Fear as a Precursor to Suicide in Adolescents: A Concept Analysis

OBJECTIVE: Within the United States, suicide ranks as the second leading cause of death among the adolescent population, with continual increases projected in the future. Ultimately, much research focuses on depression and anxiety in adolescents; however, little focus has been given to the concept of fear and its role as a precursor to suicidal ideation and attempt. The concept of fear is the focus of this concept analysis to further understand its role in adolescent suicide. METHODS: For this concept analysis, Walker and Avant's method was utilized to review and thoroughly examine the concept of fear. The Standards for Reporting Qualitative Research (SRQR) guideline is followed. RESULTS: Utilizing specific criteria in narrowing the search, a total of 43 articles were reviewed to identify attributes of the concept fear. After reviewing the literature to identify all possible uses of the concept, such as fear of disclosure, fear of negative evaluation, fear of social exclusion, fear of cultural consequences, and fear in outside contexts, defining attributes consist of dread, stigma, and exclusion. Cases are further examined to show a model, related, contrary, and borderline case. Antecedents, both psychosocial and systemic, are reviewed and established as bullying, social rejection from peers, familial response, perceptions of providers, and gaps in consistent screening. Consequences may cause an adolescent to underreport symptoms or withdraw, leading to potential suicidal ideation and attempt. CONCLUSIONS: Ultimately, utilizing routine universal suicide screening and close monitoring within healthcare settings may be the key to reducing fear and preventing adolescent suicide.