Published online by Cambridge University Press: 04 December 2009
The adolescent period in contemporary Western society is characterized by a distinctive pattern of morbidity and mortality. Suicidal behavior and completed suicide are more common in adolescence than in any other developmental epoch (save, for males, in old age). It is also notable that the leading causes of adolescent deaths (at least in the U.S.) – accidents, homicide, and suicide – are preventable ones, frequently associated with life-styles characterized by impulsivity, recklessness, and substance or alcohol use. (Cultural contributions to this pattern are apparent in the U.S., where the low legal age for driving and easy availability of guns contribute to the high national adolescent mortality rates from motor vehicle fatalities, homicide, or suicide.) In addition to high rates of suicidal attempts and ideation, adolescence in the industrialized world is also characterized by increased health-threatening behaviors, such as tobacco, alcohol, and drug use; unprotected sex; fighting; reckless driving; and, in the U.S., weapon-carrying (Centers for Disease Control and Prevention, 2002).
In attempting to integrate these striking epidemiological observations, Holinger (1979) and others have postulated a “continuum of selfdestructiveness” in adolescence ranging from the covert (e.g., substance use, unprotected and precocious sexual activity, reckless driving) through the overt (e.g., self-mutilation and suicide attempts). Holinger's account, however, leaves open what underlying factors might account for this proposed association. Jessor (1991, 1998) and others (summarized in Dryfoos, 1990) have attempted to explain the frequent association in adolescence between various forms of “problem” or risk behaviors, but these accounts have generally not considered suicidal behavior as part of the constellation of “problem” behaviors or as one of the outcomes to be explained by the various vulnerability models proposed.