Suicide and Attempted Suicide by Australian Youth in Modern Australia

This paper explores suicide and attempted suicide by Australian youth in modern Australia. It reviews 14 primary studies to ascertain intervention and prevention measures. The study finds that the risk factors of suicidal behavior include mental disorders, drug and substance abuse, internet and social media, and family history. Effective interventions and preventive mechanisms are needed to manage suicidal behavior among young adults.

Running head: Suicide and Attempted Suicide 1
Attempted suicide and Suicide by Australian Youth in modern Australia.
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Suicide and Attempted Suicide
LIST OF FIGURES
Figure 2.1: Global Male: Female suicide ratios per 100,000 people in 2016...........................6
Figure 3.1 Flow Chart of systematic research Strategy..........................................................24

Suicide and Attempted Suicide
Table of Contents
LIST OF FIGURES....................................................................................................................2
ABSTRACT...............................................................................................................................4
1.0 INTRODUCTION................................................................................................................5
1.1 Definitions........................................................................................................................5
1.2 Overview global suicide...................................................................................................5
1.3 Overview of Australia suicide..........................................................................................6
2.0 LITERATURE REVIEW.....................................................................................................8
3.0 METHODS AND SEARCH STRATEGY PROCESS......................................................23
4.0 SUICIDE AND ATTEMPTED SUICIDE IN AUSTRALIA............................................25
4.1 By Age............................................................................................................................25
4.2 By Region.......................................................................................................................25
4.3 By Indigenous and non-indigenous................................................................................25
5.0 SUICIDAL FACTORS......................................................................................................26
5.1 Mental Disorder..............................................................................................................26
5.2 Trauma............................................................................................................................27
5.3 Family history.................................................................................................................27
5.4 Alcohol and Drugs..........................................................................................................28
5.5 Social Media...................................................................................................................28
6.0 SUICIDE PREVENTION AND INTERVENTION STRATEGIES.................................29
6.1 Individual and Family Therapy.....................................................................................29
6.2 Transitory Interventions during High-risk Periods........................................................29
6.3 Technology and the Internet...........................................................................................29
6.4 Universal and Selective Prevention................................................................................30
FINDINGS...............................................................................................................................31
DISCUSSIONS........................................................................................................................32
LIMITATIONS........................................................................................................................33
TRUSTWORTHINESS...........................................................................................................33
CONCLUSION........................................................................................................................34
References................................................................................................................................35

Suicide and Attempted Suicide
ABSTRACT
Purpose:This paper purposes to explore suicide and attempted by Australian youth in
modern Australia with an objective of ascertaining intervention and prevention measures.
Design/ Methodology/ Approach: 14 primary studies were reviewed. The selection of
papers was conducted to incorporate a wide range. The articles were screened, and quality
check is done and the approved ones were included in the review. Different themes were
developed due to the analysis
Findings: studies have emphasized the prevalence of suicide and attempted suicide among
the youth globally. The risk factors of suicidal behavior include mental disorders, drug and
substance abuse, internet and social media and family history. Given the magnitude of the
trend, there is a need for preventive mechanisms and effective interventions to help manage
suicidal behavior among young adults.
Originality/ Value: The study incorporates primary relevant articles from a broad range of
suicide and attempted suicide in addition to exploring the most effective prevention and
intervention strategies
Keywords: suicide, attempted suicide, risk factors, prevention, intervention
Paper type: A critical literature review

Suicide and Attempted Suicide
1.0 INTRODUCTION
1.1 Definitions
Suicide is an intentional act of terminating one’s individual life (Turecki & Brent, 2016).
Self-harm implies self-inflicted injury in which an individual has to intention to die.
Attempted suicide has been defined by as an involvement in a potentially harmful activity to
oneself in which the intention is to take one’s own life (Nock et al., 2013).
1.2 Overview global suicide
Suicide is a global issue. Because of that, the World Health Organization (WHO) has been
addressing it as early as 1950, two years after its establishment (Fleischmann, 2016). The
statistical data on suicide as presented by WHO of its member states are reliable and
unbiased. Suicides are ranked second leading causes of early deaths in young people of 15 to
29 years, whereas the suicide rates of those aged 15 to 44 years being ranked at number three.
The highest mortality rate is caused by accidents related to transportation (Bertolote &
Fleischmann, 2015). Fleischmann (2016) reports that 78% of suicides in 2015 took place in
low- and average income countries based on the WHO 2014 data.
The world suicide mortality rate in 2016 was 1.8%, with Africa countries being represented
by 0.5%, and the South-East nations having 1.9% of the world mortality rate as shown in
Figure 2.1 (WHO, 2016). According to WHO (2016), most of the African countries alongside
other developing countries reported the lowest mortality rates of 0 and 49, while some
countries such as Mexico, Panama, Turkey, Congo among others had suicide rates between
5.0 and 9.9. The highest suicide rates of 15 and above were reported in countries such as
Poland, Switzerland, Finland, and Thailand among others.
Young adults and adolescents aged between 15 and 29 years have the highest suicide rates
worldwide. Suicide is the third leading cause of death in the age bracket of 10 to 14 years,
while in the age group of 10 to 34 years, suicide is the second most common cause of death

Suicide and Attempted Suicide
(NCIPC, 2016). Generally, it is an observable trend that the majority of the young die of
suicide compared to the old folk. However, the comparative numbers per age bracket are
eight times more than in the old people (Bertolote & Fleischmann, 2015). Likewise, WHO
reports the lowest worldwide suicide rates amongst adolescent and children aged 15 years
and below, but increases after that at a steady pace up to the age of 70 and beyond
(Fleischmann, 2016).
Figure 2.1: Global Male: Female suicide ratios per 100,000 people in 2016.
Figure 1 Figure 2.1: Global Male: Female suicide ratios per 100,000 people in 2016.
Source: (WHO, 2016)
1.3 Overview of Australia suicide
Suicide rates in Australia have been on the rise to alarming levels which have attracted the
attention of world humanitarian organizations and researchers. According to the Australian
Bureau of Statistics (2016), the Australian suicide rate as at 2016 was 11.7% per 100,000
population, which represented an increase by 1.1 per 100,000 population in 2007. The
statistics further report a mortality rate of 2,866 people due to suicide. The statistics provided

Suicide and Attempted Suicide
by the World Health Organization is relatively equal to that of the Australian Bureau of
Statistics. The WHO (2018) placed Australian suicide rate at 10.4% per 100,000 population
annually using age-adjusted data. On the other hand, the standardized age rate of suicide as
reported by the Australian Department of Health was 10.3 per 100,000 people in 2005,
representing a decrease of 4.4 up from 1997. The mortality rate due to suicide in Australia is
thrice higher in men than in women. The Australian Bureau of Statistics indicates that there
were 17.8 deaths per 100,000 population in men and 5.8 deaths per 100,000 for the females.
More astonishing is the prevalence of suicide rate among the young Australian population.
The death of the majority of young people in Australia aged between 15 and 24 years is
caused by suicide (WHO, 2014).

Suicide and Attempted Suicide
2.0 LITERATURE REVIEW
Study
Method/
Sector Aims Key findings
Authors & Date
The method
used in the
study
Method,
Purpose or
research
question author
posed
Major finding of the study
Main idea or themes distilled from the finding.
How does the finding confirm thoe of studies
or information not found in other sources?
Székely et al.
(2013)
European
Alliance
Against
Depression
(EAAD)
programme,
Hungary
The objective
of the study was
to assess the
effectiveness of
the EAAD
programme as a
community
intervention
programme in
decreasing
suicide rates in
both men and
women. The
EAAD
programme was
actualised in
Szolnok town in
Hungary with a
population of
76,311 with
highest suicide
rate. The
effectiveness of
the intervention
Decreased suicide rate during the
intervention programme compared to the
former three years and after one year of
follow-up.
Suicide rates and trends: The rate of suicide
decreased by 56% between 2004 and 2005 and
by 60.1% between 2006 and 2007. No
significant difference of the decrease in suicide
rate based on gender.
Secondary outcome measures: There was an
increase in the number of emergency hotline
service calls, more so those related with suicide

Suicide and Attempted Suicide
was examined
by comparing
the rates of
suicide in the
experimental
area after the
intervention
with the
differences in
the nationwide
suicide rates and
those in the
waitlist group.
Khasakhala, Ndetei
& Mathai, (2013)
Interviews,
Kenya
The study
assessed the
association
between suicidal
behaviour and
existing
substance or
psychiatric
disorders among
young adults
and depressive
and
consumption of
alcohol among
their parents. A
sample of 678
participants
There was a significant statistical relationship
between depressive, consumption of alcohol,
and drug abuse disorders and suicidal conduct
among youths.
Suicidal behavior among the young adults in
association with their background features:
Youth background characteristics such as
depression, drug, and substance abuse
disorders have a substantive statistical
association with suicidal behavior in youths.
Suicidal behavior among the young adults in
association with the features of their parents:
The findings showed a substantial association
between depressive disorder in the mother and
supposed rejection behavior by the mother with

Suicide and Attempted Suicide
consisting of
226 biological
fathers and 202
biological
mothers, and
250 youths.
youth suicidal behavior.
The outcomes of the study indicate that youths
diagnosed with disorders related to substance
abuse and psychiatric have their mothers
diagnosed with depressive disorder.
Wanyoike, (2015).
Kenya
Qualitative and
quantitative
methods
The study was
aimed at
assessing the
existence of
suicide among
university
students. The
target
population
consisted of 50
university
students
distributed
across six
university and
40 mental health
care provider. A
sample size of
35 students and
30 healthcare
practitioners
were included in
the analysis. the
author used
structured
interview
schedules and a
The author found out that the society has a
critical role in the control, prevention and
intervention of suicide among the youths.
However, no existing data regarding the
suicide rate among the youths in Kenya was
ascertained.
Cause of suicide: the study found out that the
main causes of suicide among the Kenyan
university students include loneliness (10%),
depression (39%), anger (15%), hopelessness
(30%), and conflict (6%), with depression
being reported as the most common cause.
Impact of suicide: 70% of the respondents
reported that suicide led to trauma, shame,
anger, sense of guilt and betrayal. Stigma was
identified as the most significant effect of
suicide and suicidal behaviour
Intervention: the study findings indicated that
73% of the participants believed that it was
possible to prevent suicide, with 42% believing
the same on condition that support is made
available

Suicide and Attempted Suicide
questionnaire to
gather data from
the respondents
Freuchen,
Kjelsberg, &
Grøholt (2012).
Comparison of
quantitative
data
The study
adopted data
form a
countrywide
psychological
autopsy of
adolescents aged
15 years and
below who had
succumbed to
suicide or
accidents in
Norway (n=84).
A distinction
between the two
death causes
were determined
as well
The study found out that victims of young
suicide cases had less risk factors and less
attempted suicide compared with the older
youths.
Risk factor for suicide: mental health issues,
self-harm, attempted suicide among others
Mental health: most parents attributed suicide
behaviour in their children to mental health
problem
Asarnow, Hughes,
Babeva, & Sugar
(2017).
Randomised
control trial
A randomised
control trial was
carried out on
youths of 12-18
years who had
experienced
attempted
suicide or any
other self-harm
in the past 3
months. The
adolescents
The authors found out that there were high
chances of survival in the absence of suicide
attempt during the follow-up after
administering the SAFETY programme to
youths compared to the Education and support
accessing community treatment (E-TAU).
Thus SAFETY is the most appropriate
approach in the prevention of suicide attempts

Suicide and Attempted Suicide
were
randomized to
SAFETY or
normal
intervention as
advocated by
parental
education. The
findings were
assessed at
baseline, 3
months before
and after the
intervention
period, with a
follow-up of six
to twelve
months.
Czyz, Horwitz,
Eisenberg,Kramer,
& King (2013
Web-based
questionnaire
The study aimed
at exploring
self-recorded
barriers to
expert aid
seeking among
college students
at increased risk
of suicide and
ascertain
whether the
hindrances are
different based
on the clinical
features and
The study found out that the leading barrier to
seeking for professional aid was the notion that
treatment is unnecessary (66%) with stigma
(12%) being reported as the least barrier.
Self-reported barriers to seeking the advice of
professionals:
The students considered the suicide behaviours
as inconsequential hence no need for
professional help. 18% preferred self-
managing their issues using self-help methods

Suicide and Attempted Suicide
demographic
information. 165
respondents not
seeking
treatment were
recruited for
inclusion and
assessment. The
Web-based
questionnaire
was used to
collect data
Dvorak, Lamis,. &
Malone (2013).
Cross-sectional
study
The study
assessed the
relationship
between the
elements of the
impulsivity
model and
alcohol intake as
pointers of the
prevalence of
suicide among
college students.
A sample of
1100 students
successfully
undertook the
online
evaluation
prompts in
demographics,
prevalence of
The research ascertained a positive relationship
between all the predictors with high frequency
of suicide.
Depressive symptoms x alcohol use x urgency:
at increased intake of alcohol/high-urgency, the
relationship between depressive signs and
suicide frequency was potentiated. At
decreased alcohol consumption or low-
urgency, the relationship was slightly
weakened.
Depressive symptoms x alcohol use x sensation
seeking: at increases alcohol or sensation
seeking point, the association between suicide
frequency and depressive symptoms was a
little bit higher and vice versa.

Suicide and Attempted Suicide
suicide,
impulsivity and
depressive
symptoms.
Inder et al. (2014) Parallel cross-
sectional
analyses
The objective of
the study was to
ascertain the
determinants of
suicidal ideation
and attempted
suicide using
two data sets of
rural and urban
residents of
Australia. The
National Survey
of Mental
Health and
Wellbeing data
set of 2007
(n=8,463)
under-
represented the
residents from
the rural
community.
While the
Australian Rural
Mental Health
Study (n=634)
over-represented
the rural
community. The
The study reported similarity in the predictors
and rates of suicidal ideation and attempted
suicide in all the geographical locations.
12-month suicidal ideation: Psychiatric
disorder was reported to be the primary
determinant of the one year and lifetime
attempted suicide and suicidal ideation in all
the locations.
Lifetime suicidal ideation: Other factors like
marital status, apparent fiscal hardship,
employment status, and mental health service
were critical determinants for lifetime suicidal
ideation and attempted suicide
In the sub-analysis of the ARMHS, enhanced
apparent infrastructure, higher optimism and
accessibility to service are linked with lower
possibility of lifetime suicidal ideation when
factors such as sex, age, mental health service
were considered.

Suicide and Attempted Suicide
attempted
suicide and
suicidal ideation
and mental
disorder were
ascertained
using the World
Mental Health
Composite
International
Diagnostic
Interview, and
different
logistical
regressions
undertaken.
Handley et al.
(2012)
Composite
International
Diagnostic
Interview
The study aimed
at determining
the role of
depression in
rural suicidality
and the effect of
co-existing
psychiatric
disorders to
attempted
suicide and
suicide ideation
using a sample
of Australian
rural
community. A
sample size of
The outcomes of the analyses showed that 41%
of the respondents with suicidal ideation in
their lifetime and 34% of those with attempted
suicide reported no background cases of
depression.
Suicidal ideation: this were forecast by the
youths, presently unmarried, and post-
traumatic disorder or anxiety when there was
control for lifetime depression.
Suicide attempts: these were forecast by
disorders related to substance abuse, lifetime
anxiety, in addition to youths that are presently
married and working.

Suicide and Attempted Suicide
618 participants
were enlisted in
the Composite
International
Diagnostic
Interview which
investigated
suicide attempts,
affective
disorders,
suicidal
ideation,
depressive
disorders, and
disorders due to
drug abuse in
the lifetime.
Logistic
regression
analyses were
carried out to
determine the
role of
depression and
supplementary
diagnoses to
suicidality.
Sharma, Nam,
Kim, & Kim,
(2015).
Cross-sectional
survey
The study is
aimed at
assessing the
occurrence of
suicidal ideation
and attempted
The findings indicate a relatively high
prevalence of suicidal ideation and attempted
suicide in the area of study. Female sex were
highly susceptible to cases of attempted suicide
and suicidal ideation.
Risk factors of suicidal ideation: female

Suicide and Attempted Suicide
suicide, and
related factors
among
adolescents
enrolled in
urban schools in
Peru. The
authors carried
out a cross-
sectional survey
using 916
adolescents in
secondary
schools in 2014.
Data collection
was carried out
using a
structured
questionnaire of
the Global
School-based
Student Health
Survey. Logistic
regression
models were
used to analyse
data at 5%
significance
level.
adolescents that engaged in fights, slighted,
attacked, smoked and were initiated into sexual
intercourse were noticeably linked with high
rate of suicidal ideation.
Risk factors of suicide attempt: the female
adolescents who were involved in drug and
substance abuse, fight, attacked and insulted
were reported to experience suicide attempt
Milner et al. (2014) Case control
study
The research
aimed at
examining the
impact of
After the adjustment for other factors, the
outcomes showed that involuntary job was
linked to both attempted and suicide odds ratio
of 1.82.

Suicide and Attempted Suicide
involuntary job
loss on suicide
attempt and
suicide in
youths. The
authors
conducted a case
control study of
youths aged 18
and 34 years in
New South
Wales Australia.
The sample size
for the suicide
attempts was
101 and for
suicides was 84.
Regarding the
suicide cases, a
structured
interview was
carried out on
the next kin and
with cases of
attempted
suicide admitted
to the hospital.
the controls
obtained from
the overall
population were
compared to
cases on the
Low socio-economic status also influenced
suicide and attempted suicide at an odds ratio
of 3.80.
Mental disorders also influenced attempted
suicide and suicide with an odds ratio of 7.87
to 12.01

Suicide and Attempted Suicide
basis of gender
and age. The
analysis was
adjusted to
accommodate
other factors.
Strandheim et al.
(2014)
Prospective
Cohort study
that is
population
based
The objective of
the study was to
assess the
relationships
between health
and lifestyle
influences
reported in the
adolescents and
development of
suicidal
thoughts after 4
years of follow-
up. An
invitation was
made to all
students in the
two year classes
in Nord-
Trondelag
school and a
response of 80%
was attained.
The sample size
included in the
analysis was
2399 high
The authors found out that the 17 to 19 years
teenagers’ experienced suicidal thoughts
during the follow-up that is 158 boys and 250
girls. Factors such as depressive signs, baseline
anxiety, behavioural issues, tension, and
muscular pain were all linked to suicidal
thoughts after the follow-up study. the Female
sex predominated in one to six ration of youths
that underwent suicidal thoughts

Suicide and Attempted Suicide
school students
aged 13 to 15
years enrolled in
the Young-
HUNT 1 study
and later
followed up
after 4 years
when they are
17 to 19 years.
Park & Lee (2016). Web-based
survey
The study
assessed the
factors that
influence
attempted
suicide in young
adults from
multicultural
families in
South Korea.
The study was
based on the
Korean Youth
Risk Behaviour
Web-Based
Survey
(KYRBS)
conducted in
2105. The
sample size was
727 adolescents
whose parents
were not born in
The findings show that increased odds of
attempted suicide was significantly associated
with high residence rate in large cities by the
female sex, residing with a relative, alone or
with friends, socio-economic status, perceived
depression and disagreement with. The
outcomes are an indication that suicidal
behaviour is much prevalent in adolescents
from multicultural families with particular risk
factor such as foreign parents, teacher- student
conflict and living independent of the parents

Suicide and Attempted Suicide
South Korea.
The females
were 351
whereas the
males were 376.
Out of these 41
had experiences
suicide attempts
within one year
Randall, Doku,
Wilson,& Peltzer,
(2014).
Cross-sectional
study
The authors
explored the risk
factors
associated with
suicidal
behaviour
among junior
and senior high
adolescents in
Benin. The
study was based
on the Global
School-based
Health Survey
carried out in
2009 in Benin.
A sample of
2690 young
adults were
included in the
analysis. a
multinomial
logistic
regression was
The outcomes of the study show that 23.2% of
the participants had contemplated on suicide,
and 28.3% had attempted suicide within the
last 12 months. Loneliness, disquiet, drug and
substance abuse, and the absence of support
from adults were independently associated
with results of ideation.

Suicide and Attempted Suicide
used to test risk
factors such as
socio-
environmental,
demographic,
and
psychosocial
factors for their
relationship with
attempted
suicide and
suicidal ideation
Asante, Kugbey,
Osafo, Quarshie, &
Sarfo (2017).
Cross-sectional
survey design
The objective of
the study was to
assess the
prevalence and
risk and
preventive
influences
related with
suicide in
Ghana. The
authors used an
International
School-based
Student Health
Survey data
obtained from
senior school
going youths
The findings indicated that students in senior
high school experienced high rates of suicidal
behaviour. The suicidal ideation reported a
suicidal behaviour prevalence of 18.2%,
suicidal attempt had 22.5% and suicidal plan
reported 22.2%. Further, analysis showed that
the odds of suicidal behaviour are further
increased by anxiety even after other variables
are regulated. Other risk factors that lead to
suicidal behaviour such as attempted suicide,
suicide planning and contemplation include
physical assault, food insecurity, and being
bullied.

Suicide and Attempted Suicide
3.0 METHODS AND SEARCH STRATEGY PROCESS
Different and relevant articles, websites, and books were critically examined under the
literature review. The researcher used search engines such as PubMed and Google Scholar to
conduct systematic research to ascertain the articles and government websites that reported
on the factors associated with suicide and attempted suicide across the world. The researcher
used the following key terms during the research: suicide, attempted suicide, adolescents,
prevalence, incidence, risk factors, mental disorders, impact, strategies, prevention, suicidal
behaviors, suicide methods, and mortality. The search was limited to publications published
within five years.
A total of 70 abstracts and articles were retrieved and after screening, filtering, and quality
check, 57 studies were selected for analysis. Furthermore, ten articles were excluded due to
replication and fifteen for not being primary articles. The remaining 32 studies assessed for
suitability and 12 of them that did not meet the inclusion criteria were excluded further. Five
more papers did not have full access and were thus eliminated leaving a sample of 15 articles
which were included in the analysis. The researcher then came up with several themes
relevant to the study topic as demonstrated in the literature review section of this study.

Suicide and Attempted Suicide
Figure 3.1 Flow Chart of systematic research Strategy
Figure 2 Figure 3.1 Flow Chart of systematic research Strategy
Articles identified using
search engines (n=70)
Studies chosen after
quality check and
screening (n=57)
Selected studies for
assessment to meet
inclusion criteria (n=32)
Sample (n=15)
Articles excluded as a result of replication
(10), not primary articles (15)
Number of excluded articles because they
do not meet inclusion criteria (12)
Papers with no free access - 5
IdentificationScreeningSuitabilityInclusion

Suicide and Attempted Suicide
4.0 SUICIDE AND ATTEMPTED SUICIDE IN AUSTRALIA
4.1 By Age
In 2017, the highest mortality rate among 15 to 44-year-old people in Australia was attributed
to suicide, which is also the second leading cause of death among the people aged 45 to 54
years old. The median suicide age at death was 44.5 years which is half that of all other
deaths. The males’ median age of death was 44.0, whereas that of the females was 45.7 years.
The leading proportion of suicide deaths was reported among the age group of 45 to 49 years
in males and females. The highest age-specific suicide rate in 2017 was reported among the
males of 85 years and above, representing 32.8 deaths per 100,000 population. About the
females, the age-specific suicide rate was reported in the age group of 45 to 49 years, with the
lowest rate being recorded in the age group of 85 years and above (Australian Bureau of
Statistics, 2017).
4.2 By Region
In 2017, all Australian states had recorded an increase in the deaths caused by wilful harm
except for South Australia, Victoria, and Tasmania. The leading increase in suicide rates of
804 deaths in 2017 was found in Queensland, while the Australian Capital Territory reporting
the greatest percentage increase in deaths due to self-harm compared to the survey in 2016.
Increase in mortality rates as a result of suicide was also reported in Western Australia and
New South Wales. Concerning time series of ten years, The Northern Territory state recorded
the leading suicide rate per capita in 2017, followed by Queensland with 130 deaths
representing 49.6% of all the rise in suicide mortality. The most significant increase in
mortality rate due to wilful self-harm was reported in the Australian Capital Territory with
14.1 from 7.2 deaths per 100,000 people (Australian Bureau of Statistics, 2017).
4.3 By Indigenous and non-indigenous
The suicide rate among the Aboriginal and Torres Strait Islanders Australians is startling as it
is twice that reported among non-indigenous Australians with some remote locations being

Suicide and Attempted Suicide
much higher. For every three deaths, one is attributed to suicide (29%) in the Indigenous
people of the 15 to 34 age bracket. Additionally, between 2008 and 2012, the primary cause
of death in this age group was suicide. The suicide mortality rate in 2014 among the non-
indigenous people was 1.8%, while in all indigenous people it accounted for 5.2%. It is
likely that the indigenous people are twice more prone to succumb to suicide than non-
indigenous people (The Department of Health, 2013).
In far rural regions, most of the suicide cases are carried out by hanging which is witness
more often by most of the members of the community. As a result increased cases of trauma,
sorrow, depression, drug and substance abuse which influences suicidal behavior have been
witnessed among the Aboriginal and Torres Islander peoples. Suicide cases have been on the
rise among the indigenous people for the last three decades, with the male youths being at
greater risk. The indigenous males aged 15 to 19 years are 4.4 times likely to end their lives
through suicide compared to those of Australian male youths. On the other hand, the females
from the Aboriginal community are 5.9 times at risk of death due to suicide than those of
Australia (The Department of Health, 2013).
5.0 SUICIDAL FACTORS
5.1 Mental Disorder
Increased mortality risks in most of the cases of mental disorders have been deteriorating
over time (Walker, McGee, & Druss, 2015). Chesney, Goodwin, and Fazel (2014) conducted
a meta-review on the mental disorders and associated mortality risk and found out that mental
disorders were the leading general cause of mortality risks. Different mental diseases had
posed different mortality risks with schizophrenia and bipolar disorders having an SMR score
of 2.5 and adjusted risk ratio of 2.3 respectively. Hoertel et al. (2015) found out that 75.3%
males and 66.9% females that had attempted suicide had past medical conditions of DSM-IV

Suicide and Attempted Suicide
Axis I.PAFs mental disorders accounted for 12.8% suicide cases of while smoking
dependence had 30% suicide cases
5.2 Trauma
Existing literature has associated increased mortality rates due to suicide to be caused by
psychiatric disorders. For instance, a critical review of psychological studies by Hawton,
Comabella, Haw, and Saunders (2013) showed that over 90% of those who succumb to
suicide had initially been diagnosed of a psychiatric disorder. Furthermore, the prevalence of
suicidal thoughts and suicidal attempts have been attributed to those who have been
diagnosed with trauma (Franklin et al., 2017). Edmondson, Brennan, and House (2016) have
demonstrated that increased cases of suicidal conducts and successful suicides have been
found among people with bad life experiences. Zhang, Jia, Zhang, Wang, and Liu (2015)
conducted a study among patients admitted to a psychiatric ward after incidences of suicide
attempts and found out that the initial suicide attempts were noticeably determined the
negative life experiences they had undergone previously.
5.3 Family history
Studies have explored the significance of the family factor as a determinant of suicidal
conduct among the youths. These family factors include parental psychopathology, suicidal
conducts, disagreement in the family, divorce, death of parents, discordance between parents
and children, and maltreatment (Turecki and Brent, 2016). There exists substantial evidence
that suicidal conduct is familial, and in some cases, genetic, and that the obligation to suicidal
conduct is passed on in families despite psychiatric disorder (Rajalin, Hirvikoski, & Jokinen,
2013). The authors found out that families with cases of attempted suicide showed increased
suicide risk in other family members. This is proving to the assertion that phenotype
transmission for the inclination of suicidal behavior was present. There is also an increased
rate of 2 to 6 fold of suicidal conduct among relatives of youth suicide victims and attempters

Suicide and Attempted Suicide
of suicide (Page et al., 2014). Studies have also compared the children of parents who are
mood disordered against the offsprings of those who are not and found out that the children
of the former group are five times more likely to engage in suicidal behavior (Brent et al.,
2015). Suicide attempts were more prevalent in offsprings whose parents had depicted
suicidal behavior, hence showing that suicidal behavior can be familial. The transmission of
suicidal tendencies from the parent to the offspring were controlled by the inheritance of
impulsive aggression (Brent et al., 2015).
5.4 Alcohol and Drugs
Disorders associated with drug abuse can significantly contribute to the risk of suicide, more
so in young adults when they coincide with upsetting disorders (Nock et al., 2013). Darvishi,
Farhadi, Haghtalab, and Poorolajal (2015) assessed the association between binge drinking
and suicide attempts in young adults. The authors found out the adolescents aged 13 years
and below who engaged in heavy drinking were 2.6 times much more likely to engage in
suicide attempts when equated to those that didn’t. Wong, Zhou, Goebert, and Hishinuma
(2013) indicated that drug abuse when under depression increased the threefold the risk of
entertaining suicidal thoughts
5.5 Social Media
Some studies have indicated that there is a positive correlation between the prevalence of
internet usage with the suicide rates in the general population. Daine et al. (2013) undertook a
systematic review and assessed the relationship between the frequency of internet usage and
suicide rate and found that those who frequently used the internet were at significant risk of
entertaining suicidal thoughts. Biddle et al. (2016) carried out a systematic web search of
keywords associated with suicide and found out that over 50% of the websites were
prosuicide and provided real-time information on suicide. These studies indicate that detailed
information on suicide method can readily be accessed on the internet.

Suicide and Attempted Suicide
6.0 SUICIDE PREVENTION AND INTERVENTION STRATEGIES
Generally, studies have shown with convincing evidence of the effectiveness of the use of
psychological interventions in the treatment of suicidal cases. This approach is focused on
minimizing or discouraging the youths from entertaining suicidal thoughts and behaviors, and
fostering behavior change and improving interpersonal relationships.
6.1 Individual and Family Therapy
Nock et al. (2013) found out that the integration of individual and family therapy was
successful in youths that were contemplating suicide. The authors applauded the use of
Integrated Cognitive Behavioural Therapy (I-CBT) because it allows the combination of
three major elements namely parent training, individual and family CBT. Diamond, Russon,
and Levy (2016) pointed out that Attachment-based Family Therapy (ABFT) was significant
in improving the quality of family relationships through the use of the individual approach.
The young adults that were enrolled under I–CBT reported minimal suicide attempts during
the entire period of study (Asarnow, Berk, Hughes, & Anderson, 2015).
6.2 Transitory Interventions during High-risk Periods
Empirical evidence suggests that treatments carried out during post-discharge have been
more effective in reducing suicide and attempted suicide. The examples of brief interventions
deal with aspects of emergency control such as safety planning, provision of psychoeducation
to parent and adolescents (Asarnow, Hughes, Babeva, & Sugar, 2017). Kennard et al. (2015)
showed that safety planning as an independent intervention beneficial to patients in
ascertaining the most appropriate managing strategies for cases of suicide. Asarnow et al.
(2017) have also pointed out a small RCT shows that such brief interventions can be
worthwhile for dropping the number of suicide attempts.
6.3 Technology and the Internet
Suicidal behaviors have lately been attributed to the increased influx of suicidal information
on the internet that is readily accessible. Furthermore, Franklin, Puzia, Lee, and Prinstein

Suicide and Attempted Suicide
(2014) indicated that individuals who express suicidal or self-harm behaviors had prior
thoughts of the same. The use of a smartphone application that discourages any thinking of
suicide or self-harm was found to reduce any involvement in suicide or attempted suicide
among online recruited participants who received the treatment. However, the outcomes of
these interventions are in their initial stages and did not continue post-intervention. There is,
therefore, the need to further research to test and determine their effectiveness since they best
fit the technological savvy youths.
6.4 Universal and Selective Prevention
Most of the suicide prevention strategies focus on offering school-based education to create
awareness of suicide signs and symptoms and ascertain the populations at risk. A randomized
control trial on European nations was conducted and involved the creation of awareness on
youth mental health. The study reported a decline in cases of self-reported suicidal cases and
attempts compared to the use of independent use of posters for awareness (Wasserman et al.,
2015).
The objective of screening interventions is to find out the young adults population that is at
risk of suicide by carrying out formal mental health evaluations in the average daily life.
Based on the findings various screening interventions in school settings, several referrals
have been made to mental health services thus leading to more unsuccessful attempted
suicides and suicide aversion among the adolescents (Moyer, 2013). Wasserman et al. (2015)
propose the use of gatekeeper programs which aims at offering skills to individuals who can
be able to effectively respond to people who are at risk of committing suicide.
Selective prevention programs have also been recommended to help in the management of
common suicidal risk factors by equipping people with skills on problem-solving and self-
control (Calear et al., 2016). Many interventions aimed at addressing family conflict or

Suicide and Attempted Suicide
tension have also been recommended. Furthermore, these programs have been effective in
preventing drug abuse and the management of various disorders that contribute to suicide or
attempted suicide (Connell, McKillop, & Dishion, 2016).
FINDINGS
The search for primary articles relevant to suicide and attempted suicide in the youth of
modern Australia identified 70 articles which after critical review and assessment for quality
15 were included in the analysis. Thematic analysis was used to analyze the findings which
were presented in different themes and sub-themes. The search for articles on the prevalence
of suicide and attempted suicide identified six articles. A common finding across the articles
is that suicidal rates varied widely based on many factors such as culture, gender, age,
location, family among others. However, the highest prevalence of suicidal behavior was
reported on adolescents. For instance, Asante et al. (2017) were highest in school-going
teenagers, while Nock et al. (2013) found out that lifetime prevalence of suicide ideation,
attempts, and organization was highest in adolescents. According to Handley et al. (2012),
the prevalence of suicide is highest in the rural communities that in urban centers and yet the
degree of depression is much higher in towns than in remote areas. The authors found out that
while suicide is mostly caused by depression, other factors such as demographic influences
also have a significant impact on suicidal behaviors.
Eight of the articles reviewed were on factors that influence suicidal behavior. The findings
of the review indicated that a range of factors affected suicidal behavior among the youth.
Some of this factor include drug and substance abuse, depression, anxiety, a poor child-parent
relationship among others. Dvorak et al. (2013) suicide proneness among college students
was influenced by risk factors such as depressive signs, alcohol use among others. Handley et
al. (2012) demonstrated that it is not depression alone that significantly affects suicidal
behavior but other factors such as environmental, familial, psychiatric conditions and

Suicide and Attempted Suicide
demographic characteristics. Similar conclusions were generally arrived at by Sharma et al.
(2015); Strandheim et al. (2015); Park & Lee, (2016) among others.
A review of the articles on suicide prevention and intervention resulted in the analysis of five
articles. The findings across the review showed that suicide and suicide attempt can be
prevented as long as the appropriate mechanisms for the same are put in place. However, a
behavioral approach was emphasized across the review based on its effectiveness in previous
studies and because suicide and attempted suicide is a behavioral issue. Asarnow et al.
(2017) recommended a cognitive behavioral intervention with a particular focus on the family
members. Czyz et al. (2013) found out that barriers towards a professional treatment of
suicide and attempted suicide were behavioral. The EAAD intervention program was a
community-based intervention that focuses on behavioral therapy (Székely et al., 2013).
DISCUSSIONS
The systematic review of the 15 articles alongside others indicated that suicide and attempted
suicide among the youth was very high worldwide. Additionally, modern Australia was
leading in mortality rates due to suicide according to both the Australian Bureau of Statistics
and the World Health Organization among other surveys. The factors that have been found to
contribute to the high incidences of suicidal behavior include depression, drug and substance
abuse, internet and social media, family factors and mental disorders. However, the most
common factors that influence youth suicidal behavior among these factors include drug and
substance abuse and depression. Zhang, Jia, Zhang, Wang, and Liu (2015) Observes that
negative life experiences that the youth undergo are the primary cause of depression and drug
abuse.
Similarly, other studies have attributed the increased suicidal behavior among the youths to
unemployment and involuntary job loss, which further aggravates depression and mental

Suicide and Attempted Suicide
disorders. This, therefore, calls intervention approaches to suicide and attempted suicide. The
study findings have ascertained that a cognitive behavioral approach is the most effective
method to be used both in prevention and intervention. Other interventions and preventive
programmes include regulation of the information that is accessed by the youths on the
internet in addition to establishing emergency response mechanisms.
LIMITATIONS
This review had limitations despite the rigour with which it was conducted. The rampant
omissions in the articles included the absence of testing for publication bias and the lack of
more than one data extractor. This limited the validity and reliability of the reviews and thus
by extension this one. Moreover, most of the suicide statistics in some countries were
underreported, a phenomenon common across nations (Yang, Jia, & Qin, 2015). Even though
this study has used only primary articles, the data sets upon which the studies are based have
their weaknesses. Ioannidis (2013) shows that such datasets are often overpowered to such an
extent that the results obtained maybe statistical substantial even when there are small
variations in mortality.
TRUSTWORTHINESS
The analysis of data from a range of reviews and comparing the findings with other studies
conducted in a different setting but with more or less the same objective ensured that
triangulation was accomplished. As a result, the credibility of the findings was strengthened.
The review of different studies under different settings and the deduction of a common
finding across the studies ensured the transferability of the study (Leung, 2015). This implies
that the findings of this study can be used in other contexts with varying or the same
phenomena. All the reviewed articles were based on primary data, an aspect that strengthens
the confirmability of the findings. Primary data discourages any potential bias that may be
due to the researchers’ different motivations. Therefore, the outcome of this study is reliable

Suicide and Attempted Suicide
as there is neutrality regarding the influence of the researcher on the findings. Furthermore,
this increases the dependability of the findings in addition to the extensive information
provided in each review (Elo et al., 2014).
CONCLUSION
Prevalence of suicide and attempted suicide has become a public health problem worldwide.
Most strikingly are the increasing prevalence of suicidal behavior among the youth. More
specifically cases of attempted suicide and completed suicide in Australia are much higher
than any other country in the world. A critical review of fifteen original articles relevant to
suicide and attempted suicide across the world have indicated the magnitude of the matter by
addressing the risk factors of suicide, prevalence, and the most effective intervention and
prevention approaches. The most common factors that influence suicidal behavior among the
youth include mental disorders, social media and internet, and family history. Lastly, the
findings of this review showed that suicide and attempted suicide can be controlled as long as
appropriate support mechanisms are put in place.

Suicide and Attempted Suicide
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