Volume 8 Issue 9 September, 2018
A 15-year-old boy was referred to Narayana Health City from Mysore for management of acute liver failure and to have a potential liver transplant. He had allegedly ingested two tubes of rat poison (yellow phosphorus) after failing to commit suicide by hanging the same day. He presented to us with grade III hepatic encephalopathy for which he was managed with intubation and ventilation and maintaining neuroprotective measures. He underwent 3 sessions of plasma exchange and CRRT(continuous renal replacement therapy) was initiated to control hyperammonaemia and lactic acidosis. He recovered from acute liver failure without the need for a liver transplant. He was then assessed by our paediatric psychiatric team and further management with antidepressants and community support was done.
Globally, suicide by adolescents is on the rise. In India, suicide is the leading cause of death in adolescents. For every unfortunate suicide there are twenty-five failed attempts and countless suicidal thoughts. Fortunately, four out of five teenagers give clear warning signs which can be detected by parents, teachers and caretakers. Timely counseling and referral can save young lives.
Warning signs of Suicide
Verbalizing death wish; Acquiring means of self-harm / suicide; Feeling of hopelessness; Self hatred; Saying goodbye as if this is the last one; Isolation from friends and family, deterioration of social relationships. Excessive anger and aggression, fall in academic performance, reckless driving, drug abuse (alcohol and tobacco).
Parents and teachers being the foremost caretakers are likely to identify the above warning signs much earlier than others. They should remain calm, be empathetic, ensure safety of the teen and help the disturbed adolescent. Professional help from a pediatrician, counselor or psychiatrist may be necessary. Delay or reluctance will worsen the situation. Any change in behavior and loss of interest in activities enjoyed previously for more than two weeks maybe pointers towards a mental disorder.
Many parents wrongly believe that a mention about death wish by a teenager is an attention seeking behavior. Caretakers should take every word very seriously. Talking to distressed teens about suicidal intentions makes them feel that parents are caring, nonjudgmental and empathetic. They also feel understood and supported. Parents should help the teen to cope with the stressful situation. Talking to teens about suicidal thoughts does not predispose them to self-harm. Caretakers must take note of “protective factors” which prevent teenagers from ending lives and help them cope with stressors. This learning should begin early in life and the active process of life skills education must continue through teenage and youth.
Protective factors
Life skills and resilience, family and school connectedness, restriction to lethal means, cultural and religious beliefs, strong support system, peer support and trained peer educators. Life is full of everyday challenges and teenagers are vulnerable to the various stressors like academic pressure, competitive sports, peer influence, social media hazards, substance abuse, separation from parents, bullying, disturbed relationships, body image dissatisfaction, sexual identity confusion and uncertainty about the future. Life skills act as vaccines against external influences and internal emotional turmoil. Life skills education by parents and teachers nurtures a mentally strong, resilient and responsible teen who can handle stress and challenges effectively.
Following life skills should be taught to children from a young age:
1) Self awareness: Knowing ones likes, dislikes, strengths and weaknesses 2) Decision making 3) Critical thinking 4) Coping with stress 5) Handling emotions 6) Effective communication 7) Nurturing relationships
8) Personal safety 9) Goal setting
Teaching resilience to children and teenagers is the most vital parental task. Resilient teens are flexible, adjust well to life situations and excel in academics, career and inter personal relationships.
