Preventing suicide by young people requires integrative strategies

To the Editor: The incisive editorial by Dudley and Lin1 should serve as a clarion call for the development of “more robust strategies with targeted, customised approaches … evidence‐based interventions and peer‐reviewed evaluations”.

Their sobering editorial highlights the immense challenges that need to be overcome to affect the growing suicide rates underscored by Hill and colleagues.2 They point out that transgenerational trauma and socio‐economic disadvantages increase suicide in Indigenous populations and call upon collaborative governmental support to address the problem. Intriguingly, although prevalence is higher in moderate to severely disadvantaged youth, the statistics among the least disadvantaged youth are not lagging far behind.2 This suggests that there are likely additional commonalities, such as mental illness, which features in at least half of all such suicide (> 55%).2 It is in light of this confronting reality that we raise the additional need for in‐depth knowledge and mechanism‐informed targeted treatment to avert suicide.

It is concerning that one‐third of parents and carers are inadequately informed of mental health services available for mentally ill youth, impeding access to appropriate services,1 which clearly needs to be addressed. But simultaneously, it is important to identify more specific interventions and discern when and how to apply them effectively. This requires a reconceptualisation of suicide as a process, which involves both broad factors within the social environment and specific changes within cognitive and emotional processing networks within the brain.3 Mental illnesses, such as depression, have an impact on the latter by creating a cognitive drive that can be modelled as sequential steps that emerge from a faulty appraisal system to engender feelings of defeat and entrapment that increase hopelessness.3 It is because of these poorly understood antecedents4 and lack of rescuing factors that suicidal ideation ensues3 and is intensified to ideation or intent by additional motivational factors before being converted volitionally to planning and attempting suicide.3 The latter alters neural network connectivity, and further increases the likelihood of future suicide.5

Such deeper insights are needed to provide a framework for targeted preventive interventions. Therefore, we strongly resonate with the authors’ demand for targeted evidence‐based interventions and urge that in addition to these much‐needed initiatives, our energies should also be invested in mechanism‐based research.