Student suicide: what’s the role of family physicians?

Kwok-keung Ng 吳國強

HK Pract 2016;38:50-51

More than 20 students committed suicide since the start of this academic year.¹ To prevent tragedies from happening again and again, the government has set up a committee to investigate the causes. Various working groups will also be formed to recommend preventive measures.

Family physicians are familiar with individual members within households, as well as the interactions among various family members within these households. Can we contribute more to help these youngsters?

According to some studies², many students would seek help before committing suicide. However, they might not present with mood symptoms nor express their suicidal ideations. They may complain of distressing somatic symptoms that result in absence from school, or inability to sit for examinations. They might also complain of sleep disturbance with frequent nightmares. Sometimes we might only be able to obtain clues from their facial expression, or other vague non-verbal cues.³ It would be helpful if family physicians can perform more in-depth assessment of these youngsters for their emotions, adaptation and interpersonal relations.

The entire family is usually affected if a child has behavioural or conduct problems. The influence of parents on their children’s psychological wellbeing should never be underestimated.^4-5 Pressure from the academic curriculum, the need for pursuing their ‘dream’ school, and peer competition often influence parents to strive for top places right at their children’s academic outset. Some youngsters, no matter they enjoy it or not, are fully engaged in activities from Mondays to Sundays. On the contrary, some other parents could not spend time with their kids, as they need to work for very long hours to earn their livings. Family physicians should build on their excellent rapport with individual parents and provide appropriate professional advice, especially when their kids start to present with symptoms.

There is no doubt that parents would try their best to guide their children to success. It is also true that most children would try their best to perform well and meet their targets. However, is the communication between parents and children an effective one? Do parents know whether their expectation on their children’s future is the same as their children’s own dreams? ‘Having the ability to perform well’ and ‘having the passion to perform well’ are totally different, and should better be explored and thoroughly discussed. On the other hand, do children appreciate what their parents have prepared to facilitate their survival in this highly competitive world? Do children show understanding if their parents can only entertain some of their requests?

Although there are no easy answers for these questions, an effective platform for communication is essential. I believe that family physicians, who take care of their patients’ bio-psycho-social wellbeing, can facilitate the establishment of a platform for effective parent-child interaction. With this platform, apart from discrepancies in academic/career path, feelings, emotions, worries and concerns can also be shared. Unstable mood conditions may be picked up and intervened earlier.

There is no simple solution for student suicide. We family physicians can definitely take an active role to contribute. Our long-term trustful relationship with individual families may help in identifying at risk children and families. Our roles as facilitators and coordinators can also help to develop effective communication network among families for better troubleshooting and early intervention.

Mission is not impossible.