SoA-Oct2006

Handbook of WMA Policies
World Medical Association ½ S-1991-01-2006

WMA STATEMENT
ON
ADOLESCENT SUICIDE
Adopted by the 43rd
World Medical Assembly, Malta, November 1991
and revised by the 57th
WMA General Assembly, Pilanesberg, South Africa, October 2006
1. The past several decades have witnessed a dramatic change in causes of adolescent
mortality. Previously, adolescents mostly died of natural causes, whereas they now
more likely die from preventable causes. Part of this change has been a worldwide rise
in adolescent suicide rates in both developed and developing countries. In the
adolescent population, suicide is currently one of the leading causes of death. Suicides
are probably under-reported due to cultural and religious stigma attached to self-des-
truction and to an unwillingness to recognize certain traumas, such as some automo-
bile accidents, as self-inflicted.
2. Adolescent suicide is a tragedy that affects not only the individual but also the family,
peers and larger community in which the adolescent lived. Suicide is often ex-
perienced as a personal failure by parents, friends and physicians who blame them-
selves for not detecting warning signs. It is also viewed as a failure by the community
by serving as a vivid reminder that modern society often does not provide a nurturing,
supportive and healthy environment in which children can grow and develop.
3. Factors contributing to adolescent suicide are varied and include: affective disorders,
trauma, anxiety disorders, emotional isolation, self-esteem, excessive emotional stress
(such as teasing and harassment), romantic fantasies, thrill-seeking, drug and alcohol
abuse, the availability of firearms and other agents of self-destruction, and media
reports of other adolescent suicides resulting in copycat acts. Most often suicide is the
result of several factors acting together, rather that any one isolated factor. Youth
within correctional facilities are at higher risk for suicide than the general population
yet have fewer resources available to them. However, the lack of a consistent personal
profile makes it difficult to identify those adolescents at risk for suicide.
4. The health care of adolescents is best achieved when physicians provide compre-
hensive services, including both medical and psychosocial evaluation and treatment.
Continuous, comprehensive care provides the physician the opportunity to obtain the
information necessary to detect adolescents at risk for suicide or other self-destructive
behaviour. This service model also helps to build a socially supportive patient-physi-
cian relationship that may moderate adverse influences adolescents experience in their
environment.
S-1991-01-2006½ Pilanesberg
Adolescent Suicide

5. In working to prevent adolescent suicide, the World Medical Association recognizes
the complex nature of adolescent bio-psycho-social development, the changing social
world faced by adolescents, and the introduction of new, more lethal, agents of self-
destruction. In response to these concerns, the World Medical Association recom-
mends that National Medical Associations adopt the following guidelines for physi-
cians. In doing so, we recognise that many other players – parents, governmental
agencies, schools, communities, social services – also have important roles in this area.
GUIDELINES
1. All physicians should receive, during medical school and postgraduate training, edu-
cation in child psychiatry and adolescent bio-psycho-social development, including
the risk factors for suicide.
2. Physicians should be trained to identify early signs and symptoms of physical, emo-
tional, and social distress of adolescent patients and the signs and symptoms of psy-
chiatric disorders that may contribute to suicide as well as other self destructive be-
haviours, including depression, bipolar disorder, substance use disorders and a pre-
vious suicide attempt.
3. Physicians should be taught how and when to assess suicidal risk in their adolescent
patients.
4. Physicians should be taught and keep up-to-date on the treatment and referral options
appropriate for all levels of self-destructive behaviours of their adolescent patients.
The physicians with the most significant training in adolescent suicide are child and
adolescent psychiatrists, and the patient should be referred to one if available.
5. When caring for adolescents with any type of trauma, physicians should evaluate the
possibility that the injuries might have been self-inflicted.
6. When caring for adolescents who demonstrate a deterioration in thinking, feeling or
behaviour, the possibility of substance abuse and addiction should be raised and the
threshold should be low for urine toxicology assessment.
7. Health care systems should facilitate the establishment of mental health consultation
services aimed at preventing suicide, and should pay for the socio-medical care given
to patients who have attempted suicide. Services should be tailored to the specific
needs of adolescent patients.
8. Epidemiological studies on suicide, its risk factors and methods of prevention should
be conducted.
9. When caring for adolescents with psychiatric disorders or risk factors for suicide,
physicians should educate parents or guardians to watch for the signs of suicide and
educate them as to the options for evaluation.