Patricia Casey: Are these teenage suicides new, or did we just hush them up before?
THE death by suicide last week of a girl aged 12 came as a further shock to the nation. In the wake of the suicides of two other girls aged 13 and 15 in recent months, questions are being asked as to why Irish society has become so cruel that these young people felt there was no other option but to end their lives.
Suicide in the 12-to-15 age group is very rare, currently no more than one or two a year at most for the total population. The fact that three have already occurred in a three-month period in 2012 is a source of great concern.
A fundamental question is whether similar deaths occurred in previous decades and were simply hushed up by families and coroners because of the shame such deaths might have brought to the families.
While a possibility, this is unlikely because other societies with different mores and different data collection methods, including the UK and Austria, also report very low suicide rates among children in past decades.
These same countries also reported an increase in the 15 to 19 age group, as has Ireland. So it appears Ireland is not an outlier in this regard, except in relation to the recent cases.
In an attempt to fully comprehend child suicide in Ireland in the wake of recent deaths, the focus has shifted on to society and parents – have these factors been making a contribution to the recent rise or is it due to mental illness presenting at this time of life? In truth, we do not know.
The scientific study of any behaviour requires an adequate sample in order to identify possible risk factors, and it also needs long-term studies to identify causative factors. Rare events and here-and-now cross-sectional studies will not answer these questions.
What we do know, from the work of Kevin Malone, Professor of Psychiatry at St Vincent's University Hospital, is that our rate of suicide among under-15s is higher than in Britain and the actual suicide rate in the 12 to 15 age group is 1.6 per 100,000 deaths. This recent study also showed that the suicide rate in this age group has been static for some time, possibly demonstrating that the present rush of deaths is a one-off occurrence.
Suicide is complex and usually there is no single cause. The transition from childhood to adulthood is a very stressful time, marking the first break from the security of home and the nurturing influence of parental closeness, in the direction of personal independence. Adequate preparation for this and healthy parental attachments from babyhood facilitate a smooth transition. Loneliness due to frequent house moves or recent parental separation also create difficulties during these periods in life.
More innate concerns relate to impulsivity and burgeoning emotionality in the pubertal period resulting in an inability to control suicidal urges. Bullying and, in the Irish context, cyber-bullying have been suggested. An even greater risk factor that has been overshadowed is proximal bullying and physical assaults associated with this. The presence of mental illness, often undiagnosed in children and young adults, is also worthy of consideration.
Yet none of these considerations answers the question as to why this age group is even thinking about suicide when in past decades such dark thoughts were for those in the adult world.
How could innocence be so dramatically lost? Could it be that the public and media preoccupation with suicide is contributing, that what we are witnessing is an epidemic of copy-cat suicide currently focussed on cyber-bullying?
Suicide is a legitimate issue for public discussion, but it must be tempered by the realisation that that discussion can be harmful, especially when media guidelines on its reporting are breached.
None of us knows the actual cause of this girl's deeply tragic death or the deaths of two other girls recently, also allegedly due to cyber-bullying.
The coroners' inquests will throw some light on the underpinnings of the disturbing loss of these young lives. But they will not assist in identifying why this increase is happening at this time in our social history and whether it is a blip or a new departure. Such answers, sadly, require the passage of time.
Patricia Casey is Professor of Psychiatry at University College Dublin and consultant psychiatrist at the Mater