As World Suicide Prevention Day approaches on September 10, it is horrifying to think that, every year in Canada, more than 20% of youth between the ages of 13 and 18 experience deep emotional pain - to the point that they want to die or that they think about the possibility of harming themselves. As the second leading cause of death for young people in Canada, suicide accounts for more deaths in this age group than cancer, AIDS, and all other natural causes of death combined. And for every youth who dies by suicide, there are an estimated 200 attempted suicides.

Unlike several other Western nations, Canada has no national youth suicide prevention strategy or policy to guide activities that would tackle this major health issue. Alarmingly, only one in every six Canadian youth who needs mental health services is able to access those services. Given this significant shortage in the mental health sector, it is crucial that broad-scale youth suicide prevention strategies be put into practice in communities and schools to promote resiliency and minimize risk factors for suicide before youth experience mental health issues. A national youth suicide prevention strategy, funding priorities in this area, and strong communication between community agencies will be required in order to direct consistent suicide prevention efforts.

Community-based suicide prevention is especially relevant for youth living in rural areas. Fewer mental health resources are available in these communities. Fearing that seeking help will compromise anonymity in small towns, rural youth are also less likely than their urban counterparts to request help from mental health practitioners.

Young rural males are at particularly high risk for suicide. In two independent studies, rural male youth were found to be 50% more likely to die by suicide than urban male youth. Males in general are more at risk for suicidal death than females. As male youth living in rural regions are at elevated risk for suicide, it is an important public health concern to understand potential factors that both contribute to and protect against suicide as well as suicidal thoughts and behaviours, in order that effective programs can be designed to promote positive mental health in these particularly at-risk youth.

As part of my doctoral work in Clinical Psychology, partly funded by the Canadian Institutes of Health Research, I recently conducted a study in rural schools in Eastern Ontario, within the framework of an ongoing investigation comparing rural and urban youth. The most striking finding was that rural youth who reported involvement in a personally meaningful extracurricular activity, such as a sports team, school band, drama production, club or church youth group, had a lower likelihood of experiencing suicidal thoughts and behaviours.

In rural communities, the farther youth lived from school, the less likely they were to be involved in extracurricular activities, and the more likely they were to be suicidal. Engagement in extracurricular activities, particularly for rural males, appears to help protect against youth suicide but only if those activities are valued as enjoyable, challenging, promote feelings of success, and are thought of as important to the individual.
For rural males, youth engagement in meaningful activities appears to promote self-esteem and, in turn, reduce the risk of suicidal thoughts and behaviours. For rural females, youth engagement yields positive social support networks, potentially buffering against depressive symptoms and enhancing self-esteem, which relates to a lower likelihood of suicidality.

In this study, Aboriginal youth did not appear to be at greater risk of experiencing suicidal thoughts than non-Aboriginal rural youth. However, the number of Aboriginal youth in the study was small. This is why more research is needed to explore the relationship between youth engagement and suicidality in Aboriginal youth.

Understanding how protective factors, such as meaningful engagement, can differ by gender and geographic region will have direct relevance to prevention efforts for both male and female youth within higher-risk communities, as well as in urban settings. This study will hopefully act as a springboard to the application of the findings from this research to designing effective suicide prevention programs in schools involving mentoring and engaging youth.

In the meantime, until policies are established in Canada to prevent youth suicide, parents and teachers have a major role to play in helping to produce well-rounded, high functioning, mentally healthy young people, by encouraging them to participate in activities which would be meaningful for them.

To prevent youth suicide it is time for us all to get involved to help youth get involved.

Laura Armstrong, a Canadian Institutes of Health Research and CHEO Research Institute-funded researcher, is a Doctoral Candidate in Clinical Psychology at the University of Ottawa. Some of the data from this study have recently been published in the peer-reviewed journal Vulnerable Children and Youth Studies. Members of Youth Net at CHEO followed-up with participants in this study identified as being at risk for suicide and connected them with appropriate services in the community.