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.

Glossary Terms

Symptoms or signs that begin and worsen quickly; not chronic.

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

A disease in which a person craves alcohol, is unable to limit his or her drinking, needs to drink greater amounts to get the same effect, and has withdrawal symptoms after stopping alcohol use. Alcoholism affects physical and mental health, and causes problems with family, friends, and work. Also called alcohol dependence.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A disease or condition that persists or progresses over a long period of time.

A mental state in which one is not thinking clearly.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of identifying a disease, such as cancer, from its signs and symptoms.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A record of a person's current and past illnesses, and those of his or her parents, brothers, sisters, children, and other family members. A family history shows the pattern of certain diseases in a family, and helps to determine risk factors for those and other diseases.

A type of therapy in which the whole family talks with a professional counselor to solve family problems.

Inherited; having to do with information that is passed from parents to offspring through genes in sperm and egg cells.

The normal response to a major loss, such as the death of a loved one. Grief may also be felt by a person with a serious, long-term illness or with a terminal illness. It may include feelings of great sadness, anger, guilt, and despair. Physical problems, such as not being able to sleep and changes in appetite, may also be part of grief.

State of being separated from others. Isolation is sometimes used to prevent disease from spreading.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

The time of life when a child experiences physical and hormonal changes that mark a transition into adulthood. The child develops secondary sexual characteristics and becomes able to have children. Secondary sexual characteristics include growth of pubic, armpit, and leg hair; breast enlargement; and increased hip width in girls. In boys, they include growth of pubic, face, chest and armpit hair; voice changes; penis and testicle growth, and increased shoulder width.

Something that may increase the chance of developing a disease. Some examples of risk factors for cancer include age, a family history of certain cancers, use of tobacco products, certain eating habits, obesity, lack of exercise, exposure to radiation or other cancer-causing agents, and certain genetic changes.

A group of severe mental disorders in which a person has trouble telling the difference between real and unreal experiences, thinking logically, having normal emotional responses to others, and behaving normally in social situations. Symptoms include seeing, hearing, feeling things that are not there, having false ideas about what is taking place or who one is, nonsense speech, unusual behavior, lack of emotion, and social withdrawal.

A hormone found in the brain, platelets, digestive tract, and pineal gland. It acts both as a neurotransmitter (a substance that nerves use to send messages to one another) and a vasoconstrictor (a substance that causes blood vessels to narrow). A lack of serotonin in the brain is thought to be a cause of depression. Also called 5-hydroxytryptamine.

The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.

The act of taking one's own life on purpose.

One who remains alive and continues to function after overcoming difficulties or life-threatening diseases like cancer.