U nderstanding why anyone would want to take their life is difficult. When it’s a young person who does it, suicide can seem even more tragic. For the vast majority of people, suicide is unthinkable. Nevertheless, suicide in the United States is on the rise. In April, the Center for Disease Control announced its latest findings from its National Vital Statistics System for Mortality. These included a 24% uptick in the age-adjusted suicide rate from 1999 – 2014, with the greatest uptick happening after 2006. The CDC found the greatest increase occurred with girls between the ages of 10 – 14, but it is important to note that the suicide rate among teen girls, from an epidemiological perspective, remains low. According to the American Foundation for Suicide Prevention, suicide is the 10 th leading cause of death in the United States. In Connecticut, over three times as many people die annually of suicide than from homicide, with suicide being the second leading cause of death for people between the ages of 15 and 24. In New York, suicide is the second leading cause of death for those ages 15 – 34 and the second leading cause of death for those ages 10 – 14. Over twice as many New Yorkers die annually from suicide than from homicide. When it comes to adolescents, those numbers are more dramatic for a simple reason: Teenagers don’t normally die. And that’s what worries prevention experts. “It’s not that we’re losing lots of teens to suicides,” explains Doreen Marshall, Ph.D. “It’s that [suicide] is one of the reasons they die when they do.” Marshall works as vice president of programming atThe American Foundation for Suicide Prevention (AFSP), which works with schools and educators on preventing suicide among adolescents. Its film, More than Sad , is available for schools to screen and is used in classrooms nationwide. The AFSP also provides a free download, After a Suicide , as a toolkit for schools dealing with the aftermath of a suicide. “Schools and educators spend a lot of time with our young people. Oftentimes the opportunity to notice behavior changes happens more in that context than it would at home.” These opportunities could include interactions with peers, awareness of the school and social stressors, or even access to academic work. For example, a student might write an essay, the topic of which worries the teacher. In many households, this picture of the student’s interactions at school isn’t made clear to parents. Says Marshall, “A lot of times, if the student isn’t bringing that information home, it doesn’t get there.” Communication is key. Says Marshall, “We know from research that when teenagers are indistress they are probablymore likely to tell a peer than they are an adult.” Empowering students to pass that information along to an adult is one of the things the AFSP works on. School protocols will dictate how the information is handled. If a student tells, for example, a coach that a peer is in distress, that information should be passed along to the school psychologist or counselor. “We don’t want teachers acting as mental health professionals,” says Marshall. “We want the teacher to connect them to the mental health professional [at the school] that’s empowered to act.” Marshall insists this doesn’t let parents off the hook. Parents need to be educated about the warning signs. These include changes in behavior like no longer doing an activity the teen used to enjoy or isolating themselves. Changes in behavior include changes in school performance, with
an important caveat: “We notice that particularly students who are high-achieving can mask and manage a great deal of distress without letting anybody know. That doesn’t mean they are near suicide. Often those are the students who aren’t getting noticed, because they’re doing so well everyone assumes they’re okay. What might be happening is they might be very anxious, they might be putting a lot of pressure on themselves or have a distorted sense of what will happen if they don’t pass a certain class. We can’t ignore that.” Minds Full of Worry “Suicide is a sign of pathologic mental distress,” says Dr. John T. Walkup, Director, Division of Child and Adolescent Psychiatry, New York-Presbyterian Hospital and Weill Cornell Medical College. In 80 – 90% of suicides there is an underlying mental health problem, previously diagnosed or not. One in five high school students will have a mental health illness. “Twenty percent of kids will have a mental health problem before they graduate from high school,” says Walkup. “Mental health problems are the illness of adolescence and young adulthood. Cancer, cardiovascular disease are the diseases of aging, by and large. Young people die in accidents, by their own hand, or by the hand of others.” Walkup explains that anxiety is extremely common among young people, likely two to three times more common than depression among this cohort. And although depression is the mental illness most associated with suicidal thoughts, it is anxiety that is more closely associated with suicidal acts. Anxiety disorders, explains Walkup, have not received the attention of other mental illnesses. “We have tended to look at [anxiety] as a normal variant, a personality trait, and not as a disorder to treat, if you will. Especially to treat at an early age.” Dr. Walkup is one of the psychiatrists trying to change that. He is the co-program director at the Youth Anxiety Center at New York Presbyterian Hospital. Whereas depression is persistent mood-state, anxiety is a trigger disorder. Those suffering from anxiety disorders use avoidance as a coping mechanism. These disorders can present at a very young age, when a child is between six and 12 years old. They include separation anxiety, social anxiety disorder, generalized anxiety disorder, specific phobias, panic disorder, obsessive compulsive disorder and post-traumatic stress disorder. The disorders are treatable with selective serotonin reuptake inhibitors and cognitive behavioral therapy. One of the challenges in preventing suicide among adolescents is that the underlying mental health problem might be presenting for the first time. Parents can help by facilitating early detection. Pediatricians can evaluate a child and put parents in touch with a mental health professional. And getting teens to trust mental health professionals is an important part of getting an accurate assessment later on, should the teen be in crisis. For those families who have a history of mental health problems, early evaluation is even more important. Says Dr. Walkup, “If you think your child may have a mental health problem, go get a [mental health] checkup. When I talk to families I say, ‘You have a lawyer, an accountant, a religious leader – why wouldn’t you have a mental health professional?’”
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