Suicide is as rare among adolescents who have no other mental disorders as it is among adults. The adolescent often believes that his or her disease is outside the realm of control, and is in the hands of God or some other force. Refusing treatment is not a way of attempting suicide, but comes from his or her belief that fate, luck, or God determines life and death.

In the general population, about 2,000 adolescents in the United States die by suicide each year. Suicide continually ranks as the second or third leading cause of death of persons between the ages of 15 and 34 years old. Children are less prone to suicide before puberty due to immature reasoning capabilities that make planning and carrying out suicide difficult. The suicide rate in young people has more than doubled during the period from 1956 to 1993. This increasing suicide rate has been blamed on the increase of adolescent alcohol abuse. Chronic and acute illnesses were not major causes of suicide in the young. The suicide rate for male adolescents is four times as high as the rate for females. The suicide rate for white adolescents is about twice as great as the rate for African-Americans and Hispanics. Little is known about the occurrence of thoughts of suicide and attempts in children with cancer.

The risk factors for the general population of children include:

• Biologic factors: Family history of mental problems such as depression, schizophrenia, alcoholism, drug dependence, and conduct disorders. Genetic predisposition to low levels of serotonin is associated with depression.



• Predisposing life events: An early family history of abuse by a parent; negative life event such as loss of a parent; childhood grief; and disturbed, hostile relationships in the family. Many other social problems and negative life events do not seem to cause suicidal behavior.



• Social factors: The very nature of adolescence itself with its desire to experiment with drugs and alcohol. Conflict or confusion about sexual orientation can be a factor in adolescent suicide. Also, characteristics such as perfectionism, impulsiveness, inhibition, and isolation all can lead to thoughts of suicide.



• Mental problems: Ninety five percent of young people who commit suicide have a mental disorder. These are usually major depression, schizophrenia, alcoholism, drug dependence, and conduct disorder. However, most children with mental problems do not commit suicide.



• Contagion: An expression that describes the phenomenon of young people identifying with others who have committed suicide. Some young people who are vulnerable may copy suicidal behavior. Friends of a patient with cancer who has committed suicide should be offered support and counseling.



• Deadly weapons available: A gun in the house can allow suicide to occur.



• Motivating events: The diagnosis of cancer can cause a person at risk to attempt suicide. Usually a mental disorder, other life stresses, an upsetting event such as a failure in school, or life-threatening disease such as cancer is already present.

Some adolescent cancer survivors may be overwhelmed by feelings of hopelessness. This may lead to thoughts of suicide. Suicide is treated by the careful evaluation of the child with cancer and his or her family. The multiple factors that can make a child's life unbearable need to be examined. Suicide prevention must include individual evaluation; referral to the correct health professionals; treatment with medications; and both individual counseling and family therapy.

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