Political and Social Affairs Division
TABLE OF CONTENTS
1. Gender Differences
Cultural Differences: Quebec
Strategies That Work
Culturally Specific Approaches: Natives
rates greatly increased in the 1960s and 1970s and, while they have levelled
out in the 1980s, they are still at the highest level in Canadian history.
Between 1960 and 1978, the overall suicide rate rose from 7.6 per 100,000
population to 14.8, according to Statistics Canada figures. During the
last decade, the suicide rate, though relatively stable, has been about
double the rate throughout most of the period from1921 to 1961 and well
above previous highs recorded during the Depression of the 1930s. It is
important to remember that the actual number of suicides in Canada may
be under-reported. A death is only certified as a suicide by medical and
legal authorities when the victims intent is clearly proven.
The federal government
moved to address the suicide problem by appointing a National Task Force
on Suicide in Canada in 1980. Its report was made public in 1987. Though
the statistics used are from 1985 at the latest, and more often earlier,
the study is the most comprehensive examination of the phenomenon ever
done in Canada. Seven population groups were identified by the Task Force
as being at high risk; one of these was young people. While males aged
20-24 constitute the age group with the most significant rise in suicide
deaths in the past 20 years, marked increases have been noted in the 15-19
age group, again most significantly among males. The report describes
and evaluates a range of prevention, intervention and follow-up programs,
and makes a number of recommendations having to do not only with the determinants
of suicide but with the means of preventing it. No major federal policy
initiatives have resulted from the report. It is not the aim of this paper
to review the findings of the Task Force report but rather to comment
on changes in dealing with certain aspects of the teenage suicide phenomenon
that have taken place since the Task Force research and have been discussed
in the literature since 1987.
Though the suicide
rates are higher in Canada than in the United States, Canadian statistical
trends correspond for the most part with the American; therefore, some
American studies will be cited in this paper in an attempt to focus more
precisely on suicide among teenagers.
There are no definitive
explanations of why more teenagers are committing suicide than ever before.
Suicide is multi-dimensional behaviour and difficult to define in any
The foremost theoretician
on suicide, Emile Durkheim, defined three types. The first is altruistic
suicide, where the individual is so closely integrated into a group or
society that he or she will commit suicide for the perceived benefit of
the group. Examples would be the Japanese kamikaze pilots of World War
II and the mass suicide at Jonestown.
The second type
is egoistic suicide; this is characterized by a strong value system, weak
group integration and an overpowering sense of personal responsibility.
The group itself is not strong enough to provide the individual with a
sufficient source of outside support and strength and the society is not
sufficiently integrated to be able collectively to mitigate the individuals
feeling of responsibility and guilt for moral weakness and failure.
the third type of suicide identified by Durkheim, is not characterized
by a strong value system. It results from not being properly integrated
into a system of cultural values and thus seeing social norms as meaningless.
The characteristic feelings of isolation, loneliness and personal confusion
noted in this type of suicide are often brought on by a major disruption
in ones way of life, such as the death of a parent or a move to
a new home far from friends.
might be thought to provide the best explanation for the phenomenon of
teenage suicide, as it hinges on experiences closely associated with adolescence.
Subtle distinctions exist, however.
1. Gender Differences
No matter what
the age group, being male has been found to raise the odds of suicide
in Canada. It should be noted, however, that maleness is only significant
in terms of completed suicide, with parasuicide (attempted suicide) being
up to three times as common among females as males. There are ten times
as many suicide attempts as there are deaths, but males are six times
more likely to die of suicide than are females. This has been found to
be a cross-cultural phenomenon.
Leenaars, president of the Canadian Association for Suicide Prevention,
says the reasons for this gender disparity are more sociological than
psychological.(1) He explains
that males are socialized to hide their feelings and deny pain if they
are "to be men." This emphasizes personal responsibility for
not fitting into the dominant male culture. Male culture places no great
emphasis on mutual support during adolescence, but rather thrives on competition.
It is a culture, too, which has been weakened by the sexual revolution
and is in the process of change. These factors show that suicidal impulses
in young males have more to do with the egoistic model than the anomic
Females, on the
other hand, tend to follow the anomic model. In studies carried out to
determine why teenage girls and women make so many suicide attempts and
yet experience so few suicide deaths, theorists have gone much further
than Durkheim. Self-in-relation theory, which is applied in researching
females and depression, is helpful in illuminating gender differences
in suicidal behaviour. Current literature consistently links the primacy
placed by females on relationships with factors influencing suicidal behaviour.
Thus, stress resulting from an inability to deal with interpersonal conflicts
is more likely to be a factor for females than for males. This theory
focuses on four common processes which, when exaggerated, underlie womens
suicidal attempts: the concepts of vulnerability to loss, inhibition of
anger, inhibition of action and aggression and low self-esteem. Rather
than perceiving these as weaknesses, as in traditional theory which views
the male experience as the norm, self-in-relation theory looks at these
behaviours as sources of strength based on a female norm. By examining
the normative experience of females, greater understanding of the gender
differences in suicidal behaviour is emerging.
used to explain the gender differences between suicide attempts and suicide
completions hinges on the methods of attempted suicide used. Teenage girls
tend most often to use drugs while boys use more instantaneously lethal
methods, such as firearms. Such differences are changing, according to
American sources. The Centers for Disease Control noted that in 1970 fewer
than one-third of the suicides by women aged 15 to 24 were carried out
with a firearm, while in 1984 firearms were used in a little more than
half of the female suicides in that age group. While, in 1970, 42% of
the young women who killed themselves used drugs, by 1984 this percentage
had dropped to 19%. Sociologist James Mercy expects these trends to continue
because of the easy availability of firearms in the United States and
the increasing difficulty of obtaining lethal types of barbiturates.(2)
theory for explaining the gender difference put forward by psychologist
Lee Salk of Cornell University Medical School drew a link between birth
trauma and later suicide. He observed that infant mortality rates begin
dropping substantially around fifteen years, before teenage suicide rates
begin escalating. Pointing out that male babies suffer from more birth
complications than females, he went on to document the three common denominators
that turned up repeatedly among the suicides he studied: respiratory distress
for over one hour at birth, lack of prenatal care before the twentieth
week of pregnancy, and chronic ill health of the mother during pregnancy.
He even went so far as to demonstrate a correlation between methods used
in suicide attempts and the type of intervention used at birth.
was pursued by doctors in Sweden, who found that suicide was more closely
associated with birth trauma than with any other of the 11 risk factors
for which they tested, including such socioeconomic variables as parental
alcoholism and a broken home. This theory continues to be very controversial
among the medical community, where obstetrical control and intervention
are increasing, rather than decreasing as these scientists advocate.
2. Cultural Differences:
Comparison with the United States
A recent comparison
of suicide rates in the U.S. and Canada found that the teen suicide rate
among Canadian males is 57% higher than in the United States. Antoon Leenaars
of the Canadian Association for Suicide Prevention attributes this to
the cultural theory that Canadians are more repressed than Americans;
the suggestion is that Canada was founded as a colony based on the British
values of Queen and religion, while the United States was built by aggressive,
gun-toting pioneers who fought their way westward crushing all obstacles
in their path. "Because of that," says Leenaars, "it has
been suggested that in the U.S. they kill each other. In Canada we kill
simplistic on their own, the observations of Dr. Leenaars suggest
a cultural dimension to suicidal behaviour that may be useful to consider
in prevention techniques, as will be discussed later with respect to Native
3. Cultural Differences:
Quebec has the
highest rate of teen suicides of all the Canadian provinces, as well as
one of the highest rates in the world. Dr. Mounir Samy, founder and director
of Montreal General Hospitals adolescent crisis intervention team,
citing the Quiet Revolution and family breakdown, argues that the social
upheaval in Quebec since the 1960s has affected troubled teenagers by
giving them nothing stable to fall back on. Another contributor, Samy
suggests, is the "suicide option" our society offers. "We
are a society that values the quality of life rather than its quantity
Life is [seen by some teenagers as] not worth living if you cannot guarantee
its quality."(4) The
cultural aspect of suicide behaviour can be examined both broadly and
specifically. While this aspect is only part of the picture, it is nonetheless
an essential element in the search for effective solutions.
4. Suicide Clusters
While the increase
in suicides has levelled out in recent years, the number of "cluster
suicides" is on the increase and has served to focus public attention
on teenage suicide in Canada. In Lethbridge, Alberta, three youths committed
suicide within three months of each other and a similar tragedy occurred
in Antigonish, Nova Scotia. While some suspected Satanic cult influences
in the Lethbridge case, there has been no substantial evidence of this.
Teenagers themselves say media focus on the possible influence of cults,
heavy metal music or music videos are just attempts by adults to relieve
their own feelings of guilt and to avoid listening to the real problems
of teens. While reasons for the increase in cluster suicides are inconclusive,
it is safe to say that young people who do not find solutions to their
problems from family, doctors or teachers, look to their peers for assistance.
Some studies, such
as a 1990 study by Simon Davidson, director of psychiatric research at
the Childrens Hospital of Eastern Ontario, say that half of all
teenagers think about suicide. Dan Wiseman, head of social services for
the Ottawa Board of Education has noted, however, that only 10 to 12%
of those students actually attempt suicide, while only 1 to 2% die. Wiseman,
who helped implement the Ottawa Boards in-house teen suicide prevention
program, says that, because teenagers lack experience in solving problems
and dealing with stress, suicide becomes a viable alternative.(5)
According to the
London/Middlesex branch of the Canadian Mental Health Association, which
has been very active in teen suicide prevention programs, there are several
warning signs of suicidal intent: depression; statements that show a preoccupation
with dying; drastic behaviour or mood swings; lack of interest in future
plans; making final plans; previous attempts (80% of people who kill themselves
have attempted to do so before); sudden improvement after a period of
depression; and self-destructive behaviour.(6)
depression, drug abuse, delinquency and family breakdown can all be implicated,
either separately or in combination. The importance of family relations
is noted by American therapists, who point out that family therapy is
on the decline, with parents being increasingly unwilling to be involved
in the therapy of their children.
Of teenagers who
eventually attempt suicide, 80% show up at a doctors office before
doing so. The teenagers complain of symptoms, such as insomnia, fatigue
or problems at school, that should sound alarm bells but whose significance
may be missed by the doctor.(7)
This finding has diverted the focus of prevention techniques away from
the family unit and the medical profession and toward the schools.
a consulting psychologist for the Board of Education in London, Ontario,
concluded from his survey of the literature on the subject of teen suicides
that 95 to 97% of them could be prevented.(8)
study of the effects of age, period and cohort examined Canadian statistics
from 1921-25 to 1981-85.(9)
It concluded that divorce of parents and urbanization increase the likelihood
of committing suicide, while the effect of religious secularization, although
present, does not reach statistical significance. This study confirms
that suicide is mainly an age-specific phenomenon, with period and cohort
being of limited relevance for the substantive understanding of suicide
in Canadian society.
In the search for
prevention techniques to be implemented through the school system, Dr.
Barry Garfinkel, director of child and adolescent psychiatry at the University
of Minnesota, has designed questionnaires eliciting information on depression,
which he has administered to 15,000 students annually for several years.
A student scoring positive on the questionnaire is sent to a guidance
counsellor or school psychologist. This strategy has gained approval in
Canada, specifically in Quebec, where the problem of teenage suicide is
tool has been peer-group discussion groups. Particularly in view of the
rise in "copycat" or suicide clusters, this method is seen as
a crucial aspect of prevention. When a suicide occurred at A.B. Lucas
Secondary School in London in October 1987, the students friends
and a guidance teacher formed a breakfast club to focus some of their
grief into positive programs that would help students. The club has grown
to 260 students and branched out into orientation programs that help Grade
8 students to make the transition from junior high to high school.
For more effective
program planning and management at suicide prevention centres, the Greater
Vancouver Mental Health Service has over the past ten years developed
a computer information system with the input of counsellors, researchers,
community agencies, a clinical consultant and other professionals. The
system, which is reviewed annually, was designed to meet practical needs
in ongoing counselling, long-term planning and evaluation. The information
collected is published in report form and used in public education activities.
It should be noted that confidentiality is built into the system.
The National Task
Force Report of 1987 included a proposed educational program for school
personnel and students; model suicide intervention services for hospitals,
communities and Native people; and an Alberta model for a systematic approach
to suicide prevention.
Culturally Specific Approaches: Natives
risk group is made up of Native Canadians. The incidence of suicide among
Native teenagers is often ten times that among their white counterparts.
While it is not within the scope of this paper to examine the Native situation
in detail, the success of culturally specific prevention methods used
in some communities is worth noting.
Just as suicide
in Native communities is a distinct phenomenon, so are the methods these
communities use to deal with it. Non-Native methods of education and prevention
tend to rely on facts, while Natives use story-telling as a means of giving
information about suicide. The technique was demonstrated in an internationally
acclaimed radio program called "Kill the Feelings First" developed
by George Tuccaru, a Native employee of CBC North in Yellowknife. In this
program, stories stimulate the audience to examine various questions in
the search for resources with which to cope. The challenge to mental health
service planners in Canada is threefold: Are they willing to look at traditional
Native health processes as good resources for mental health? Will they
trust Natives to develop their own methods and approaches? Will they be
able to see Native mental health from a spiritual, though not necessarily
religious, perspective? The National Task Force on Suicide in Canada recommended
that prevention strategies for Native people should be culturally oriented.
in Grande Cache, Alberta, formed a peer support group following the suicide
of a 16-year old Native youth who had lived in a number of white foster
homes since the age of nine.(10)
While Native community leaders saw this initiative as an important first
step they stressed the need to improve family communication and to deal
with the problems of alcoholism, violence and sexual abuse found in many
Suicide has been
related to lack of social integration, feelings of "alienation"
in the population, transience, and rapid changes in values, income and
lifestyle. Poor job prospects, families in a state of flux, and changing
social and moral values could all contribute to high youth suicide rates
in the population as a whole. It is important to realize that suicidal
behaviour is not necessarily linked to mental health problems and that
unemployment and alcoholism are not widespread problems among suicidal
While the reasons
for suicide are complex and difficult to define, the experience of adolescence
brings unique problems to this high-risk age group. Author Marion Crook
interviewed a number of teenagers in British Columbia who had attempted
suicide. Common denominators that emerged were problems in their family
situation and low self-esteem as well as the fact that they had not been
helped in their contact with teachers, doctors or other professionals.
The pressure to excel, which is not only perpetuated by parents and peers
but pervades television programming and commercial advertising, was found
to add to the anxiety of adolescence. Skills for coping with these problems
and sympathetic assistance from parents, teachers, doctors, other teenagers
or television, are essential. The complexity of the issue must not discourage
community or government agency efforts to deal with a problem that is
responsible for more adolescent deaths in Canada than anything except
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Corr, Charles A.
and Joan N. McNeil. Adolescence and Death. Springer Publishing
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Every Parents Guide to Understanding Teenagers and Suicide.
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Crow, Gary A. and
Letha I. Crow. Crisis Intervention and Suicide Prevention. Charles
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Curran, David K.
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and Karen Rayter. Suicide. Peguis Publishers Limited, Winnipeg,
Burt Dowsett, "Young Men, Senior Males Form Most Suicidal Groups,"
in London Free Press, 12 June 1990.
Judy Folkenberg, "Guns and Gals," in Psychology Today,
"Teen Suicide," in Windsor Star, 7 April 1990.
"Teen Suicide Rate Linked to Quiet Revolution," in Montreal
Gazette, 13 May 1988.
John Ibbitson, "Experts Rap Report on Teen Suicide," in Ottawa
Citizen, 17 January 1989.
According to Burt Dowsett in "Suicide: Recognizing the Symptoms,"
in The London Free Press, 12 June 1990, the death of a parent,
particularly a mother, increases the risk of a suicide attempt 600 times.
Richard Sutherland, "Teenage Suicide Epidemic in Canada," The
Financial Post, 22 February 1990.
Dowsett, "Suicide: Recognizing the Symptoms" (1990).
Frank Trovato, "Suicide in Canada: A Further Look at the Effects
of Age, Period and Cohort," in Canadian Journal of Public Health,
Vol. 79, No. 1, January/February 1988.
Gerry Gee, "Teens Meet Suicide Issue Head On," in Windspeaker,
28 July 1989, p. 13.