Suicide imposes a triple burden on the family: grief at loss, as with any death; rage at desertion, for this was a deliberate death; and guilt at having failed the victim. When the suicide is a young person, the distress among the survivors is the greatest; it shakes us all to be forced to recognize that the despair of youth can be so profound. The doctor is plagued by the question: Could I have forestalled it? All are frightened. Few go through life without at least fleeting thoughts of suicide. Confrontation with its cold actuality makes us shudder at ourselves. Suicide is a disorder for which there can be no treatment.
Religion, law, and medicine are at one in agreeing that suicide should be prevented. But "should" is not the same as "can." The problem is daunting: Is prevention possible?
Any serious attempt at an answer requires us to put the problem in epidemiologic perspective by examining national data on rates and secular trends in adolescent suicide. So informed, we can then consider the opportunities for effective intervention through public health measures as well as at the level of personal encounter medicine in clinical practice.
DEATHS FROM VIOLENCE
Although the health of American adolescents, as measured by most indicators of morbidity and mortality, improved rapidly over the first 60 years of this century, mortality rates among those between 15 and 24 years of age have actually risen by 11% during the past 20 years. This is principally because of increasing deaths from violence (accidents, homicides, and suicides) which account for three fourths of all deaths in this age group.1