attempted suicide.
Five percent of Oregon high school students sniffed glue
(or otherwise abused inhalants such as spray paints) during the 30 days prior to the survey, and the more often they did this, the more likely they were to attempt suicide. Fully 46% of frequent users (10+ times in the previous month) said they tried to kill themselves, six times higher than the 8% recorded for abstainers.
"School counselors need to be more protecting and secrative. You can't tell them about drugs or suicide or they have to tell the cops. If you have no one to turn to, you go to the counselor. But you cant even trust them. Were in High School now not Elementary School. We deal with bigger problems other than friends & enemies. We have to deal with death, depression, abuse, sex & they tell the cops." Illicit Drug Use. Illicit drug
use was widespread among the state's high school students with one in four (23%) using marijuana, the most commonly used illicit substance. As with other substance use (e.g., tobacco and alcohol), the greater the use, the greater the odds that the user would try to commit suicide. Both cocaine
use and injection
drug use were better predictors of suicidal behavior than marijuana use; 41 percent of heavy cocaine users and 56 percent of injection drug users reported trying to kill themselves.
Use of multiple substances is clearly associated with an increased risk of suicide attempts. Fifty-three percent of students said they used alcohol, tobacco or other drugs. 31 Table 6 summarizes the association between suicidal behavior and use of mood-altering substances. Those who used six or more substances were over 13 times more likely to say they tried to kill themselves than were students who reported no substance use, (53% vs. 4%). For many adolescents in emotional pain, drugs and alcohol may be a way of numbing feelings of rejection and despair. 32
In a national study, substance abuse by parents was also linked to suicide attempts by their children; runaway and homeless youth whose family members were substance abusers were twice as likely to attempt suicide as were those whose parents were not substance abusers. 33
"To escape from reality, behind the smoke we hide."
Sexual intercourse at an early age was associated with sexual abuse and suicidal behavior. (This does not mean that sexual intercourse at an early age, in and of itself, causes youth to attempt suicide.) One-third (35%) of high school students had had sexual intercourse - five percent before they were teenagers ( Table 7). As with tobacco use and alcohol consumption, the younger a student was when he or she first had sex, the greater the odds that he or she would attempt suicide; the preteen group was more than four times more likely to attempt suicide than were virgins (22% vs. 5%). 34 Youth who had six or more sexual partners by the time of the survey were also over four times more likely to attempt suicide than those who had none (again, 22% vs. 5%). Those who had sex with three or more persons in the previous three months were five times more likely to attempt suicide than were virgins (26% vs. 5%).
". . . we wont aLL Live Forever so Just Do it!"
One in ten sexually active youth reported becoming pregnant (or causing a pregnancy). The four percent of all students who were ever pregnant (or caused a pregnancy) attempted suicide with a greater frequency than virgins or those who were sexually active but had not been involved with a pregnancy ( Figure 8). At greatest risk were adolescents who had experienced two or more pregnancies; they were eight times more likely to make a suicide attempt than were virgins (41% vs. 5%), the second highest odds ratio for a single risk factor.
"I think that the main reason for kids using drugs, and having sex early is maybe an escape from a trapped world. There is no one there, but drugs and sex partners."
and drug use are inter-related; among substance (tobacco, alcohol, or other drug) users, 51 percent were sexually active, but among non-users only 16% were sexually active. Substance users were five times more likely to become pregnant or to cause a pregnancy. Figure 9
shows the risk of attempting suicide by sexual history and number of substances used.
"There are a lot of kids here ready to burst under stress. Inside we're so full of pain, everyone is even if we don't come across as risk takers. More & more the non-risk takers are edging nearer & nearer to the riskier side, Drugs and alcohol isn't the true problem it's just how we're dealing w/things. I'm just surpirised that so few are committing suicide."
Percentage of students who had
intercourse before age 12
that were sexually abused
Same-sex sexual orientation is generally accepted as a related underlying cause of teen suicidal behavior. The issue cannot be addressed from the YRBS, however, because no question regarding sexual orientation was included in the survey. One question, however, asked the students whether they had been harassed in the previous 30 days and, if so, why. Two percent of the respondents said they had been because they were perceived to be gay, lesbian, or bisexual. These students were four times more likely to say that they attempted suicide than were their non-harassed peers (21% vs. 5%). Among those perceived to be gay, lesbian, or bisexual, harassed males were six times more likely than their non-harassed counterparts to attempt suicide (17% vs. 3%) while females were four times more likely (28% vs. 7%). Recently published data from Minnesota found that gay and bisexual males in grades 7-12 reported attempting suicide seven times more often than did their heterosexual counterparts. 35
"Why do you think so many teens turn to sex, drugs, and violence? It's a way of coping with their fear and confusion."