Suicide risk factors among adolescents and young adults
The World Health Organization reports on the increase of suicide rates among the young, especially those aged 15-19. The paper lists and discusses the precipitating or risk factors and the cultural factors to suicide. It also discusses the social, physical and psychological/behavioral factors or determinants of health, using the 2002-2003 annual report of the San Francisco Department of Public Health as illustrative example.
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Suicide Tendencies
MIND AND BODY AXIOM
Suicidal Tendencies
Suicide and Its Factors
A review of the World Health Organization's mortality database on suicide from 90 countries in 2005 showed those in the 15-19 age group topped the list (Wasserman et al., 2005). The data came from 90 out of the 130 member states of the WHO. The review found that there were more male than female fatalities in almost all the countries, except in China, Cuba, Ecuador, El Salvador, and Sri Lanka, which had more female than male fatalities. In the 90 respondent countries, suicide was the fourth leading cause of death among young men and the third for young women. An increase in suicide rates was observed among young males, especially before 1980 and in countries outside Europe (Wasserman et al.).
Cultural Factors
Recent surveys among ethnic and racial minority youth in the U.S. showed that Latinas have the highest suicidal behavior rates as compared with African-Americans and non-Hispanic White adolescent females (Zayas & Pilat, 2008). This cultural phenomenon has been interpreted as a product of some specific aspects of Hispanic or Latino history, tradition, ideology and/or social standards. Other studies, however, contend that the psychological profile and the risk factors in the case of Latina adolescent females may not be too far or different from those of non-Hispanic adolescent females. It must be appreciated that Latina adolescents are at the stressful crossroads of cultural and familial factors, such as familism, acculturation, relatedness and autonomy. These collide against developmental, social, and individual factors, which trigger suicidal behaviors. Interventions for treatment must consider and include family and cultural aspect (Zayas & Pilat).
Physical, Psychological and Social Factors of Health
The 2002-2003 Annual Report of the San Francisco Department of Public Health (2003) listed social determinants, behavioral determinants, and clinical determinants as the social, physical, and psychological factors, which influence health. Social and physical conditions produce varying health, disease and injury patterns in the population. Individual factors, such as risks or response to stress, determine the general effects of environmental factors. The social and physical environments also affect individual factors (SFDPH).
Social determinants to health are economic conditions, racial disparities, transportation and access to food (SFDPH, 2003). Economic conditions, which conduce to poor health, are low income and income inequality. In the case of San Francisco in 2000, 5% of its households earned less than $50,000 a year and almost a third of them earned only less than $35,000. While many earned substantial incomes, many earned less than what they needed for subsistence. More than 40,000 households earned incomes below the minimum wage level for California. The federal poverty level standard of measure is no longer applicable today with the number of families living below subsistence levels. Poverty in San Francisco continues to rise, especially among children under 5 and the youth aged 18-24. Poverty rates among ethnic families are higher among non-couple than married couple families and among female-headed than male-headed families. The 2000 census reported that 65% of households were renters and 37.5% of them spent more than 30% of their income for rent. Homelessness remains a problem in San Francisco because of the lack of affordable housing, incomes below subsistence levels, and behavioral, mental and physical problems (SFDPH).
Racial disparities are another social determinant of health (SFDPH, 2003). While White households in the subject State of the report earned more than $75,000, African-American and Latino households earned less than a quarter of that level. According to the California Budget Project, a family with 2 children needs to earn more than $50,000 to live in modest comfort in San Francisco. Transportation is another social determinant to health. Traffic and commuting safety, pollution by air or noise, social isolation or interaction, a substitute for exercise, and time pressure are among the ways transportation affects health. Tabulations show that most people in San Francisco traveled by car, truck or van alone (SFDPH).
According to the California Health Interview Survey conducted in 2001, about 28.8% strove to provide regular food (SFDPH, 2003). Of this number, 9.4% experienced physical hunger. The lack of assured access to sufficient food through socially appropriate means constitutes food insecurity (SFDPH).
Physical environment as another determinant has to do almost exclusively with air quality (SFDPH, 2003). The federal Clean Air Act empowers the Environmental Protection Agency to set heath standards for air pollutants, such as ozone, nitrogen dioxide and particulates. Standards for ozone and nitrogen dioxide standards were kept above the minimum but larger particulates went over the State standard in the last 4 years. Particulates can induce asthma and other respiratory conditions or make them worse (SFDPH).
Behavioral determinants are psychological factors influence health (SFPDH, 2003). These are smoking, physical inactivity, diet and abuse of alcohol and drugs. The U.S. Surgeon General identified cigarette smoking as the leading preventable cause of both disease and death in the country. California has a lower smoking rate than the national average, but it is still the major contributing factor to the State's disease and death rates. Tobacco use differs between the sexes and among income and educational levels. Men smoke more than women, most of them Whites and African-Americans. Most smokers earn lower incomes than those who earn higher incomes. The second leading determinant of death in the country is physical inactivity. The Surgeon General encouraged those who are inactive to increase their activity level in order to improve health and reduce the risk of dying or developing serious diseases. These include heart disease, diabetes, high blood pressure, and colon cancer, which are all associated with physical activity. In San Francisco, males are less inactive than females, Whites than ethnic groups and the highest income group also less inactive than lower income groups. Unhealthy diet accounts for much mortality in the U.S. Adequate knowledge about the importance of a healthy diet can prevent many health conditions, including obesity. The U.S. Healthy People Program contains specific objectives and schemes in creating a healthy diet. On the other hand, illness and death rates from alcohol and substance abuse continued to rise to crisis levels for San Francisco. The main alcohol and drug-related causes of death in San Francisco during the period were poisoning, alcohol use, cirrhosis of the liver, and drug use. A study conducted by the National Institute of Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism conducted on the costs of the addictions showed that $246 billion was spent in 1992 alone. Most of the treatment cost went to hospitalizations and half of all the expenses went to drug-related crime. On top of all, many young lives are lost to drug and alcohol abuse (SFDPH).
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