In 2015, as a requirement of my Masters in Psychology, I completed research to understand why young people believe their peers engage in suicide.  The following is a summary of my research.

What is suicide?

• The World Health Organization (2014) defines suicidal behaviour as “a range of behaviours that include suicide ideation, planning for suicide, attempting suicide and suicide itself” (p. 12).  More specifically, suicide is defined as “the act of deliberately killing oneself” (World Health Organization, 2014, p. 12). 
• An attempted suicide is defined as “any non-fatal suicidal behaviour”, which includes “intentional self-inflicted poisoning, injury or self-harm which may or may not have a fatal intent or outcome” (World Health Organization, 2014, p. 12).
• Non-fatal self-harm without suicidal intent is included within the definition of a suicide attempt.  The World Health Organization acknowledge the complexity of this, highlighting that it can be difficult to assess suicidal intent due to “ambivalence or concealment” (World Health Organization, 2014).

Is suicide a criminal offense?

The New Zealand Crimes Act (1908) contained two provisions relating to the criminalisation of suicide: 

• Section 192: aiding and abetting suicide “everyone is liable to imprisonment with hard labour for life who counsels or procures any person to commit suicide, if such person actually commits suicide as a consequence of such counselling or procurement, or who aids or abets any person in the commission of suicide” (Crimes, 1908, p.605)
• Section 193: attempt to commit suicide “everyone who attempts to commit suicide is liable to two years’ imprisonment with hard labour” (Crimes, 1908, p.605).

Based on this legislation, suicide was considered to be a crime, and the term “committed suicide” was coined.

Later amendments to the legislation resulted in the removal of Section 193.  The current legislation (the Crimes Act, 1961), has two provisions related to suicide:

• Section 179: aiding and abetting suicide “1) everyone is liable to imprisonment for a term not exceeding 14 years who a) incites, counsels, or procures any person to commit suicide, if that person commits or attempts to commit suicide in consequence thereof; or b) aids or abets any person in the commission of suicide.2) a person commits an offence who incites, counsels, or procures another person to commit suicide, even if that other person does not commit or attempt to commit suicide in consequence of that conduct.  A person who commits an offence against subsection 2 is liable on conviction to imprisonment for a term not exceeding 3 years”.
• Section 180: suicide pact “1) everyone who in pursuance of a suicide pact kills any other person is guilty of manslaughter and not of murder, and is liable accordingly; 2) where 2 or more persons enter into a suicide pact, and in pursuance of it, 1 or more of them kills himself or herself, any survivor is guilty of being a party to a death under a suicide pact contrary to this subsection and is liable to imprisonment for a term not exceeding 5 years; but he or she shall not be convicted of an offence against section 179; 3) for the purposes of this section, the term suicide pact means a common agreement between 2 or more persons having for its object the death of all of them, whether or not each is to take his or her own life; but nothing done by a person who enters into a suicide pact shall be treated as done by him or her in pursuance of the pact unless it is done while he or she has the settled intention of dying in pursuance of the pact; 4) it shall be for the person charged to prove that by virtue of subsection 1 that he or she is not liable to be convicted of murder. Or that by virtue of subsection 2, he or she is not liable to be convicted of an offence against section 179; 5) the fact that by virtue of this section any person who in pursuance of a suicide pact has killed another person has not been or is not liable to be convicted of murder shall not affect the question whether the homicide amounted to murder in the case of a third person who is a party to the homicide and is not a party to the suicide pact”. 

At this time, based on New Zealand legislation, suicide, or an attempt, by an individual is not considered to be an offence.  Therefore, “committed suicide” is no longer an appropriate term.  In fact, some people, who have lost a loved one to suicide, can find the term offensive.  For this reason, the term “died from suicide” was used throughout my research. 

Does talking about suicide increase suicidal tendencies in young people?

Based on a literature review exploring the impact of enquiring about suicidal ideation in adolescents and adults, Dazzi, Gribble, Wessely, and Fear (2014) found no statistically significant increase in suicidal ideation among participants who were asked about suicidal thoughts.  In addition, Dazzi et al. (2014) reported that acknowledging and talking about suicide may in fact reduce, rather than increase, suicidal ideation.  

Prevalence

Suicide rates are based on the number of people who have died by suicide (per 100 000 population), which allows for comparison between countries.  As depicted in the following maps, New Zealand has one of the highest rates of suicide (particularly for males).   

New Zealand age-standardised suicide rates (per 100 000 population) 2010-2019

 New Zealand suicide rates (per 100 000 population) 2019

For up to date information refer to the World Health Organization suicide rates. 

What are the risk factors?

The period of adolescence and young adulthood is a complex developmental stage, with many socio-cultural factors that influence decisions.  It is imperative to consider which factors place a young person at risk of suicide.  Research has identified many risk factors associated with suicidal behaviour.  Commonly cited risk factors include previous suicide attempts, psychopathology, anxiety, family relationships, sexuality, adverse life events, and bullying.

Participants

My research consisted of six focus groups, held between 20 September 2015 and 13 October 2015.  There were a total of 19 participants recruited from Wellington, Sanson, and Whanganui (New Zealand).  The age of participants ranged from 16 to 24 years old, with a mean age of 19.74 years (SD = 5.04).

Results

With the use of thematic analysis, five themes (each with two subthemes) were identified.  These were; relationship factors, internal factors, gender, external factors, and support services.  

Relationship Factors – participants believed that relationships with other people influenced their peers, resulting in thoughts of suicide (and suicidal behaviour).  There were two subthemes: bullying and intimate relationships.

Participants’ discussions identified how the complexity of relationships, with someone perceived as a bully and intimate partners, can influence suicidality.  Many participants believed that there had been an increase in cyber-bullying and that bullying was a primary factor in youth suicide.  All participants believed, within a bullying relationship, that those most at risk of suicide were the young people being bullied.  This is inconsistent with the research of Kaltiala-Heino et al. (1999), who found that bullies were more at risk of suicide. 

Petrie (2012) claims that New Zealand has one of the highest rates of bulling within the developed world.  The higher rates of bullying are possibly influenced by factors related to New Zealand’s unique multi-cultural society (Ward & Masgoret, 2008) or differences in the socio-economic status within New Zealand (Kljakovic et al., 2015).  Of significance, Kljakovic et al. (2015) identified that Māori were victim to more cyber-bullying than New Zealand Europeans or ‘other’ ethnicities.

Some participants identified that young people who do not possess the necessary skills to manage the dissolution of an intimate relationship can perceive their future in a negative manner, which can influence suicide.  Given previous research (such as Beautrais, 2001) this was an expected result.  Of significance, participants identified how the loss of a first relationship, or being in a relationship that was sporadic, could have a negative impact.  This is similar to research by Sprecher, Felmlee, Metts, Fehr, and Vanni (1998) who found that the level of commitment a young person had in their relationship, was related to their distress in the period immediately following the dissolution.  In addition, high distress levels are due to relatively poor coping skills during a crisis (Mikulincer, Florian, & Weller, 1993).

Overall, it was the dynamics of the relationship, with someone considered a bully or an intimate partner, and the manner in which they perceived the relationship, that participants believed led an individual to contemplate suicide.

Internal Factors – participants attempted to understand the context of another young person’s suicide by considering internal psychological factors.  There were two subthemes: depressive disorders and coping skills. 

In general, participants believed that a young person’s emotional state significantly influenced suicidality, particularly depressive disorders.  While this is consistent with previous research, which has identified a correlation between depressive disorders and suicide (such as Brent et al., 1993, & Fisher, 1999), some participants believed there was a causal relationship.  Participant’s reported their knowledge on this relationship had typically been acquired from the media.  

Given this, it is necessary to clarify the relationship between depressive disorders and suicide for the general public of New Zealand.  If young people living in New Zealand believe that suicide results from depressive disorders this will limit those who do not have a depressive disorder in seeking support. 

Furthermore, participants identified that young people have limited coping skills and experience required for regulating internal distress.  There was a similarity with the themes identified by Roen et al. (2008), such as young people attempting suicide because they view it as a viable option and suicide being trivialised.  This is possibly attributable to the high rates of youth suicide within New Zealand, which appears to normalise the occurrence.

Gender – participants believed that gender influenced suicidal behaviour.  There were two subthemes: kiwi masculinity and suicide rates.  

Within New Zealand, males die from suicide at a higher rate than females.  Participants were aware of this and discussed how the gender difference could be accounted for by the method of suicide, which is consistent with previous research (e.g. Beautrais, 2003).  In addition, participants identified a stereotype of kiwi masculinity, and the need to be perceived as “macho”, which was also identified in “Target Zero” (King, 2015).  This provided a valuable insight to how gender stereotypes can influence suicidality, especially within New Zealand.  

In addition, participants were aware of the difference in rates between males and females and offered possible reasons for this (such as method of suicide).  The difference in rates of male and female suicide could be the result of socially constructed masculinities and femininities (Payne, Swami, & Stanistreet, 2008).  Payne et al. (2008) acknowledge the importance of gender-sensitive policies as these may provide more success in addressing suicide, compared to policies which are gender-blind.  A well designed campaign could challenge the kiwi masculinity stereotype that is engrained within New Zealand culture.

External Factors – participants believed that environmental factors influenced suicidal behaviour.  There were two subthemes: alcohol and other drugs and circumstances.  

The majority of participants believed that alcohol and other drug use was a significant contributing factor to youth suicide, and that it impacted on a young person’s ability to think clearly.  Previous research has considered the impact of alcohol and drug use, and has identified this as a common risk factor (e.g. Shaffer et al., 1996).  Within New Zealand, in the period 2011-2012, a high proportion (85%) of young people aged 18 to 24 years old consumed alcohol (Ministry of Health, 2013).  Additionally, during the same period, the rate of young people aged 18 to 24 years old who were drinking at a hazardous level was 36% (Ministry of Health, 2013).  It is likely that youth in New Zealand consider alcohol consumption to be a normal occurrence.  Given the relationship between alcohol and other drug use and suicide it can be argued that the legal age for alcohol consumption should be raised.  In addition, this highlighted that for young people with alcohol and other drug use, there is a possible shortage of support services, or they are reluctance to access these services.  

Furthermore, participants identified that suicide can be the result of a difficult circumstance. While participants did not identify specific circumstances, they believed that a stressful or traumatic event, played a role in an individual’s suicide attempt.  This is consistent with previous research (such as Houston et al., 2001) that has considered the circumstances present before a suicide.

Support Services – participants discussed the availability of, and access to, support services.  There were two subthemes: access and reluctance/barriers. 

Several participants discussed support services available within New Zealand, such as phone lines.  However, they identified, that for various reasons, many young people are reluctant to access phone services.  Previous research identified that young people rarely (2%) utilise dedicated youth phone lines, and are more likely (18%) to engage in web based chat with their peers (Gould, Monfakh, Lubell, Kleinman, & Parker, 2002).   

Participants identified that young people are hesitant to access these services due to fear of being judged or the belief that they need to “harden up”.  This is similar to research of Givens and Tija (2002) who identified that barriers for young people accessing support include: a lack of time, lack of confidentiality, stigma of seeking support, and the associated financial cost.  

In addition, participants discussed the New Zealand campaign on depressive disorders, fronted by Sir John Kirwan.  They believed that a similar campaign, on youth suicide, will be beneficial for young people living in New Zealand.  It is important that such a campaign provides information on accessing support when feeling suicidal, without normalising suicide, as this would depict suicide as an acceptable option amongst young people (Cialdini, 2003).

Recommendations

This results from this research led to a variety of recommendations.  Firstly, New Zealand must address the gender stereotypes within society.  Given how some young males within New Zealand are aware of, and adhere to, a kiwi masculinity stereotype, there may be a reluctance to express their thoughts and emotions and access support when suicidal.  The first step is to acknowledge that any person, regardless of their gender, can become distressed and suicidal, and require support, and that males do not need to adopt the traditional notion of being the stronger gender (Payne et al., 2008).

Secondly, the New Zealand educational curriculum needs to be adapted to provide students with information and support immediately after a suicide (or attempt) occurs within their community.  This is particularly important as Shilubane et al. (2014) reported that the participants in their study were pre-occupied with suicide, due to a lack of support offered after a peer had attempted or died from suicide.  Through acknowledging suicide, students will gain a more thorough understanding.  It is expected that they will be more likely to access support if they, or their peers, later require it.  It is hoped that providing this educational component to young New Zealanders, on an annual basis, will reduce their reluctance to access support.  It is important to remember that acknowledging and talking about suicide may in fact reduce suicidal ideation.    

Simultaneously, it would be useful to implement a nation-wide suicide prevention campaign, similar to the campaign on depressive disorders that was fronted by Sir John Kirwan.  Careful consideration needs to be given to acquire the most appropriate spokesperson (or people).  Ideally, this campaign would enable young people to acknowledge that they can seek help if they, or someone they know, is feeling suicidal.  If managed correctly, this campaign will empower young people to seek help when feeling suicidal, and importantly, it will not glorify suicide.

Furthermore, there is a need for an additional framework that supports young people to manage the environmental factors, such as bullying, alcohol or other drug use, and the dissolution of an intimate relationship, which impact on their daily lives.  This can be established within schools and cover topics such as: distress tolerance, emotional regulation, and social skills, as previous research has identified that positive self-appraisals provide a source of resilience (Johnson, Gooding, Wood, & Tarrier, 2010).  Ideally, these topics will be incorporated into the health curriculum, with guidance counsellors providing additional support to students.  Additionally, there needs to be continued support for young people who are no longer at school.  This could include advertising access to support services at locations such as restrooms in shopping centres.  Finally, teachers need to be mindful of how their students are coping at school, to consider their social and emotional well-being as well as their academic well-being, and to encourage them to seek support if necessary.

The majority of participants’ knowledge on suicide resulted from the media.  Therefore, it is necessary that the messages within the public domain are accurate, and that the media consider the purpose of their reporting (in accordance with the Coroners Act, 2006, section 71).  Most importantly, it is recommended that all media reports and interventions use the appropriate terminology, and refer to an individual who has ‘died from suicide’, rather than someone who ‘committed suicide’.  

Lastly, it is imperative to acknowledge that there are many factors that influence youth suicide.  To imply that suicide is caused by only one variable ignores the other factors that influence suicide (Sinyor et al., 2014), and may increase a young person’s reluctance to seek support when feeling suicidal.

Limitations and Future Research

A limitation of this research is the lack of diversity within the sample.  The majority of participants were female (84%) and 79% of the sample identified as solely New Zealand European or Pakeha.  Given that New Zealand males die from suicide at a higher rate than females, and that Māori experience higher rates of suicide than non-Māori, it would be beneficial to conduct research with a sample that is more diverse.  In addition, future samples that record participants’ personal statistics, such as sexuality and alcohol and other drug use, would be useful, as these factors have, in previous research, been identified as relevant to suicide and may in fact influence participants own perspectives on suicidal behaviour.   

This research utilised focus groups; there are possible limitations with this approach.  Information from focus groups may not be as in depth as individual interviews, and participants may not express their honest opinions.  Participants may have found it uncomfortable to discuss their opinions on suicide in the presence of others.  In each focus group it is possible that participants were reluctant to discuss views that differed from other people, or they may have felt pressure to provide answers in accordance with the questions being asked.  

References

Beautrais, A. L. (2001). Child and young adolescent suicide in New Zealand. Australian and New Zealand Journal of Psychiatry, 35(5), 647-653.

Beautrais, A. L. (2003). Suicide and serious suicide attempts in youth: A multiple-group comparison study. The American Journal of Psychiatry, 160(6), 1093-1099.

Brent, D. A., Perper, J. A., Moritz, G., Allman, C., Friend, A, Roth, C., … Baugher, M. (1993). Psychiatric risk factors for adolescent suicide: A case control study. Journal of American Academy of Child and Adolescent Psychiatry, 32, 521-529.

Crimes. (1908). Retrieved from http://www.enzs.auckland.ac.nz/docs/1908/1908C032.pdf

Dazzi, T., Gribble, R., Wessely, S., & Fear, N. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363.

Givens, J. & Tija, J. (2002). Depressed medical student’s use of mental health services and barriers to use. Academic Medicine, 77, (9), 918-921.

Gould, M., Monfakh, J., Lubell, K., Kleinman, M., & Parker, S. (2002). Seeking help from the internet during adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1182-1189.

Houston, K., Hawton, K., & Shepperd, R. (2001). Suicide in young people aged 15-24: A psychological autopsy study. Journal of Affective Disorders, 63(1), 159-170.

Johnson, J., Gooding, P., Wood, A., & Tarrier, N. (2010). Resilience as positive coping appraisals: Testing the schematic appraisals model of suicide (SAMS). Behaviour Research and Therapy, 48(3), 179-186.

Kaltiala-Heino, R., Rimpela, M., Marttunen, M., Rimpela, A., & Rantanen, P. (1999). Bullying, depression, and suicidal ideation in Finnish adolescents: School survey. British Medical Journal, 319, 348-351.

King, M. (2015, June 15). Target Zero [Television documentary]. Retrieved from http://www.maoritelevision.com/tv/shows/pakipumeka-aotearoa-new-zealand- documentaries/S06E001/target-zero

Kljakovic, M., Hunt, C., & Jose, P. (2015). Incidence of bullying and victimisation among adolescents in New Zealand. New Zealand Journal of Psychology, 44(2), 57-67.

Mikulincer, M., Florian, V., & Weller, A. (1993). Attachment styles, coping strategies, and post-traumatic psychological distress: The impact of the Gulf War in Israel. Journal of Personality and Social Psychology, 45, 101-117.

Ministry of Health. (2013). Hazardous drinking in 2011/12: Findings from the New Zealand Health Survey. Wellington, New Zealand: Ministry of Health.

Payne, S., Swami, V., & Stanistreet, D. (2008). The social construction of gender and its influence in suicide: A review of the literature. Journal of Men’s Health, 13, 1- 13.

Petrie, K. (2012). Student peer bullying: A brief overview of the problem and some associated myths. TEACH Journal of Christian Education, 3, 4-9.

Roen, K., Scourfield, J., & McDermott, E. (2008). Making sense of suicide: A discourse analysis of young people’s talk about suicidal subjecthood. Social Science & Medicine, 67, 2089-2097.

Shaffer, D., Gould, M., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., & Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53(4), 339-348.

Shilubane, H. N., Ruiter, R. A. C., Bos, A. E. R., Reddy, P. S., & van den Borne, B. (2014). High school students’ knowledge and experience with a peer who committed or attempted suicide: A focus group study. Bio-Med Central Public Health, 14(1081), 1-9.

Sinyor, M., Shaffer, A., & Cheung, A. H. (2014). An observational study of bullying as a contributing factor in youth suicide in Toronto. Canadian Journal of Psychiatry, 59(12), 632-638.

Sprecher, S., Felmlee, D., Metts, S., Fehr, B., & Vanni D. (1998). Factors associated with distress following the breakup of a close relationship. Journal of Social and Personal Relationships, 15(6), 791-809.

Ward, C., & Masgoret, A. (2008). Attitudes towards immigrants, immigration, and multiculturalism in New Zealand: A social psychological analysis. International Migration Review, 42, 227-248.

World Health Organization. (2014). Preventing suicide: A global imperative. Retrieved from http://www.who.int/mental_health/suicide prevention/world_report_2014/en/