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Adolescent Suicide From an International Perspective

David Lester, American Behavioral Scientist 2003 46: 1157 DOI: 10.1177/0002764202250659 The online version of this article can be found at: http://abs.sagepub.com/content/46/9/1157

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ARTICLE

Adolescent Suicide From an International Perspective

DAVID LESTER
The Richard Stockton College of New Jersey

A review of international suicide rates indicates that although youth suicide rates are high, they are lower than rates for the elderly, have increased less dramatically in recent decades, and are higher for boys than for girls. It is argued that the increases in adolescent suicide rates that have occurred in some nations are a result of improved quality of life for adolescents, a factor that leads young people to blame themselves for failure.

Keywords: quality of life; international perspective; national suicide rates; adolescent suicide; sex differences

In introductions to articles on suicide, authors typically make statements to the effect that suicide is a very important problem and that adolescent suicide is an especially significant aspect of the problem (e.g., Flouri & Buchanan, 2002; Rathus & Miller, 2002). These statements are peculiar, particularly when they come from U.S.-based authors publishing in American journals.1 First, a look at the suicide rates around the world on the World Health Organization Web site (now available at www.who.int) indicates that the United States has an average suicide rate (see Table 1). For example, in 1990, the suicide rate in America was 12.4 per 100,000 per year. In Hungary in 1990, the suicide rate was 39.9 (Lester, 2001). If Hungary had our suicide rate, it would consider the problem solved, just as if we had the crime rates of Western European nations, we would consider our crime problem solved. In 1990, 35 nations had higher suicide rates than the United States, whereas 33 had lower rates (see Table 1).2 The same issue arises with youth suicide rates. We are often told that suicide is a leading cause of death among adolescents. Of course, adolescents rarely die from natural causes; suicides, homicides, and accidents are bound to be among

Authors Note: Please address inquiries to David Lester, Ph.D., Psychology Program, The Richard Stockton College of New Jersey, P.O. Box 195, Jimmie Leeds Road, Pomona, NJ 08240-0195; email: lesterd@stockton.edu.
AMERICAN BEHAVIORAL SCIENTIST, Vol. 46 No. 9, May 2003 1157-1170 DOI: 10.1177/0002764202250659 2003 Sage Publications

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AMERICAN BEHAVIORAL SCIENTIST Suicide Rates Around the World in 1990 (per $100,000 per year) 39.9 38.1 30.3 27.6 27.1 26.5 26.1 26.0 24.1 23.9 23.6 21.9 20.7 20.3 20.1 19.3 19.1 19.0 17.8 17.5 17.2 16.4 15.7 15.5 15.3 14.8 14.7 14.2 13.7 13.5 13.1 13.0 12.9 12.7 12.5 United States Hong Kong El Salvador Puerto Rico Uruguay Netherlands Ireland Romania Portugal Turkmenistan United Kingdom Italy Spain Zimbabwe Uzbekistan Liechtenstein Argentina Taiwan Surinam Israel Barbados Chile Costa Rica Venezuela Tajikistan Ecuador Georgia Greece Armenia Colombia Nicaragua Malta Mexico Azerbaijan 12.4 11.7 11.6 10.5 10.3 9.7 9.5 9.0 8.8 8.1 8.1 7.6 7.5 7.4 7.2 6.7 6.7 6.7 6.7 6.5 6.2 5.6 5.2 5.0 4.4 4.4 3.6 3.5 2.8 2.7 2.4 2.3 2.3 1.6

TABLE 1:

Hungary Sri Lanka Finland Slovenia Estonia Russian Federation Lithuania Latvia Denmark Croatia Austria Switzerland Ukraine Belarus France Czech Republic Kazakhstan Belgium Luxembourg Germany Sweden Japan Iceland Norway Yugoslavia Moldova Bulgaria Mauritius Trinidad and Tobago New Zealand Singapore Poland Australia Canada Krygyzstan

SOURCE: World Health Organization (www.who.int).

the leading causes of death. But often, youth suicide rates are not as high as those in other age groups.3 For example, for decades, newspaper and journal articles have discussed the alarming high rates of suicide among African American youth. When I calculated suicide rates by age for African Americans from 1933 to 1992 (Lester, 1998), I found that suicide rates have always been higher, and still were in 1992, in African American men age 25 to 34 than in those age 15 to 24. But that is not as newsworthy. Studying suicide in those age 25 to 34 has little cachet. Suicide rates by age and sex are presented in Table 2 for 1995. Only New Zealand had higher rates of suicide in youths than in other age groups. Several countries had relatively high suicide rates among the young (Australia, Canada,

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TABLE 2:

Suicide Rates in 1995 by Age (per 100,000) 15-24 25-34 35-44 45-54 55-64 65-74 75+

Men Argentina Armenia Australia Austria Azerbaijan Belarus Bulgaria Canada Costa Rica Croatia Cuba Czech Denmark Estonia Finland France Germany Greece Hong Kong Hungary Ireland Israel Italy Japan Kazakhstan Kyrgyzstan Latvia Lithuania Mauritius Mexico Moldova Netherlands New Zealand Norway Poland Portugal Romania Russia Singapore Slovakia Slovenia South Korea Spain Sweden Switzerland United Kingdom United States

8.9 3.2 23.1 25.8 1.4 28.6 13.9 24.7 11.8 21.9 14.6 18.4 13.2 28.0 36.6 15.2 13.3 4.4 9.0 19.2 23.8 9.8 7.3 11.3 42.7 20.2 37.8 48.6 15.8 7.6 11.9 9.2 44.1 22.6 16.5 5.8 11.6 53.7 12.2 12.6 33.7 11.5 8.7 13.4 24.2 11.0 22.5

9.1 7.3 31.0 32.4 0.8 63.9 18.0 29.9 14.7 25.0 24.8 25.9 26.1 62.1 51.8 32.2 20.0 7.4 13.8 37.2 26.5 9.7 10.5 20.1 67.6 29.5 79.7 76.1 33.4 9.2 35.7 14.5 33.9 22.1 26.4 10.7 20.1 91.5 13.9 24.6 36.5 16.4 12.5 20.9 24.9 17.9 25.6

10.9 6.8 24.8 38.5 3.0 81.8 23.7 30.0 18.6 32.2 25.9 34.1 27.6 107.5 67.8 41.2 27.5 6.5 12.9 72.9 29.7 11.0 12.0 24.1 79.7 41.8 100.4 128.1 37.6 7.3 48.6 19.5 25.1 21.9 38.6 8.6 31.1 107.5 20.7 34.7 50.5 18.8 11.6 28.3 30.1 18.0 24.1

15.1 10.8 21.7 41.3 1.9 118.3 31.0 28.3 14.7 37.0 32.5 36.4 26.0 138.9 57.4 39.8 30.1 7.2 16.8 84.2 19.7 13.1 13.6 36.0 94.8 59.7 119.1 160.2 35.2 7.2 62.5 15.8 26.1 23.5 43.7 15.5 41.6 121.7 22.8 42.9 72.9 25.4 13.1 31.8 40.1 14.3 22.8

19.9 13.3 21.3 44.8 1.2 94.9 35.3 22.9 16.0 42.4 47.9 33.6 41.0 108.7 55.2 35.1 30.2 6.3 21.5 68.9 16.0 19.9 15.4 39.2 90.7 46.6 125.1 125.2 26.9 9.2 59.1 18.0 19.7 22.0 37.6 17.3 31.5 104.7 23.3 34.1 77.0 26.6 15.8 29.4 40.2 11.9 22.0

28.0 9.8 18.5 54.6 4.2 73.5 46.4 19.8 9.5 69.9 61.7 34.0 38.8 88.0 50.4 47.5 35.4 7.9 40.5 88.0 22.7 20.2 22.6 30.4 75.5 44.3 103.9 106.3 24.8 9.7 51.0 18.2 29.7 31.8 32.2 30.1 23.8 89.8 36.4 45.9 75.0 33.8 25.3 29.3 49.7 11.3 28.7

43.8 7.1 26.8 121.4 5.5 70.3 104.8 26.6 8.4 104.8 124.4 87.5 63.7 110.5 54.9 97.0 83.3 17.4 64.4 168.9 21.2 37.2 43.3 53.2 88.0 45.7 106.1 135.1 27.8 18.8 61.7 25.7 29.5 24.4 32.4 51.6 31.6 93.9 107.1 54.5 104.7 47.5 45.1 42.9 88.2 15.7 48.3 (continued)

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AMERICAN BEHAVIORAL SCIENTIST (continued) 15-24 25-34 35-44 45-54 55-64 65-74 75+

TABLE 2

Women Argentina Armenia Australia Austria Azerbaijan Belarus Bulgaria Canada Costa Rica Croatia Cuba Czech Denmark Estonia Finland France Germany Greece Hong Kong Hungary Ireland Israel Italy Japan Kazakhstan Kyrgyzstan Latvia Lithuania Mauritius Mexico Moldova Netherlands New Zealand Norway Poland Portugal Romania Russia Singapore Slovakia Slovenia South Korea Spain Sweden Switzerland United Kingdom United States

3.3 1.0 6.1 3.8 0.0 4.5 4.0 4.9 4.0 5.3 17.9 4.2 2.3 6.8 8.4 4.6 3.9 0.8 5.6 3.8 3.6 4.2 1.6 5.5 10.3 9.9 6.0 7.5 11.2 2.0 4.1 4.4 12.3 5.5 3.0 3.0 2.6 9.8 11.6 2.0 4.2 7.3 2.1 5.2 6.7 2.2 3.7

2.6 3.5 6.4 8.5 0.4 6.7 6.7 5.8 2.4 6.0 14.8 3.7 4.6 8.8 13.4 8.6 5.1 1.4 7.6 8.6 7.7 1.0 2.6 8.2 10.2 6.3 6.7 11.4 4.2 1.2 6.5 6.6 6.7 5.2 3.5 2.8 4.2 11.4 9.2 4.8 10.7 8.5 2.2 6.4 7.7 3.1 5.2

3.0 2.0 7.0 11.2 0.6 10.5 6.8 8.3 3.6 10.0 16.1 9.2 12.9 18.9 19.3 12.6 7.8 0.8 9.2 16.8 7.3 3.3 3.6 8.6 9.3 6.0 21.8 21.6 6.1 0.9 10.9 8.7 6.6 10.1 7.2 3.9 5.9 15.0 12.0 5.8 15.4 7.3 3.6 13.5 10.7 4.7 6.5

4.1 1.3 7.7 14.4 0.0 17.5 6.8 8.6 2.2 10.0 20.4 9.3 16.3 21.1 17.2 15.8 10.4 1.4 8.8 21.7 8.1 3.8 4.6 13.1 14.8 15.0 25.1 24.8 6.8 1.3 13.6 9.5 8.4 9.9 7.7 5.5 7.4 18.4 12.2 7.4 15.2 7.7 3.9 13.9 15.5 4.2 6.7

4.3 5.6 6.0 14.1 0.0 15.3 11.7 7.4 4.5 17.1 21.2 12.9 18.2 31.7 16.6 16.3 12.0 2.3 13.3 24.8 6.9 6.5 5.8 15.7 15.6 10.0 19.2 23.3 9.1 0.8 14.1 7.9 5.4 7.4 7.9 7.2 7.5 17.9 8.5 7.1 23.6 7.6 6.3 12.7 18.2 4.0 5.3

6.1 0.8 5.0 19.0 0.0 17.1 25.4 5.6 0.0 19.8 27.3 15.5 22.1 25.4 12.7 18.1 14.4 2.1 23.8 29.9 2.3 8.4 7.4 19.5 19.6 17.1 19.2 26.6 12.1 1.2 18.2 10.6 5.3 9.5 8.0 6.5 8.5 23.0 28.7 9.1 19.8 13.4 7.0 11.0 23.8 4.3 5.4

6.6 3.9 5.2 29.0 1.1 16.1 35.6 3.7 0.0 26.4 30.9 30.6 27.0 35.1 9.7 21.6 23.9 1.6 38.9 60.0 2.8 22.2 8.2 34.4 32.1 11.6 38.5 33.0 7.8 1.0 28.0 9.9 8.2 5.4 6.4 13.1 6.7 34.8 53.8 6.3 27.3 18.9 10.3 17.2 18.0 5.7 5.5

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Costa Rica, Ireland, and Norway), but the majority of countries had the highest suicides in the elderly or the middle-aged. The highest suicide rates in 1995 for those age 15 to 24 (see Table 2) for men are found in Russia, Lithuania, New Zealand, Kazakhstan, Latvia, and Finland; for women, the highest youth suicide rates are found in Cuba, New Zealand, Singapore, Mauritius, Kazakhstan, and Kyrgyzstan. The presence of recently liberated Eastern European nations is noteworthy, but New Zealand and Finland are also present. The youth suicide rates in these nations are extremely high, twice as high as the youth suicide rate in the United States for men and 4 to 6 times higher for women. A look at international statistics also shows that not every nation has experienced a rise in adolescent suicide rates since 1970, and the rise, when it occurs, is more often found in boys than in girls. For example, from 1980 to 1990, Lester (2001) found that male youth (15-24) suicide rates increased in 15 of 32 nations and female youth suicide rates in 10 of the 32 nations (see Table 3). Elderly (age 75+) suicide rates rose in 19 nations for men and 16 nations for women, apparently a more serious problem.4 Clearly, not all nations experienced a rising male youth suicide rate. For example, although for the period 1980-1990 Ireland reported a 154% increase in the male youth suicide rate and New Zealand a 95% increase, Japan had a decline of 45%, Czechoslovakia 38%, Israel 38%, Hungary 36%, and Switzerland 27%. The rise in youth suicide rates is not found in every decade. In Table 4, the percentage increase in male youth suicide rates is shown for 1970-1980, 19801990, and 1990-1995. The increase was much more widespread in the 24 nations for the 1970-1980 period, when 21 of the 24 nations experienced an increase, whereas only 13 experienced an increase for the 1990-1995 period. In addition, whereas some nations experienced an increase in male youth suicide rates in all three periods (such as Spain and the United States), other nations did not (such as Hong Kong and Hungary). Lester (1993) found few social predictors in 1970 for the change in the youth suicide rate from 1970 to 1980 for a sample of 29 nations. For the present article, the percentage increases in male and female youth suicide rates from 1980 to 1990 (from Table 3) were compared with social indicators for nations of the world in 1980 using a previously established data set (Lester, 1996b). Two correlates were identified for the increase in the male youth suicide rate,5 but these two variables did not predict the increase in the female youth suicide rate. The correlates of the increase in youth suicide differed for boys and girls and did not fit into any theoretical model, leaving us with no explanation for these increases.6 Explanations proposed to account for a rise in the male adolescent suicide rate usually apply equally well to adolescent girls. Thus, the suicide rates of both boys and girls should be increasing. Consequently, complete explanations of the rising youth suicide rate also must account for why youth suicide rates rise in

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AMERICAN BEHAVIORAL SCIENTIST Percentage Change in Youth and Elderly Suicide Rates From 1980 to 1990 Percentage Change Men Total Youth +51 13 +25 1 6 38 13 +83 +36 10 +73 10 36 +154 38 +11 45 1 +95 +87 +8 +42 19 +72 +48 +65 13 27 +9 24 21 5 Elderly 2 +26 11 15 +14 5 6 10 +50 +6 +5 +6 3 +289 1 +34 14 17 +8 +20 +29 +8 +39 7 26 +81 +13 +8 +33 +6 1 +22 Total 7 10 +7 24 +14 10 27 45 +16 0 21 14 19 +9 5 11 5 3 24 +56 +21 +15 25 37 +15 +86 8 16 11 16 32 +6 Women Youth +4 18 43 7 65 4 87 33 +21 19 +83 12 +2 +21 +175 17 43 3 17 +213 +91 24 24 42 34 +55 9 49 9 +5 20 36 Elderly 13 +5 +22 29 +infinity 10a +2 44 +5 +5 61 29 17 47 47 8 19 +24 65 +61 +68 +45 100 60 +14 +102 +31 +1 +11 +6 8 +28

TABLE 3:

Australia Austria Bulgaria Canada Costa Rica Czechoslovakia Denmark England/Wales Finland France Greece Hong Kong Hungary Ireland Israel Italy Japan Netherlands New Zealand Northern Ireland Norway Portugal Puerto Rico Scotland Singapore Spain Sweden Switzerland United States USSR West Germany Yugoslavia

+26 8 +8 4 45 10 12 +10 +19 +6 +17 12 7 +73 +17 +13 8 4 +51 +107 +27 +21 +24 +30 +19 +67 13 14 +10 24 21 +4

a. The data for Czechoslovakia are for 1981 to 1990 because 1980 data were not published by the World Health Organization.

men but not in women, in some nations but not in others, and in some recent time periods but not in others.

DO YOUTH SUICIDES INCUR ANY ECONOMIC LOSS? Introductions to articles on youth suicide also cite the cost to the society from this loss of life. For example, Weinstein and Saturno (1989) said, In economic

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TABLE 4:

The Rise in Male Youth Suicide Rates 1970-1995 1970-1980 1980-1990 +51 13 +25 1 13 +83 +36 10 +73 10 36 38 +11 45 1 +95 +8 +42 +72 +48 +65 13 27 +9 13 11 0 1990-1995 13 +3 0 +1 6 17 28 +8 15 +27 5 +46 +24 +23 +12 +16 +2 22 +19 8 +23 9 2 +2 13 10 1

Australia Austria Bulgaria Canada Denmark England/Wales Finland France Greece Hong Kong Hungary Israel Italy Japan Netherlands New Zealand Norway Portugal Scotland Singapore Spain Sweden Switzerland United States Increases Decreases No change

+42 +7 +23 +59 +47 +7 +67 +67 +76 +10 +13 +120 +51 +18 +43 +61 +278 7 +66 1 +115 9 +61 +50 21 3 0

and human terms, youth suicide in the United States is a public health problem of the first magnitude, and one that is growing rapidly (pp. 4-82). They estimated the cost to society of youth suicides in the United States in 1980 as $2.27 billion. Lester and Yang (2001) noted that these costs are overestimates because suicidal people are often psychiatrically disturbed and incur huge costs for the treatment of their psychiatric disorders. Furthermore, they are often marginal people in the society, and so estimates of the loss of earnings over their life span are overestimated. Finally, premature death may actually reduce social costs as Viscusi (1994) argued in discussing the issue of cigarette sales. He calculates that the premature death of smokers reduces nursing home costs, social security, and pensions. Viscusi estimated that each pack of cigarettes sold saves the society about 55 cents. Lester and Yang made a similar argument for suicide in general and youth suicide in particular. Youth suicides probably result in a net savings for society.7

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This is not to argue that we should not be concerned about understanding and preventing youth suicide. However, we should not distort the data or the magnitude of the problem to support the need for prevention. We should, if asked, help those vulnerable to suicide for humane reasons, not for economic reasons.

IS THE SUICIDE RATE AN INDICATOR OF A SICK SOCIETY? The writings of Raoul Naroll on suicide are not well-known among suicidologists, partly because his essays were in books rather than journals and some remained unpublished, known only to colleagues. Naroll (1963, 1969) noted that classical 19th-century ethnologists occasionally evaluated the quality of primitive cultures based on their own personal set of values. Instead, Naroll suggested that evaluations of cultures could be made by observing actual behaviors, including suicidal behavior. From this perspective, cultures with a high suicide rate are inferior to those with a low suicide rate.8 This is a common practice today. For example, the rising rate of suicide among the youth in some nations in the 1970s was seen by many as an indication that the quality of life of the youth had deteriorated. For example, Eckersley (1993) titled his article Failing a Generation: The Impact of Culture on the Health and Well-Being of Youth. Eckersley, an Australian, interpreted the high youth suicide rate as an indicator that something is seriously wrong with the society:
I believe that behind suicide and other youth problems also lies a profound and growing failure of the culture of western industrial societiesa failure to provide a sense of meaning, belonging and purpose in our lives and a framework of values. (Eckersley, 1993, p. S16)

Eckersley saw suicide as a problem, along with drug use and delinquency, which indicates that society is failing in some way. There is an alternative way of looking at this issue. Henry and Shorts (1954) theory of suicide incorporates the basic ideas of Durkheims (1897) theory in addition to the frustration-aggression hypothesis developed by Dollard, Doob, Miller, Mowrer, and Sears (1939) to explain the societal level of murder as well as suicide.9 Henry and Short assumed that the basic and primary response to frustration is aggression directed toward another person rather than toward the self. In addition, they identified the sociological factors that legitimize other-oriented aggression. In particular, the strength of external restraint was seen as the primary basis for the legitimization of other-oriented aggression. When behavior is required to conform rigidly to the demands and expectations of others, the share of others in the responsibility for the consequences of the behavior increases,

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thereby legitimizing other-oriented aggression. When external restraints are weak, the self must bear the responsibility for the frustration generated, and other-oriented aggression is not legitimized.10 Henry and Shorts theory leads to such predictions as that groups within a society exposed to more external restraint will be more homicidal and less suicidal than groups exposed to less external restraint. Lester (1971b) showed that the suicide and homicide rates of Whites and Blacks in both the United States and South Africa (before liberation) fitted this prediction. Common sense suggests that as we improve conditions in the world, people should be happier. If we reduce poverty and oppression (such as sexism and racism), clean up the environment, and improve the educational and cultural offerings for our citizens, then we should be much happier. As the quality of life increases, life should be more worth living and suicide less common. In contrast, Henry and Shorts theory would predict that when external conditions are bad, we have a clear source to blame for our own misery and this directs anger outward rather than inward. When times are good, there is no clear external source of blame for our misery and so we are more likely to direct our anger inward. Henry and Short would argue that a higher quality of life would lead to higher rates of suicide and lower rates of homicide, whereas a lower quality of life would lead to lower rates of suicide and higher rates of homicide. For example, there is a low frequency of suicide in countries subjected to famine or civil war (Lester, 1997). Studies by Lester (1989) supported the hypothesis derived from Henry and Shorts theory. In an analysis of American states in the 1920s, the higher the quality of life in a state, the higher the suicide rate and the lower the homicide rate. Similar results were found for the quality of life of the states in the 1940s and for nations of the world in the 1980s.11 One obvious prediction from Henry and Shorts theory is that suicide and murder are opposite behaviorssocieties with high rates of one should have low rates of the other. For example, as noted earlier, societies with a higher quality of life had higher suicide rates but lower homicide rates than societies with a worse quality of life. For other variables, the correlations of suicide and homicide rates with social indicators are often, but not always, opposite (Lester, 1987). However, if there is some validity in Henry and Shorts theory, then changing social conditions in such a way that suicide becomes less common may result in social conditions that make murder more common. We would have replaced one problem with another.12 It is important to note that Henry and Shorts theory has been much more successful in cross-sectional (and ecological) studies than in longitudinal studies. For example, from 1933 to 1982, the suicide and homicide rates of 15- to 24year-olds in the United States rose and fell in parallel rather than in opposite directions (Holinger, 1987), a phenomenon that Holinger attributed to the proportion of youths in the population.13

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The importance of the research on suicide rates and the quality of life is that if the suicide rate is higher in modern nations with a higher quality of life (as measured objectively, based on a number of social indicators), suicide may be a measure of the psychological health of a society. Societies with a high suicide rate may be healthier than those with a low rate. Naroll may have been wrong.

CAN THIS HYPOTHESIS BE APPLIED TO INDIVIDUALS? If Henry and Short are correct, then removal of external stress should lead to an increase in the suicide rate because removal of external stress will make it increasingly difficult to account for feelings of distress and depression by referring them to external frustrations. Suicide rates may rise, therefore, after wars end, after winter, or after a divorce, and research support exists for all three phenomena. Lester (1997) has noted that the low frequency of suicide reported by survivors of the concentration camps in the Second World War is consistent with Henry and Shorts proposition. Concentration camp inmates had a clear external source to blame for their misery, thus making anger more likely and depression and suicide less likely. Removal of personal stressors also may lead to an increased likelihood of suicidal behavior. For example, compared with the suicide rate during pregnancy, the suicide rate postpartum should be high. The suicide rate should be higher for those who have a disability removed. In such cases, a circumstance that formerly could be held responsible for ones misery is removed and, if the misery continues, it will be less easy to externalize the blame. For example, one of the first people, blind from birth, who had his vision restored (after advances in surgical procedures had made this possible) committed suicide a year later (Gregory & Wallace, 1963). A letter to physicians asking for similar experiences (Lester, 1970a) resulted in a number of replies describing similar cases (Lester, 1971a, 1972). One such patient reported:
Paradoxically, when my sight started improving, I began to feel depressed. I often experienced periods of crying, without knowing the reason, maybe because of striving so intensely for vision. In the evening I preferred to rest in a dark room. Some days I felt confused: I did not know whether to touch or to look. Often I did not remember what I had before me. Recovery of vision has been a long and hard road for me, like entering a strange world. In these moments of depression I sometimes wondered if I was happier before. (Valvo, 1968, p. 21)

This proposition also can be used to explain the high rate of suicide in states such as California compared to states on the East coast (Lester, 1970b). The milder climate on the West coast provides fewer external circumstances (such as snow, ice, freezing cold, etc.) on which individuals may focus their distress. If we assume that people experience some degree of malaise and depression in

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winter, then these feelings can more easily be attributed to external frustrations on the East coast than on the West coast. Perhaps, to immunize us against depression and suicide, we need to believe that the grass is greener on the other side of the hill. This is similar to the if only phenomenon. When people are depressed, if they can say something like, If only I had a new . . . spouse, job, car, house, and so forth, then they can remain hopeful that life will improve. They can avoid hopelessness, which Beck and his associates (Beck, Weissman, Lester, & Trexler, 1974; Lester, Beck, & Mitchell, 1979) have argued is the strongest predictor of subsequent suicidality. When they no longer believe that the grass is greener, depression may more readily lead to suicide.

WHICH ADOLESCENTS COMMIT SUICIDE IN THE SOCIETIES WITH A HIGH QUALITY OF LIFE? Uhlenberg and Eggebeen (1986) noted that the social conditions of adolescents had improved in recent years. From 1960 to 1980, they documented a reduction in poverty, smaller family size, better educated parents, improved quality of schools, and increased expenditures on social welfare for children. So who among these adolescents commits suicide? Among adults, many successful and famous individuals complete suicide. Lester (1996a) documented 334 such cases. Although there were exceptions, the majority were past their success and facing the stress of old age and decline. Yukio Mishima, the Japanese novelist, killed himself in 1970 at the age of 45, at his peak, perhaps to avoid experiencing a decline. Had he continued to live, he might well have eventually won the Nobel Prize for Literature. However, it is unlikely that the majority of adolescents who commit suicide are the successful ones in society.14 Many are suffering from psychiatric disorders, especially personality disorders (Hawton, Fagg, Platt, & Hawkins, 1993). Personality disorders impair the individual in efforts to achieve. Adolescent suicides typically come from dysfunctional families in which the parents have behavioral and psychological problems (Gould, Fisher, Parides, Flory, & Shaffer, 1996; Harris & Molock, 2000; Jacobs, 1971), and this also impedes the children in their efforts to achieve. At the same time, the increasingly pervasive influence of the media shows these marginal adolescents the successes, especially material success, of other adolescents, fictional and real. Expensive clothes and shoes are advertised and stories of successful adolescents in sports and entertainment presented. Madonnas Material Girl resonates with adolescents who have to come to expect that they will get material goods and psychological well-being now. When they do not, they may regard themselves as failures. Thus, in societies with a high quality of life, adolescents who feel that they have not achieved and cannot achieve the success of others, and who have no one

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to blame for this state of affairs but themselves, may be at higher risk for suicide. However, as the quality of life of society increases, and as the suicide rate increases too, other personal and social problems, such as murder, may become less common.

DISCUSSION Although youth suicide rates are high in some nations and in some eras, it has been suggested here that adolescent suicide may not be as great a problem as some scholars and the media would have us believe. Suicide rates among adolescents have not always increased in both boys and girls in every country and in each time period. In most developed countries, the suicide rate of the elderly still exceeds that of the young. A high suicide rate, among adolescents as well as adults, may be a by-product of an improving quality of life, as predicted by Henry and Shorts sociological theory of suicide. If suicide is going to become more of a problem as the quality of life in nations of the world increases, perhaps this consequence of social change has to be accepted. We can implement the suicide prevention techniques available to us (teen hotlines, antidepressant medications, restricting access to the methods employed for suicide, and school suicide prevention programs) and hope that the prevention efforts counterbalance the social changes that increase the risk of suicide.

NOTES
1. The inclusion of such statements is a result, in part, of the formal structure of scholarly articles that requires placing the study to be presented in a context and to assert that the study is of great importance. 2. More recent data are available but for a smaller set of nations. The more recent data do not affect the conclusion based on 1990 data. For 1995, for example, the suicide rate in the United States ranked 34th out of 51 nations. 3. Unfortunately, World Health Organization (WHO) data are provided only for 10-year age groupings. Thus, international data are available only for 15- to 24-year-olds rather than for 15- to 19-year-olds, which would be preferred for the present article. 4. Looking at Tables 3 and 4, skeptics might wonder whether the choice of 1970, 1980, 1990, and 1995 might have introduced data from deviant years. Continuous time-series data for 15- to 24year-olds for 20 nations for 1960-1990 can be found in Lester and Yang (1998). Those rates do not suggest that the years chosen for Tables 3 and 4 were deviant. For example, for men age 15 to 24 in Hungary who are reported in the table as experiencing a 36% decrease in their suicide rates from 1980-1990, the suicide rates from 1980 to 1990 are 31.5, 31.4, 26.0, 26.9, 26.7, 25.3, 20.2, 24.3, 21.0, 23.8, and 20.1. The decrease appears to be valid. 5. These correlates are the 1980 suicide rate and female labor force participation. 6. This includes my speculations presented later in this article. 7. Although the tobacco companies have been criticized when they use Viscusis (1994) figures to justify their production and marketing practices, there have been no criticisms of his report in the economic literature.

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8. For a summary of Narolls theory of suicide, see Lester (1995). 9. Durkheims theory proposed simply that the suicide rate of a society was determined by its level of social integration (the extent to which the members of the society are bound together in social networks) and social regulation (the extent to which the members of the society have their desires and behaviors regulated by social customs and norms). When these levels were either too high or too low, then the suicide would be of a different type (egoistic, altruistic, fatalistic, or anomic) and the suicide rates would be higher. 10. The reasoning in this part of their theory resembles Durkheims use of the concept of social regulation. 11. The result was not found for Standard Metropolitan Statistical Areas in the 1980s. 12. Explanations for the changing homicide rate over time in the United States have focused on changes in drug use (especially cocaine use), gang involvement in crime, the relative size of the youth cohort, and socioeconomic conditions for youths. 13. According to Holinger, a greater proportion of youth results in an increase in deviant behaviors of all kinds, including suicide and murder. 14. The reported high rates of suicide at elite academic institutions such as MIT indicates that suicide can and does occur in high-achieving adolescents.

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