We talk about rising suicide rates in young people

Article in Review: Berman, A. & Silverman M. (2020). A Call to Clarify Fuzzy Sets. Crisis: The Journal of Crisis intervention and Suicide Prevention. DOI: 10.1027/0227-5910/a000673

Summary & Relevance: Berman and Silverman make their point clear in a recent editorial in Crisis: the Journal of Crisis intervention and suicide; that there is a lack of uniformity in defining the ages that should be considered in studies related to youth and young people. This lack of consistency causes the creation of a fuzzy set; where boundaries established by research are arbitrary, vague and inconsistent. Is this all just semantics, or does it really make a difference in how we understand suicide risk and prevention? Are we doing a disservice to some groups of at-risk people by bundling them into age-based groups and trying clumsily to compare their diverse experiences?

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Teens and Young Adults

We first encounter challenges of definition when considered teens and young adults. Typically we have understood teen to refer the years ending in “teen” that is, 13-19 years. It is common to refer to these years as being preceded by the pre-teen group and then followed by the young adult group. But research across these years is far from standardised in the use of language. Recent studies cited in the editorial considered pre-teens to be 11-13-year-olds, including thirteen-year-olds in the pre-teen category. Confusingly, young adult literature is written for 12- 18-year-olds but other definitions of young adult include people in their late teens or early twenties to those in their thirties.

Adolescents

The term adolescent is typically used to describe the years following the onset of puberty, as the child becomes an adult. Some may consider the teen years to be synonymous with adolescence however this is not a definitive correlation. The World Health Organisation (WHO) defines adolescence as the period between ten and 19 years of age, meaning most adolescents are also considered children (for example, under the Convention on the Rights of the Child). Further contributing to this murkiness is the fact that the age of onset of puberty differs by gender, and has also been shifting, in that an earlier onset of puberty is apparent in almost all populations. The authors refer to studies defining adolescents in a number of ways; being taken to mean the ages of ten and 19, ten and 18, 13 and 18 and 13 and 20.

Gen Y and Z

There is also a tendency to use the generational labels to refer to groups, yet there is a distinct lack of consistency about these generations. Gen Y can be considered to be born between 1981 and 1996, or 1979 and 1997, or 1979 and 1995 or even 1980 and 2000. According to the study, Gen Z’s emerged either in 1996, 1997 and 1998, and no one really knows who we mean when we speak about Post Millennials!

Youth suicide and suicide among the young

When reviewing the literature on their specialist area, Berman and Silverman found studies referring to youth, young adults and young people with the following focus groups:

• Five- 17 years
• Ten -19 years
• Ten – 24 years
• Ten- 25 years
• 15- 24 years
• 16- 23 years
• 18- 24 years
• 24 years and younger
• Under the age of 26

There is a lack of consistency even in individual studies. One article is even cited in which youth are describe as those aged 15-24 years and young adults as aged 20-24 years!

The use of five year age groups

The Centre for Disease Control (CDC) publishes mortality and morbidity data in relation to suicide and refers to young people as either aged between 10 and 19 or ten and 24. When looking at particular health themes, the CDC also breaks down age groups into five-year subgroups, (10-14, 15-19 and 20-24) to allow more age-specific patterns to emerge. However, when dealing with a group in which individuals are experiencing significant change and personal development at a comparatively rapid rate, the use of even five-year analysis may not do justice to the data. For example, one study found that between 2000-2017, the rate of suicide among young people aged between 15 and 19 increased by 47%. But when drilling down further into this data, it was found that the rate of increase for 15-year-olds was almost double at 88%. A particular risk for people aged 15 years could have easily been missed or overlooked, and services planned for and provided without this critical piece of knowledge.

Treating the whole of a person

Statistics and data need to be used to help us identify, develop and implement appropriate and relevant suicide prevention strategies. We need to look beyond our fascination with suicide rates and use information about what we know our young people are experiencing in their lives to address their key stressors and risk factors. Age is not the only characteristic that will impact a person’s experience at a certain time and is not the only indicator of risk. Young people may be in primary school, middle school or high school. They could be at university. They may already be in workplaces or the military. They have life experiences, family circumstances and personal concerns that vary wildly. If we are to better understand how to help at-risk young people, we need to better understand causes and associated risk factors as they are specific to people of different ages.

Recommendations

• A consensus on the use of the same ages ranges or groupings, which reasonably reflect developmental, biological and psychosocial issues
• Recognise developmental differences that occur in the early years of a person’s life, and consider groupings of even less than five years to better allow gathering and assessment of data 10-12 free tees, 13-14 early adolescents, 15-16 mid adolescents and 17-18 and late adolescents and 20-24 as young adults.
• Pay closer attention to time frames and periods used to assess and consider trends and quit using broad, inconsistent and fuzzy data sets when trying to identify meaningful ways of supporting at-risk people.