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Teen Suicide-1
Youth 15-19 suicides are on the increase in the US. Suicide is the second leading cause of death (after unintentional injury). Two-thirds of all suicides under 25 were committed with firearms. Suicide is increasing, particularly for those under 14. Alcohol or drugs are
involved Pay particular attention if they experience: 1. Loss of a loved one However,
you never know Risk factors line up like lights on
the street. For a student to go from thinking about suicide
to attempting suicide, all these lights have to turn green.
One light might be a fight with a parent. Another might be a
flunked test, a breakup, a peer’s suicide. They might
contemplate suicide for months, and then the final act is
often on impulse, if everything falls into place. Teachers
have even about a particular suicide. "If you would have
given me 200 names, hers would have been at the bottom of
the list of someone who would do this.” Don’t be
afraid of the “S” word. Teen
Suicide Youth and elderly suicides are on the increase in the US. And, according to The World Health Organization (WHO) over 786,000 people committed suicide around the world in 1997. This is an effective suicide rate of around 10.7 per 100,000 population per year. To put this statistic in perspective, that is the equivalent of one suicide every forty seconds, somewhere in the world. Suicide is the ninth leading cause of death in the US with 31,204 deaths recorded in 1995. This approximates to around one death every seventeen minutes. There are more suicides than homicides each year in the US. From 1952 to 1992, the incidence of suicide among teens and young adults tripled. Today, it is the third leading cause of death for teenagers aged 15-19 (after motor vehicle accidence and unintentional injury). Two-thirds of all suicides under 25 were committed with firearms (accounts for most of the increase in suicides from 1980 to 1992). The second most common method was hanging, third was poisoning. Suicide is increasing, particularly for those under 14 and in those over 65, while not the leading cause of death, the suicide rate is extremely high. Young men commit suicide successfully
at a higher rate than women in all 30 countries listed
below. In the US, the ratio between men and women was 4.1:1
while in young people 15-24 the average ratio is 5.5:1 and
the ratio increases with age within this group. In white
males over 85, the suicide rate was 73.6/100,000 in 1993.
For more information: www.cdc.gov/ncipc/pub-res/10lc92c.htm
The most common signs of a suicidal person 1. Difficulties with
relationships between friends, family, and others How to Help Someone 1. Resist trying to
help. People who feel suicidal don’t want answers or
solutions. They want a safe place to express their fears and
anxieties, to be themselves. 2. They want someone to trust. Someone who will respect them and won’t try to take charge. Someone who will treat everything in complete confidence. 3. They want someone to care. Someone who will make themselves available, put the person at ease and speak calmly. Someone who will reassure, accept and believe. Someone who will say, " care." If the person is actively suicidal Get help immediately. Do not leave your teen alone. Ask your - "Are you thinking of suicide?" Asking someone if they are suicidal will not make them suicidal. Most likely they will be relieved that you have asked. Experts believe that most people are ambivalent about their wish to die. Listen actively to what your teen is saying. Remain calm and do not judge what you are being told. Do not advise them not to feel the way they are. Reassure your teen that there is help for their problems and that they are not "bad" or "stupid" because they are thinking about suicide. Help your teen break down their problem(s) into more manageable pieces. Offer to investigate counseling services. Do not agree to keep their suicidal thoughts or plans a secret. Helping someone who is suicidal can be very stressful. Suggest that they see a doctor for a complete physical. Although there are many things that family and friends can do to help, there may be underlying medical problems that require professional intervention. Your doctor can also refer patients to a psychiatrist, if necessary. Encourage them to see a trained counselor. Do not be surprised if they refuse but be persistent. There are many types of caregivers for the suicidal. If the person will not go to a psychologist, or a psychiatrist, suggest, for example, they talk to a clergy, guidance counselor or teacher. If you are concerned that someone you know may be thinking of suicide, you can help. Remember, as a helper, do not promise to do anything you do not want to do or that you cannot do. City and school officials are also working to stem the rising death toll. Last spring, the El Paso County Public Health department hired a specialist to create a screening system to identify young people at risk. But not all parents are willing to address the problem. Kelly, the medical examiner, says family members almost always request that his office cite a cause of death other than suicide, such as the choking game. “I’ve had relatives ask me if I would call it an autoerotic asphyxia because they didn’t want to tell Grandpa that his grandson had committed suicide,” he says. “That really speaks to what we as Americans think about mental illness.” None of the obituaries for the Colorado Springs kids seem to mention suicide (a common omission everywhere), and it’s unlikely that their memorial services included more than a vague reference. Some worry that discussing suicide might inspire more kids to do it, but just because suicidal behavior can spread quickly doesn’t mean it has to. Moutier, from the American Foundation for Suicide Prevention, says thinking suicide is contagious might give young people the impression that anyone can “catch” it, even a stable, happy kid. That’s not true, she says. Whether the parents of the deceased will admit it or not, suicide in most cases involves an underlying mental health condition. Researchers have found that if someone close to an adolescent dies by suicide, the adolescent’s mental health history is a bigger predictor of future suicidal behavior than his or her relationship to the suicide victim. El Paso County’s most recent teen suicide was on September 19—a hanging on school grounds. Because teen suicides there tend to spike at the end of semesters—when students may feel as if they’re losing whatever support they had at school, Kelly says—officials may not know until winter break if things are improving. Students aren’t necessarily sending panicked glances around the classroom, wondering whom this plague will strike next. They have other things to worry about—exams, rehearsals, sports games, college applications. “When it first happens, that’s all that is on everyone’s mind,” says Chloe Love, a junior at Discovery Canyon Campus, who does suicide prevention work. Then they move on. They have to. “Sometimes,” she says, “the memories just hurt too much.” Sjoerdsma says she won’t hide how Riley died. “I’m fully aware that my daughter committed suicide, and I don’t know why.” She has done social work, and her husband is a local middle school teacher; neither saw the signs. Since her daughter’s death, she hasn’t been sleeping well, and the spate of suicides makes the grieving process more difficult. At night, she often lies awake, thinking about how she and Riley used to say good night: “I love you here to heaven,” Sjoerdsma would say. “I love you back to heaven,” Riley would respond. Sjoerdsma still says it every night.
Only now, there’s no one to say it back. Teen
suicide is contagious, and the problem may be worse than we
thought Even though her mother had no sense that Riley was having problems, she knew it was important to talk to her daughter about suicide, and so she did. Between 2013 and 2015, 29 kids in their county had killed themselves, many from just a handful of schools, including Riley’s. There had been gunshot deaths, hangings and drug overdoses. And then there were those choking deaths the victims’ parents insisted were accidental. Riley knew of at least two of the kids who had killed themselves the previous winter: an older girl at school (they had mutual friends) and a boy in her Christian youth group. Such peripheral connections are all that seem to connect most of the kids in the area who had killed themselves, and school and county officials began to worry they were witnessing a copycat effect...until copycat became too weak a word. It was more like an outbreak, a plague spreading through school hallways. About a year after Sjoerdsma and her daughter last spoke about suicide, Riley was staying at her father’s house one night when she downed a small bottle of whiskey, then sent out a series of troubling texts and Snapchat messages. “I’m sorry it had to be me,” she wrote to one friend. Then she slipped on a blue Patagonia fleece and snuck out the basement window, carrying her father’s gun. When Riley’s mother and friends saw the messages, they went looking for her at local parks, gas stations and friends’ houses, all the while begging her via texts and calls to come home. The next morning, they found her body in the woods behind her father’s house. She’d shot herself in the head. Three days later, and two days before Riley’s memorial service, another Discovery Canyon Campus student killed himself. Her daughter probably knew the boy, but they weren’t close, Riley’s mother says. Nine days later, yet another classmate committed suicide. He had been on the swim team with the boy who’d just killed himself. And that wasn’t the end of it: Five students from the school of 1,180 died by suicide between late 2015 and summer 2016, a rate almost 49 times the yearly national average for kids their age. It’s not just at that one school. As of mid-October, the total for teen suicides this year in El Paso County, home to Colorado Springs, is 13, one short of the total for all of 2015. Neighboring Douglas County had a similar crisis a few years ago, and news of a classmate’s suicide no longer fazes students in the area, kids say. “It’s become almost commonplace,” says Gracie Packard, a high school junior in Riley’s district. “Because it doesn’t happen once every four years. It happens four times in a month, sometimes.” The youngest person to die this year in El Paso County was 13. “[Even] for a job that’s generally pretty tragic, it’s disheartening,” says Dr. Leon Kelly, the county’s deputy chief medical examiner. “You feel powerless. You feel like, Another one? “Another day, another kid. It’s hard.” Death on Instagram Sociologists have long said people who form bonds are less likely to kill themselves, but sometimes the opposite is true—studies now show that one person’s suicidal behavior can spur another’s, and one death can lead to more deaths. Decades of research prove that a startling range of emotions and behaviors can be contagious—from moodiness to yawning. Young people are especially susceptible; they obsess over fads and fashion trends and copy illicit behaviors from peers, such as smoking, drinking or speeding. Or suicide. Using a statistical formula typically applied to tracking outbreaks of diseases, researchers at Columbia University and other institutions confirmed in 1990 that suicide is contagious and can be transmitted between people. Contagion spreads either directly, by knowing a suicide victim, or indirectly, by learning of a suicide through word-of-mouth or the media. Those same researchers found that people ages 15 to 19 are two to four times more prone to suicide contagion than people in other age groups. The way it spreads can be so similar to that of diseases that the Centers for Disease Control and Prevention (CDC) has sometimes gone into a region to investigate spikes in suicides. Analysts call those spikes suicide clusters—an unusually high number of people in an area kill themselves (or attempt to) in a short period of time. The clusters tend to happen where people socialize, such as schools, psychiatric hospitals or military units. Madelyn Gould, one of the analysts who made the contagion discovery, has said these clusters make up between 1 and 5 percent of teen suicides but are vitally important to understand because “they represent a class of suicides that may be particularly preventable.” And a few consecutive suicides can devastate a community. Another reason it is crucial to understand these clusters is that suicide is likely becoming more contagious, thanks in large part to social media. Analysts have long assumed that a suicide typically has a profound impact on six people, but that estimate is from the early 1970s and limited to close family members. Social networks (both online and in real life) are much bigger today, and soon-to-be-published research by Julie Cerel, president-elect of the American Association of Suicidology, shows that a suicide may now touch around 135 people, and about one-third of them experience a severe life disruption because of that suicide. She and her colleagues previously found, in 2015, that people who know a suicide victim are almost twice as likely to develop suicidal thoughts as the general population. The closer the relationship, the greater the risk; the younger the person exposed, the greater the risk. Young people aren’t the only ones facing a suicide problem; the national suicide rate across all demographics is at an almost 30-year high. But more than three times as many teens are killing themselves now than in the 1950s. Most of these suicides aren’t copycats, but some areas across the country are suffering from the sort of contagion that has stricken Colorado Springs; the CDC investigated cases in Fairfax County, Virginia, in 2014 and Palo Alto, California, in 2016. Other clusters have likely gone undetected because it’s often so difficult to make the connections between victims. Suicide prevention advocates tend to blame television and newspaper coverage for inspiring copycats, but for teens, social media are a growing problem. Instagram pages for kids who kill themselves sometimes contain hundreds of comments. Many are about how beautiful or handsome the deceased were, how they can finally rest in peace and how there should be a party for them in heaven. Dr. Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention, says the message seems to be that if you kill yourself, you’ll not only end your suffering but also become the most popular kid in school. Teens sometimes have more than 1,000 Instagram followers, so kids far beyond one school or community can see digital shrines to dead friends. Moutier says those posts can seem as if they’re romanticizing death. Scholars are struggling to keep up with the evolving technology, and they say there’s still a paucity of research on how suicidal thoughts spread through social media. “It makes these deaths no longer isolated,” says Cerel, and kids “are exposed and perhaps profoundly affected by someone they might have never even met in person.” Analysts say clusters could become harder to spot, because they typically occur in a specific area, but social networks for teens now spread far beyond a school, a neighborhood, even a city. The Choking Game It’s hard to identify “patient zero” in the Colorado Springs suicide outbreak because kids today are so interconnected, and the families involved have kept many details private. Researchers also know that they can’t limit their search to one group; the first suicide at one school may have been inspired by the death of a student at another. Other factors muddling the search: The coroner’s office doesn’t always track where the deceased went to school, and districts are hesitant to say how many teens they’ve lost to suicide, citing student privacy laws and fear of copycats. (Editor's note: In the 2014/15 Oregon Healthy Teen Survey, 3.6% of 8th graders and 0.8% of 11th graders had participated in the 'Chocking Game'. Comparing the two, it might appear that the increase in popularity of the acitive is a 450% increase in the last three years.) One known precursor to the current wave of suicides was in 2011, when a Colorado Springs father found his 12-year-old son suspended from a bunk bed. The parents insist it was not a suicide and instead blame the “choking game,” in which a person cuts off blood flow to the brain and then releases it in order to feel lightheaded or even high. The coroner’s office ruled the cause of death “undetermined.” In 2013, a 15-year-old from the same school district strangled himself, and his parents blamed the choking game. The number of teen suicides started picking up in the spring of 2015, when a Discovery Canyon Campus student shot herself. The next month, three local kids took their own lives. From June to November, there were five more suicides in the Colorado Springs area; in December, there was on average one teen suicide per week. The deaths surged again toward the end of the last school year, beginning with Riley’s suicide. Those tracking the situation are convinced it’s a contagion, but they’re unsure how it’s spreading. That makes it all the more frightening and difficult to stop. “It’s two years in a row we’ve dealt with the same sort of terrifying trend,” says Kelly, the medical examiner. Colorado’s Child Fatality Prevention System, which investigated all youth suicides in the state from 2010 to 2014, identified risk factors, (105 page pdf) including family arguments, relationship breakups and physical or emotional abuse. Others blame regional factors, like the nearby Army and Air Force bases, as the children of people serving in the military are at elevated risk for suicidal thoughts. (A parent’s deployment can lead to increased responsibilities at home for a kid or emotional problems because of the separation and possibility of a parent’s death.) Some blame the high altitude, which researchers have linked to suicide. Analysts also point out that young people don’t always know how to get through stressful times. Adults tend to end their lives because of major life stressors, Kelly says, but for a kid, the breaking point is often less significant. “These risk factors line up like lights on the street,” says Richard Lieberman, a mental health consultant for the Los Angeles County Office of Education. “For a kid to go from thinking about suicide to attempting suicide, all these lights have to turn green.” One light might be a fight with a parent. Another might be a flunked test, a breakup, a peer’s suicide. Kids might contemplate suicide for months, and then the final act is often on impulse, “if everything falls into place,” says Scott Poland, a school crisis expert from Nova Southeastern University in Florida. Poland and Lieberman are working with Discovery Canyon Campus and its district. Riley didn’t show any obvious signs of mental health problems, according to her mother, and wasn’t in therapy or on medication. “Teachers even said, If you would have given me 200 names, hers would have been at the bottom of kids who would do this.” But Riley was having trouble in the classroom—she fooled around during class, and her grades suffered, which added pressure. “She kept saying she hated school; she just didn’t want to be there,” Sjoerdsma says. She also struggled with her parents’ 2005 divorce. But even a few hours before her death, at a Christian youth group gathering she was dancing around and holding hands with friends, says Sjoerdsma, acting like “her normal self.” In the car with family friends on the way to her father’s house, Riley rolled down the window and stuck her hands outside. She liked to feel the cool mountain air on her palms. When she was dropped off, she told the people she was with that she’d see them tomorrow. ‘Unhang’ Yourself A little more than a week after Riley’s suicide, Brittni Darras, an English teacher at a different school in the area, posted on Facebook that she had learned of another student’s attempted suicide during a parent-teacher conference. “As her mom sat across from me, we both had tears streaming down our faces,” Darras wrote. “Feeling helpless, I asked if I could write my student a letter to be delivered to her at the hospital.” The mother agreed. After the student received it, the mother emailed Darras to share what the girl had said: “How could somebody say such nice things about me? I didn’t think anybody would miss me if I was gone.” Darras had lost a student to suicide a few years earlier. “It’s something that, as a teacher, you never entirely recover from,” she says. “Losing one in my teaching career was more than anybody should ever have to go through.” When she heard how the girl in the hospital had reacted, Darras decided to write letters to the rest of her 130 students. It took her two months. Her students were thankful, and word of what she did spread; nearly 200,000 people have shared her Facebook post. Darras is one of many people in the Colorado Springs area fighting to stop the suicides. The initiative Safe2Tell, which began as a pilot program in the city in the 1990s and expanded statewide after the Columbine High School killings in 1999, lets young people anonymously report threats by others. State police receive the reports and connect with local law enforcement and schools to intervene. Last school year, Safe2Tell received 5,821 tips, up 68 percent from the previous year. The largest category involved suicide threats. “For years, in all the work in suicide prevention, we’ve really focused on one thing, and that is seeking help if you need it,” says Susan Payne, the initiative’s executive director. “That meant putting it on the victim that’s struggling to make a phone call or seek help.” Her program encourages bystanders to look for warning signs in others and report them. Daniel Brewster wants that too. On December 31, 2015, hours before he and his daughter Danielle, 17, a Discovery Canyon Campus student, planned to celebrate the new year, she hanged herself. Brewster later looked at his daughter’s phone. “This is the part that kills me—I know she was texting other kids at the time and letting them know,” he says. She wrote, “My feet are off the floor,” and “Everything is getting hazy and dark.” None of the kids intervened; one responded by suggesting she “unhang.” “Just having a meeting with [teens] and saying, ‘OK, here are the signs; here’s what you look for; here’s what you need to do’—that’s not enough,” Brewster says. “It needs to be ingrained in these kids’ heads, because they’re our first line of defense.” Of all the young people in Colorado who killed themselves from 2008 to 2012, more than a third had told someone of their plans, according to a state report. Danielle’s was one of at least three teen suicides in the Colorado Springs area in a three-week span. Then, six weeks later, Danielle’s mother hanged herself in her daughter’s bedroom. “They’re supposed to be here,” Brewster says, choking on the words. “We’re supposed to be in this house together.” Some local students are starting their own prevention efforts. Gracie Packard was in the eighth grade when she set a date to kill herself. She had struggled with anxiety and depression since she was young and later practiced cutting. She couldn’t sleep, her grades were slipping, and she was losing weight. She would cancel plans with friends and stopped dancing, once a passion of hers. Meanwhile, other kids around town, as well as one of her siblings, were killing themselves or attempting to. “It was pretty much all around you,” she says. She recalls telling herself, “If things aren’t better by this date, then you’ve tried your best, and you can end it.” Her friends sensed something was wrong. Days before she planned to die, they staged an intervention. “We’re worried about you,” they told her. Their concern, plus a suicide prevention nonprofit she stumbled upon called To Write Love on Her Arms, convinced her to ask her mom for help. “I was physically shaking. I could hardly breathe,” she says. But “that 30 seconds of bravery in being willing to say out loud to somebody you trust that, ‘Hey, I’m not OK,’ it’s going to be one of the scariest things you’ll ever do, but it will be one of the best things you’ll ever do.” She soon started therapy. Now 17, Gracie shares her mental health story publicly and advocates for suicide prevention. An event she hosted in September drew 150 people. City and school officials are also working to stem the rising death toll. Last spring, the El Paso County Public Health department hired a specialist to create a screening system to identify young people at risk. But not all parents are willing to address the problem. Kelly, the medical examiner, says family members almost always request that his office cite a cause of death other than suicide, such as the choking game. “I’ve had relatives ask me if I would call it an autoerotic asphyxia because they didn’t want to tell Grandpa that his grandson had committed suicide,” he says. “That really speaks to what we as Americans think about mental illness.” None of the obituaries for the Colorado Springs kids seem to mention suicide (a common omission everywhere), and it’s unlikely that their memorial services included more than a vague reference. Some worry that discussing suicide might inspire more kids to do it, but just because suicidal behavior can spread quickly doesn’t mean it has to. Moutier, from the American Foundation for Suicide Prevention, says thinking suicide is contagious might give young people the impression that anyone can “catch” it, even a stable, happy kid. That’s not true, she says. Whether the parents of the deceased will admit it or not, suicide in most cases involves an underlying mental health condition. Researchers have found that if someone close to an adolescent dies by suicide, the adolescent’s mental health history is a bigger predictor of future suicidal behavior than his or her relationship to the suicide victim. El Paso County’s most recent teen suicide was on September 19—a hanging on school grounds. Because teen suicides there tend to spike at the end of semesters—when students may feel as if they’re losing whatever support they had at school, Kelly says—officials may not know until winter break if things are improving. Students aren’t necessarily sending panicked glances around the classroom, wondering whom this plague will strike next. They have other things to worry about—exams, rehearsals, sports games, college applications. “When it first happens, that’s all that is on everyone’s mind,” says Chloe Love, a junior at Discovery Canyon Campus, who does suicide prevention work. Then they move on. They have to. “Sometimes,” she says, “the memories just hurt too much.” Sjoerdsma says she won’t hide how Riley died. “I’m fully aware that my daughter committed suicide, and I don’t know why.” She has done social work, and her husband is a local middle school teacher; neither saw the signs. Since her daughter’s death, she hasn’t been sleeping well, and the spate of suicides makes the grieving process more difficult. At night, she often lies awake, thinking about how she and Riley used to say good night: “I love you here to heaven,” Sjoerdsma would say. “I love you back to heaven,” Riley would respond. Sjoerdsma still says it every night.
Only now, there’s no one to say it back. Can Addressing
Suicidal Behavior and Alcohol Use Together Prevent Suicidal
Behavior by Teens?
Although suicide in adolescents occurs infrequently, it remains the second leading cause of death for this age group. A significant risk factor for suicide in adolescents is the use of alcohol. Drinking alcohol reduces the ability to inhibit or stop behavior, depresses mood and impairs decision making and can lead those at risk for suicide to engage in suicidal behavior. Motivational interviewing (MI) interventions are a type of intervention through which clinicians encourage patients to change negative or harmful behaviors by allowing them to discuss the ways these behaviors affect them. Through MI, clinicians work with people to establish a plan for changing harmful behaviors. Previous studies have shown that MI is effective for reducing adolescent alcohol and drug use. Motivational interviewing has also been shown to be an effective intervention for adults hospitalized for suicidal ideation and behavior. While the interaction between alcohol use and increased risk for suicide in adolescents is clear, interventions for suicidal behavior generally do not focus on alcohol use. Dr. Kimberly O’Brien and her team tested a motivational interviewing intervention called Alcohol and Suicide Intervention for Suicidal Teens (ASIST) to determine if an intervention addressing both alcohol use and suicidal behavior would be helpful to hospitalized adolescents. QUESTION Is a brief MI intervention helpful to adolescents hospitalized for suicidal behavior who also use alcohol? STUDY Dr. Kimberly O’Brien and her team recruited 50 adolescents who were psychiatrically hospitalized for a suicide attempt. At the beginning of the study, clinicians assessed the participants, asking them questions about their alcohol and drug use over the past 90 days using the Timeline Follow-Back Interview; suicidal ideation experienced over the past month with the Suicidal Ideation Questionnaire; and suicide attempts in the past three months with a single question from the Columbia Suicide Severity Rating Scale. Participants were again asked these questions during a follow-up assessment three months after hospital discharge. The participants were assigned to one of two groups. One group received the Alcohol and Suicide Intervention for Suicidal Teens (ASIST) along with Treatment as Usual (TAU) as described below. The other group received only TAU. Patients in the ASIST group participated in two treatment sessions. During the first session, each adolescent met individually with a clinician who asked them about their opinions toward their alcohol use, and how their alcohol use interacts with their suicidal ideation and behavior. Each participant was then asked to establish goals related to these behaviors, create a plan for change, and identify strategies for effecting change. The clinician would discuss these behaviors with the adolescent and then provide them with personalized feedback. This feedback aimed to help the participant understand how alcohol use affects them and interacts with their suicidal behavior. Adolescents in the ASIST group also participated in a family session with their parent(s). During this session, the adolescent described their goals, change plan, and strategies for change to their parent(s). The adolescent then identified ways for their parents to provide support in achieving these goals. Finally, participants in the ASIST group were asked 20 questions relating to whether they felt the intervention was helpful. For participants who received TAU, clinicians performed an evaluation to determine which of the adolescent’s mental health problems required the most attention. The participant then received medication, if necessary. TAU included both individual and family sessions aimed at addressing a healthier lifestyle through psychoeducation, or clinician-provided instruction on exercise, sleep and nutrition. Each participant created a safety and coping plan to assist them in resisting suicidal behavior. Alcohol use was only addressed in the TAU group if the clinician determined it to be a significant problem for that participant. The TAU group had an enhanced version of treatment in order to maintain the same level of contact between the patient, their family and the treatment team. Treatment was much more extensive than what would have been typically provided. RESULTS Researchers found that all 50 participants completed either the ASIST intervention or TAU. Of these participants, 82 percent (20 in the ASIST group, and 21 in the TAU group) completed the follow-up assessment three months later. These results showed that the ASIST intervention was feasible, and can be used during hospitalization. Additionally, 92 percent of adolescents who received the ASIST intervention indicated that it helped them to understand the relationship between their alcohol use and suicidal behavior. Participants in both groups reported significantly reduced suicidal ideation alcohol use, marijuana use, and tobacco use, and greater confidence in reducing their alcohol use. Since both groups improved, the study did not demonstrate that the ASIST intervention was better than the enhanced TAU in terms of reducing the severity of suicidal ideation or alcohol use. TAKEAWAY
Dr. Kimberly O’Brien received an
AFSP Young Investigator Research Award for this work in
April 2019. She was also awarded a grant from the National
Institute on Alcohol Abuse and Alcoholism (NIAAA) as a
result of her AFSP funded study.
It might shock you that suicide is the third leading cause of death among teens (10-19 years old) in the United States. To date, many studies have identified potential youth suicide risk factors and characteristics. For example, teen students are more likely to take their life when alcohol or drugs are involved, if their parents are divorced, if they have access to a gun, are failing education, are involved in teen pregnancy, hear of other teen suicides, have low self-esteem or are highly sexually active. Although these findings are clearly related to youth suicide, there is little community discussion about the fact that these risky behaviors often originate from interactions with peers at school. A study published in the Economics of Education Review identified that youth suicide rates very closely follow the academic calendar, and noted a “summer effect”, in which suicide rates dropped significantly during the summer holidays. More importantly, they controlled for seasonal affective disorder (SAD) to ensure that it was attending school and not the change in seasons and associated lack of sunlight that is driving youth suicide. They found that it is school attendance itself that is the problem. This is no surprise really, as these suicide-heavy teen statistics all but disappear after high school, irrespective of the season. In fact, while suicides rates have more than tripled for US high schoolers since the 1950s, rates of suicide among adults and the elderly have thankfully diminished over the years. So, what are the primary drivers for back to school suicides? Recent high profile cases of “bullycide”, like those in Massachusetts, clearly demonstrate that increased stress and decreased mental health induced by the social aspects of school-life can easily manifest in suicide. One mechanism that may decrease the rate of suicide over the summer is a decrease in negative social interactions, as youth have more latitude in summer months to select the peers they want to hang out with and are not forced into stressful social confrontations through school attendance. However, cruel, hurtful or humiliating, social interactions are not the only thing students have to worry about in school. Add to this test score performance and parental demands to perform, media-borne pressures in being ‘cool’ and fitting in, the trials and tribulations of learning to think and act independently within a rapidly changing mind and body, and it is crystal clear that for some students, school life can be an overwhelming, pressure-filled, mind-bending roller coaster. Most importantly, we don’t currently have an effective, nationwide support system or set of preventative measures to help deal with these ever increasing pressures, that teaches children how to effectively develop their emotional control and manage stress, which is essential for healthy and successful modern living. Some of you may be starting to feel like this is yet another slamming of the US education system, when really this is a largely global phenomenon. Many studies report suicide as the third or fourth most common cause of teen death in hundreds of countries, typically after death by accidents, then violence, drugs or HIV, depending on the country. Whether these tragic teen suicides are also closely interlinked with school life, as in the US, remains to be seen. While there are essential and painstakingly obvious life-changing benefits to having an education, it is imperative for the safety of our children to discuss the potential costs of the current and clearly overwhelming school-related pressures felt by so many of today’s youth. In fact, in a nationwide CDC survey it was found that over 16% of students reported seriously considering suicide. These numbers are too high to be overlooked. Moreover, these results should definitely be acknowledged when considering the topical question of whether the academic year should be extended. A study that linked longer instructional days to better test scores and student performance, as well real life instances of high test scores coming from extended tuition ‘guinea pig’ schools, have been the primary fuel for the ‘give them more, it’ll make it better’ line of argument. However, in light of the back to school blues study and the mental health challenges a relatively large number of kids face, we should take extreme care and diligence in predicting the mental health implications of changing school calendar policies. While we want our kids to perform at their best, is this truly worth it when we may have to pay the ultimate price, more children’s lives? References Hansen, B., & Lang, M. (2011). Back to school blues: Seasonality of youth suicide and the academic calendar Economics of Education Review, 30 (5), 850-861 DOI: 10.1016/j.econedurev.2011.04.012 3) Marcotte,D. and Hansen, H. (2010) Time for school? Education Next, 10 (1), pp. 52–59. Molina, J., & Duarte, R. (2006).
Risk Determinants of Suicide Attempts Among Adolescents
American Journal of Economics and Sociology, 65 (2), 407-434
DOI: 10.1111/j.1536-7150.2006.00456.x Spring
Suicide: An (Un)Likely I mean, that’s, like, a given. It’s all over the press, it’s all over our popular culture. It is, in fact, THE driving force behind the weighty despair in both A Christmas Carol and It’s a Wonderful Life. Except that it’s not true. People attempt suicide and die more often by suicide far more often in the springtime. That’s been known for more than 50 years. “April is the cruelest month,” Mr. Eliot tells us in The Waste Land. His depiction of the rebirth of spring as a desolate emotional landscape is more accurate than many of us may realize. Still, just ask anyone who works in mental health. Ask anyone who works in an emergency room. Ask anyone who suffers from a psychiatric syndrome. Things tend to emotionally quiet down in December, and instead get really, really tough just as the tulips start blooming. Obviously we’re going to worry about suicide any time of the year; if someone says he or she feels that life isn’t worth living, we’re not going to ignore this sentiment just because it’s expressed during the winter months. But, just as we worry more about asthma during seasons when pollen increases, it behooves us to be more vigilant for suicidal thinking and behavior as the season changes from cold to warm. In fact, this appears to be especially the case in areas where the seasons are more pronounced. Something about all that change seems to cause as much trouble as it does delight. What’s going on? Experts aren’t entirely sure. There are, however, some pretty compelling theories. One of the most commonly cited is the increase in manic behavior in the springtime. This notion suggests that the mood activation triggered by warmer weather brings about the development of more self-destructive behavior. Certainly there is evidence that bipolar disorder worsens this time of year. Still, there are some other less commonly considered but potentially even more compelling theories to explain these unexpected phenomena. It’s All About Connection If you live in a place with a harsh winter, think about how you feel on those dark, cold days. Do you want to exercise? Do you want to go out to dinner with friends? Do you want to be with anyone? Some of you do. But it turns out that for many people, both with and without psychiatric syndromes, winter promotes a kind of emotional hibernation. We wall ourselves us in, we binge-watch Netflix, we rush from the car to the office to our houses. We sleep more. We just don’t interact as much with others when the days are cold and bleak. The pressure of social interaction increases dramatically as the weather warms. In studies of developed nations, this effect seems even more pronounced in agricultural areas. From a social perspective, this makes sense. During the winter, there are no crops to plant, no plants to harvest. But, enter spring, and it’s time to go into town, buy your supplies and eventually take what you grow or raise to market. All of this forces a level of social engagement that can, for many, be a source of significant stress. Indeed, suicidal behavior in the spring and summer might stem directly from the potential increased social interactions offer for more potent disappointment. Suicidal thinking emerges, therefore, from the pain of social disconnection precisely when those connections are increasingly possible. In fact, an interesting control study in Austria showed that inmates in the Austrian penal system had no discernible increase in suicidal behavior from season to season. If we decide to buy into the social theory of springtime suicidal increase, then this makes sense. Regardless of the weather, inmates have their social interactions tightly monitored and largely decoupled from the seasons. But, are these social theories the only explanations? It’s In The Air Think about that wonderful time when the leaves on the once naked branches become nascent and downy. Breathe in deeply the dust storm of fluorescent yellow pollen as it floats like an alien swarm off increasingly fertile pine trees. Just look around if you live someplace where spring looks quite a bit different from winter. There are flowers and inhalers alike, blooming with equal exuberance. Spring is a time of rebirth and itchy eyes. In other words, it is a time of increased physiological inflammation. According to the Asthma and Allergy Foundation of America, about 40 million Americans suffer indoor-outdoor allergies. That means that about 40 million Americans experience the wheezing, hives and runny noses that come with changes which occur between being in and outdoors—and these changes are most pronounced in spring. Most importantly, these allergic symptoms are potent markers of inflammation, the body’s immunological response to irritants. There have long been associations between mood disorders and inflammation. Injecting animals with inflammatory agents causes those animals to care less for themselves. Treating patients with medications that deliberately increase inflammation (interferon for Hepatitis C, for example) is associated with a very high risk of depression and suicidal thinking. It makes sense, therefore, that another prevailing theory around the suicidal risks of warmer weather involves the increased rate of inflammatory responses that the season’s allergens inflict. There’s good research to back up these claims as well. One study showed that the suicide rate significantly increased when the pollen count increased. Other studies have shown that depression, anxiety and sleep disturbances are higher in families who suffer runny noses that are brought about by allergies. Finally, there are studies suggesting that poorer air quality, an environmental effect of warmer weather, increases the likelihood of depression and suicidal behavior. Again, the thinking here is that the increased particles in the air trigger inflammatory responses that provoke worsening mood. Conclusions I’m not trying to disparage spring. Goodness knows that this has been a tough winter. But, we also want to accomplish two things with this blog. We’d love for the myth of winter being the worse season for suicidal behavior to be challenged. It just isn’t, and really never has been according to research. The Annenberg Foundation made an impassioned plea in 2010 that as a society we move away from this misguided notion. At the same time, I’d like to remind everyone that spring brings with it its own psychiatric risks, and that to the extent that we can, we ought to be more vigilant for suicidal behavior during the warmer months. Most importantly, and perhaps THE
take-home message of this post? No matter what the season,
be wary of issues pertaining to suicide. Self-harm is a
significant public health threat throughout the year. If
you’re worried, ask the person you’re worried
about. You won’t regret it, and you might just save a
life. Why do suicide
rates peak in the spring? This week, mental health experts at the Priory group said that May is the peak month for suicides in Britain. "The increase can be dramatic, with up to 50% more successful suicides in some cases," says Chris Thompson, director of healthcare at the Priory group. In Britain, about 6,300 people take their own lives each year, 90% of whom are likely to have mental health problems. The seasonal effect is seen all over the world, with the northern hemisphere witnessing a big rise in suicides in May and June and the southern hemisphere seeing a similar rise in November. While no one has a complete explanation as to why, the leading theory is that the increase is down to the effects of sunlight on our hormones. According to Thompson, the seasonal changes that bring most of us out of winter apathy may work against those who are coming out of severe depression. "It is a harsh irony that the partial remission which most depression sufferers experience in the spring often provides the boost of energy required for executing a suicide plan," he says. "Spring is a time for new beginnings and new life, yet the juxtaposition between a literally blooming world and the barren inner life of the clinically depressed is often too much for them to bear." Paradoxically, says Thompson, sunlight-driven changes in levels of the feelgood chemical serotonin may make people more aggressive and, if they are depressed, they could direct that aggression at themselves. The theory gains some support from research by Canadian scientists linking seasonal changes in bright sunlight with more violent suicides. Other researchers believe that the
influence of sunlight on another hormone, melatonin, is to
blame. Sunlight inhibits production of melatonin, which is
known to influence our behaviour. As
Legislature tackles teen suicide, what experts would like to
see If you tell your iPhone to find a bridge you can jump from, Siri will ask if you want her to dial a suicide crisis line. Query Google about ways to kill yourself, and the first response is a link to the National Suicide Prevention Hotline, with a button to launch live chat. A teenager struggling at most Utah schools can readily find a trained peer from Hope Squad to listen and help. Even a Facebook post that indicates suicidal thought may be answered by a crisis counselor from the national crisis line. These personal and technological prompts mark progress in a journey to prevent teen and other suicides but policymakers, legislators and others say the road to reducing suicides is very much under construction as lawmakers prepare to gather for the start of the 2017 legislative session Jan. 23. “In Utah, we are doing a little bit of a lot of things,” said Kimberly Myers, suicide prevention coordinator in the state’s Division of Substance Abuse and Mental Health. “I think to truly move the needle, almost all of them have to scale up.” Myers co-chairs the Utah Suicide Prevention Coalition with Andrea Hood, the Utah Department of Health's suicide prevention coordinator. The actions include efforts by the Utah Legislature, but also by local governments, local foundations, volunteers and families. Most teenagers don’t struggle with suicide ideation, but in Utah, suicide has passed accidents as the leading cause of death for those age 10 to 17, and the state ranked No. 8 in youth suicide nationally in 2012-2023, according to a health department report. More than one in eight teens surveyed said they’d considered self-harm or suicide, which aren't always synonymous. The Deseret News recently looked in-depth at teen suicide and the challenges in urban and rural communities. "The sky is not falling,” said Greg Hudnall, educator and executive director of Hope4Utah, who noted most people don’t try to kill themselves. “But of all deaths, suicide is the most preventable by far. We need to support and grow proven existing programs.” Teaching and learning It seems easier for technologies like Siri to ask people if they're suicidal than it is for even close companions. People tend to shy away from addressing mental health or suicide. But they must, said Hudnall, who thinks education is crucial to save lives. “More suicides are prevented by family members, peers, co-workers, fellow students and others than by any professional. The biggest challenge is the fear of talking about it.” Hope4Utah has taught more than 40,000 people in schools, churches and businesses in 65 Utah cities that it’s necessary to discuss suicide. Participants have learned warning signs, risk factors and what to do and where to get help. Hudnall saw the training work recently when a middle school bus driver overheard a student say something that could be construed as self-destructive. That prompted him to call the school district, which contacted the parents, law enforcement and mental health experts. Between them, they found the student, who had planned to die that night. “They were able to intervene because one person was listening,” Hudnall said. Utah is both teacher and student when it comes to stopping suicide. Experts learn from what works in their own and other communities, building on each others’ initiatives. Several states have also provided useful models for suicide prevention efforts. The New Hampshire Gun Shop Project, led by that state's Firearm Safety Coalition, teaches gun sellers and firing ranges how to identify those at risk for suicide. The five-year-old program has been adopted in at least 20 states and demonstrates how the gun industry can play a role in prevention. Experts agree responsible gun ownership and storage are among the most effective ways to prevent suicide because firearms are by far the most deadly method. Most gun deaths, said gun enthusiast and lobbyist Clark Aposhian, chairman of the Utah Shooting Sports Council, are suicides — more than homicides, police-involved shootings and accidents combined. In a recent Utah suicide prevention video, he talks about putting time and space between people pondering suicide and weapons. Temporarily removing guns can be an effective form of "means restriction" — removing access to ways to kill oneself such as keeping guns or potentially deadly medications out of reach during crisis. Keeping a gun somewhere else or locked away is comparable, said Myers, to holding onto the keys when someone has been drinking. No one’s trying to take away the car. Washington state offers another example of prevention via gun safety. Last year, the state passed HB2793, establishing a task force to educate gun store owners on suicide prevention and distribute safe gun storage devices in two high-risk communities. The task force will work with firearm retailers to develop incentives for participating in the education program. Utah is working on a voluntary training program for gun shop staff. The state has also distributed brochures and 30,000-plus gun locks in the last couple of years, said Myers. Policymakers frequently look to Colorado, where in 2016 the governor signed a Zero Suicide Bill based on the zero suicide model, representing a bold but not impossible goal and supported by prominent national organizations. The bill creates a statewide prevention plan focused on uniting entire communities around leadership, training, identification, patient engagement, treatment, transition and quality improvement. Utah has adopted the model, and one of its zero suicide goals is ensuring health care providers are able to provide suicide-related care. Myers said a 2014 survey asked 8,000 Utah clinicians if they felt they had the skills, training and support to engage with someone at risk of suicide; just one-third said yes. Utah has since ramped up efforts to train clinicians on evidence-based skills and interventions to engage and treat someone who is suicidal, she said. Myers and Hood say state efforts should focus on 1) clinical training that ensures health care providers know how to recognize, address and refer patients who may be struggling with suicide ideation, 2) appropriate funding for suicide-prevention coalitions statewide and 3) improving education and action around means restriction. Legislative action Utah legislators will consider in the upcoming legislative session several bills that expand suicide prevention resources. Rep. Steve Eliason, R-Sandy, plans to reintroduce HB477, creating a suicide prevention education program like New Hampshire’s to teach firearm dealers to identify suicidal customers and avoid selling or renting them firearms. The bill would also provide funding to offset costs. He believes the bill will pass easily; last session it cleared the House unanimously but died before the Senate had time to vote. He also plans to run a bill creating a position in the Department of Health to collect detailed suicide-related data. When an individual dies by suicide, a police officer writes a basic report, but it doesn't provide enough information about what led the individual to kill himself — information that could substantially inform suicide prevention efforts. Under the bill, a licensed social worker would be hired to delve more deeply into the underlying causes of suicide, conducting a “psychological autopsy” to see if the individual experienced bullying, spent time in the criminal justice system, struggled with gender identity or was receiving mental health treatment at the time of death. The investigation could include hair samples to see what drugs were in one’s system and if he had stopped taking a prescribed psychotropic medication. Eliason and Sen. Daniel Thatcher, R-West Valley City, will co-sponsor three bills to improve emergency mental health resources. One would increase funding to hire more crisis counselors for and design a higher education version of SafeUT, a smartphone app that allows someone in crisis or a concerned friend to call or text a crisis hotline and speak to a licensed clinician 24/7. Crisis counselors at the University Neuropsychiatric Institute at the University of Utah take 5,000 crisis calls and 1,000 texts a month, many from SafeUT, said Barry Rose, crisis services manager at UNI, which is rolling out a teen-targeted live-chat function in partnership with all Utah schools. Eliason said the app’s tip feature has prevented over 20 planned school attacks this year. “I don’t have the final numbers, but I can say with a pretty high degree of certainty that our youth suicides are down double digits in 2016 compared to the prior year. You can’t point to any one reason why, but we believe the app is definitely playing a significant role in combatting these issues,” Eliason said, insisting every child with a smartphone should have SafeUT installed. Another bill would create a committee to streamline the state’s crisis lines and ensure each directs callers to appropriate care. Utah has a patchwork of at least 19 separate crisis lines; some connect to 911 dispatch, a phone tree or voicemail rather than a trained mental health professional. The third bill would dedicate a statewide three-digit phone number connecting callers to a continuously manned mental health crisis hotline — an "N11" number like 611. That's challenging, because all N11 numbers are being used in some fashion. Aside from procuring a three-digit number, Eliason doesn’t anticipate challenges to any of these measures. “If you go back and look at suicide prevention legislation we’ve run, frequently it’s a unanimous vote and always bipartisan. That’s because it’s as nonpartisan an issue as issues come,” Eliason said. Big picture Mental health professionals and policymakers also have more expansive goals on the horizon. Eliason noted Utah must work toward solving a major two-fold issue: The uninsured and underinsured don’t have adequate access to mental health treatment, and those who do have coverage struggle to get an appointment. Access issues are particularly prevalent in rural Utah, where psychiatrists are few and far between. Rose said while crisis intervention is available, long-term treatment often entails long waits for an appointment. Under a bill Eliason sponsored last year, Utah now offers a $10,000 tax credit to attract new psychiatrists. Eliason said future efforts must expand access to care by increasing the state’s mental health workforce and bringing more telepsychiatry services to rural areas. Funding is a big challenge for suicide prevention, which competes with myriad important priorities for money. The Legislature now provides $191,000 for suicide prevention efforts: About $45,000 is earmarked for clinical training of 120-150 individuals. For perspective, in Salt Lake County, the state contracts with some 430 clinicians for services — not counting those in private practice. So a modest number get trained from the total who might need to provide suicide prevention services statewide. Fifteen coalitions receive $10,000 to support program efforts — many use it for a mental health “first aid” program called Question, Persuade and Refer. But Salt Lake County alone could easily use 20 coalitions, so it's a small effort compared to need, too. University of Utah suicide specialist Craig Bryan said the state would have its biggest impact if it funded a prevention center of excellence tied to a specialty outpatient clinic. The clinic would need to be one that uses only data-proven treatments and provides them at low or no cost, he said. The center’s missions also need to include training clinicians and conducting research to improve clinical services. “Fund statewide training of mental health clinicians to use empirically supported treatments,” he said. “This training should go beyond workshops or continuing education … to include ongoing supervision, consultation and monitoring of clinicians.” Only programs with “demonstrated outcomes” should be funded, he added. “Of note, satisfaction does not necessarily constitute outcomes.” “If you want to
save lives, you have to move upstream. Right now, we’re
not investing in primary prevention,” said Hood. Adds
Myers, “we’re rescuing people from the
river.” When a Father
Dies by Suicide By keeping this issue a secret he is giving it power to destroy his life while it spreads as a cancer into his thoughts, actions, and relationships. Isolation is the worst way to live a full life, because it convinces a person that no one needs to know, that no one really understands, and ultimately, that no one really cares. That’s not true! If you’re struggling and need
someone to talk to, call the national helpline at
800-273-8255 or text "SOS" to 741741 now. Asking for help is
a great way for a person to flourish in their understanding
of self and others. However, when we spend all our energies
protecting our secret from the world, this mindset can
create an independence stronghold that feels true but is a
lie really killing you from the inside out. Suicide Rate is Up
1.8 Percent According to Most Recent CDC Data (Year
2016) “We are disheartened because every suicide is a tragedy, and the suicide rate in the US has been steadily increasing for years. The more the public understands about suicide prevention, the more likely we’ll see the rate of suicide begin to decrease. Creating a culture open to talking about mental health and suicide prevention is critical. Making treatment truly accessible for all people is paramount. As the nation’s largest private funder of suicide research, we know concentrated and strategic suicide prevention efforts can be successful. We have invested in Project 2025, a high-impact, collaborative initiative developed by AFSP, aimed at the organization’s bold goal of reducing the annual suicide rate 20 percent by 2025. Based on the evidence, AFSP has determined a series of actions across four critical areas to help reach this unprecedented goal including: (1) firearms and suicide prevention, (2) large healthcare systems, (3) emergency departments, and (4) corrections system. Through Project 2025, we will reach across all demographic and sociological groups to have the greatest impact for suicide prevention, and the potential to save thousands of lives within the next decade. As a nation, we need to invest our time and resources in effective prevention efforts. The lives of millions of Americans depend on it.” Suicide – The New Numbers
To view these most recent CDC data on
suicide: afsp.org/about-suicide/suicide-statistics/
The American Foundation for Suicide Prevention is dedicated to saving lives and bringing hope to those affected by suicide. AFSP creates a culture that’s smart about mental health through education and community programs, develops suicide prevention through research and advocacy, and provides support for those affected by suicide. Led by CEO Robert Gebbia and headquartered in New York, and with a public policy office in Washington, D.C., AFSP has local chapters in all 50 states with programs and events nationwide. Learn more about AFSP in its latest Annual Report, and join the conversation on suicide prevention by following AFSP on Facebook, Twitter, Instagram, and YouTube. Contact: Alexis O’Brien,
347-826-3577 or aobrien@afsp.org Suicide Rates
For Teen Boys And Girls Are Climbing The suicide rates for adolescent boys and girls have been steadily rising since 2007, according to a new report from the U.S. Centers for Disease Control and Prevention. The suicide rate for girls ages 15 to 19 doubled from 2007 to 2015, when it reached its highest point in 40 years, according to the CDC. The suicide rate for boys ages 15 to 19 increased by 30 percent over the same time period. The analysis looked at data from 1975 to 2015, the most recent year those statistics were available. The suicide rate for teen boys increased from 12 suicides per 100,000 individuals in 1975 to 18 suicides per 100,000 people in 1990, when it reached its highest point. The numbers then declined from 1990 to 2007 and then climbed again by 2015. The suicide rate for teen girls was lower than for teen boys, but also followed a similar pattern ? increasing, then declining, then sharply spiking by 2015. “In 1975, in the United States, there were 1,289 suicides among males and 305 suicides among females aged 15 to 19 years,” the authors wrote. “In 2015, there were 1,537 suicides among males and 524 among females aged 15 to 19 years.” US Centers for Disease Control and Prevention A breakdown from the CDC on the suicide rates of males and females ages 15 to 19 between 1975 and 2015. The numbers are an alarming reminder that suicide is a growing public health problem. Last year, the CDC released a separate report that found that suicides for the U.S. population as a whole increased 24 percent over a 15-year period. Following that report, experts expressed concern over the suicide rate increase in young women ages 10 to 14, noting that demographic is one to keep an eye on. The numbers are also further proof that teens are an increasingly vulnerable group when it comes to mental health. Research shows that teen depression rates are on the rise, yet stigma or fear of asking for help often prevents people from getting medical support. Untreated mental health conditions are among the leading causes of suicide. Experts say there are multiple reasons more young people are struggling with their mental health. Heavy social media use, bullying, economic burdens, family issues and exposure to violence can all be risk factors for conditions like depression, according to Dan Reidenberg, executive director of the Suicide Awareness Voices of Education. “People often think that teens can’t get depressed or anxious, but they can. People also often think that it is ‘just normal teen angst,’” Reidenberg told HuffPost. “While the teen brain is still developing, teens do struggle with genuine mental illnesses and they need to be properly evaluated and treated.” Reidenberg, who was not associated with the CDC analysis, says the new report should be a wake-up call to everyone. He hopes it encourages more people to start talking about mental health from a younger age. “We need to make it okay to talk about things that are causing emotional pain and let people know that it is real, but it can get better,” he said. “We should be concerned, because dying by suicide shouldn’t be an option, and young people often feel like it is their only option.” Most importantly, Reidenberg stressed, there needs to be more encouragement for people to seek medical care. Uncharacteristic changes in behavior, fluctuations in academic performance and withdrawal are all signs something bigger could be occurring, Reidenberg said. “We need to change perceptions to help teens learn it is okay to ask for and get help,” he added. See the full breakdown of the
CDC’s report here. "My
friend is talking about suicide. What should I do?"
"Far
more women suffer from depression that men do, so it seems
odd that women would commit suicide at only one-fourth the
rate of men. The key difference between the two sexes may be
that women talk out their problems. George E. Murphy, an
emeritus professor of psychiatry at Washington University
School of Medicine in St. Louis, says that women may be
protected because they are more likely to consider the
consequences of suicide on family members or others. Women
also approach personal problems differently than men and
more often seek help long before they reach the point of
considering suicide. 'As a result, women get better
treatment for their depressions,' Murphy says. To reduce the
rate of suicide in men, Murphy suggests that physicians
should be alert for risk factors in men and refer them into
treatment. Writing in the Journal of Comprehensive
Psychiatry, he says that identifying men at risk require
mental health professionals to recognize that depressed men
may understate emotional distress or difficulty with their
problems." Black Men, 3/99. It's important for people with suicidal feelings to let themselves be assisted in overcoming deep depression. It's also a good idea to talk about your feelings with friends. No man is an island and there's nothing wrong with leaning on people who love you in times of need. See Suicide
Prevention Services Time-Space
Clustering of Teenage Suicide Teens’
brains make them more vulnerable to suicide ‘The young are heated by nature as drunken men by wine.” Aristotle made that observation 2,300 years ago, and since then, not much has changed about the way the adolescent brain behaves. But these days, researchers are beginning to understand exactly why a teenager’s brain is so tempestuous, and what biological factors may make teens’ brains vulnerable to mood disorders, substance abuse, and suicide. Suicide is the third leading cause of death among teens 15 to 19 years old, according to the National Centers for Disease Control and Prevention. The percentage of high school students who reported seriously considering suicide increased from 14 percent in 2009 to 16 percent in 2011. Locally, the city of Newton is reeling from the suicide of Roee Grutman, 17, a high school junior, in February, the third suicide in a single school year. The towns of Needham and New Bedford have experienced similar spates of teen suicides in recent years. Misconceptions about teen suicide abound, says Dr. Barry N. Feldman, director of psychiatric programs in public safety at the University of Massachusetts Medical School, and a suicide prevention expert who has worked with many Massachusetts high schools Neither bullying, pressure to succeed in sports or academics, nor minority sexual orientation can cause suicide, he says, but are among a number of possible risk factors. “If you focus too much on just bullying or sexual orientation, you take your eye off the underlying vulnerability a kid may have,” Feldman says. Warning signs that a teen is in danger for suicide Suicide is typically caused by a constellation of risk factors and underlying vulnerabilities. “It’s an attempt to solve a problem of intense pain with impaired problem-solving skills,” he says. Researchers have long known that the basic problem with the teenage brain is the “asymmetric” or unbalanced way the brain develops, said Dr. Timothy Wilens, a child psychiatrist at Massachusetts General Hospital specializing in adolescents, addictions, and attention deficit disorder. The hippocampus and amygdala, which Wilens calls the “sex, drugs, and rock ’n’ roll” part of the brain, feels and stores emotions and is associated with impulses. It matures well ahead of the section of the brain that regulates those emotions and impulses, the prefrontal cortex. Throughout the teenage years and up until about age 25, this executive section of the brain, also responsible for planning and decision, lags behind, Wilens says. Until the front part of the brain catches up, if kids get sad, “they really experience sadness un-tethered.” He adds. “It’s why first love really does break the heart.” It’s during this period of brain development that kids often act out based on their moods, get involved in substance abuse, and when they may be at a heightened risk to commit suicide, Wilens says. This is also when adolescents have a higher susceptibility to psychiatric disorders including depression, drug addiction, and schizophrenia. Dr. Mai Uchida, a child and adolescent psychiatrist at Mass. General, is leading two joint studies at the MGH Biederman Lab and the Gabrieli Lab at the Massachusetts Institute for Technology that are searching for biomarkers to identify the underlying vulnerability in teens. The studies are funded by The Tommy Fuss Fund, which memorializes a Belmont Hill teen who committed suicide in 2006. Just as hypertension and high cholesterol are biomarkers for heart attack, mood disorders are indicators of kids at risk for suicide, Uchida said. In a healthy teen, even though brain structure is unbalanced, the developing prefrontal cortex still should be communicating and working in concert with the brain section that feels and stores emotion, according to Uchida. In one of the studies, researchers used magnetic resonance imaging to compare the brains of 38 children between the ages of 8 and 14 who had a parent with a depressive disorder with a control group of 25 children with no genetic predisposition. Looking at the brains while the children were in a resting state the researchers saw less synchronized activation between the amygdala and the medial prefrontal cortex in the kids who had a genetic predisposition for depressive disorder than in the control group. The fact that these two brain regions are not activating together could be a potential biomarker, indicating a vulnerability for potential mental or mood disorders. In the second study — in which 62 subjects between ages 18 and 24 were given pictures of people crying and asked to think about a positive way to interpret the picture — the subjects who could not spin a positive narrative also showed less connectivity between the brain regions. “These deficits could represent a unique biological vulnerability that puts youth at risk for depression and suicide,” Uchida said. Uchida and her team are currently readying these two studies for publication. She says there is a lot more work to do, but she is hopeful the results might eventually lead to early-intervention screening. In a study published in December, researchers at the Douglas Institute Research Centre affiliated with McGill University identified the gene known as DCC as having a possible role during the maturation of the prefrontal cortex and in healthy brain connectivity. Higher function or expression of DCC appears to be associated with a greater risk of psychiatric disorders, depression, and suicide, according to Cecilia Flores, a professor of psychiatry at McGill and lead author of the study. “We are very excited to discover the function of this gene,” she said. Experiments in mice also showed that DCC gene function could be altered by both positive and negative experiences, and influences behaviors later in a rodent’s adult life. If the results translate to humans, Flores said, it offers hope that early therapy and support during the critical time in adolescent brain development could have long-term positive impact. Wilens says that one of the most useful early interventions for adolescents who might have depression, mood, or attention deficit disorders is cognitive behavioral therapy, a non-pharmaceutical approach that can help teach kids how thoughts and thought patterns influence behaviors. These are areas in which kids are lacking because of the imbalance of brain development, and could assist them in making better connections between what they are feeling and what they are thinking. “It helps put it all together and has a component that gets you to stop doing something that may harm you,” Wilens said. Feldman encourages parents and school systems to create protective “buffers” — a caring relationship with an adult, whether that is a parent, guardian, teacher, or someone in the community. UMass Medical is currently collaborating with the Department of Public Health and Department of Elementary and Secondary Education to train school personnel to develop comprehensive programs that include suicide intervention and prevention. And parents and students are urged to
take the warning signs of a troubled and potentially
suicidal teen seriously. “Don’t casually dismiss
signs as a cry for help,” Feldman says. Teens at risk
for suicide should be taken to a hospital emergency room or
somewhere where they can get immediate mental health
services. “Don’t make an appointment for a doctor
down the road.” Approach to
adolescent suicide prevention Sources of information A literature review was performed using Ovid MEDLINE with the key words suicide, attempted suicide, and evaluation studies or program evaluation, adolescent. Challenges for family physicians The following case presentation illustrates the complexity of dilemmas presented to family physicians who work with adolescents with mental health concerns. This review of adolescent suicide will equip physicians with an approach to help such patients. Case description Sarah, a 16-year-old patient you have not seen in several years, has booked an appointment to discuss starting birth control pills. Sarah’s mother was at the office last week for renewal of antidepressant medication and mentioned that Sarah has been very irritable at home and once yelled, “I might as well be dead!” You know that Sarah’s parent’s divorced last year. While taking Sarah’s blood pressure you notice that she has several scars from superficial cuts to her left wrist. How can you address these issues and determine her risks? Morbidity and mortality Canada witnesses more than 500 suicides per year among those 15 to 24 years old, with the next most common cause of death being cancer at 156 deaths per year.6 It has been estimated that for each completed suicide, there are approximately 400 attempts.7 Many high-school students contemplate suicide,3 and with the shortage of pediatric psychiatrists, much of the burden of identifying and treating high-risk youth is placed on family physicians. This article has been peer reviewed.
Cet article a fait l’objet d’une révision
par des pairs Can Fam Physician 2010;56:755-60 Facebook and
Twitter 'harm young people's mental health' Four of the five most popular forms of social media harm young people’s mental health, with Instagram the most damaging, according to research by two health organisations. Instagram has the most negative impact on young people’s mental wellbeing, a survey of almost 1,500 14- to 24-year-olds found, and the health groups accused it of deepening young people’s feelings of inadequacy and anxiety. The survey, published on Friday, concluded that Snapchat, Facebook and Twitter are also harmful. Among the five only YouTube was judged to have a positive impact. The four platforms have a negative effect because they can exacerbate children’s and young people’s body image worries, and worsen bullying, sleep problems and feelings of anxiety, depression and loneliness, the participants said. The findings follow growing concern among politicians, health bodies, doctors, charities and parents about young people suffering harm as a result of sexting, cyberbullying and social media reinforcing feelings of self-loathing and even the risk of them committing suicide. “It’s interesting to see Instagram and Snapchat ranking as the worst for mental health and wellbeing. Both platforms are very image-focused and it appears that they may be driving feelings of inadequacy and anxiety in young people,” said Shirley Cramer, chief executive of the Royal Society for Public Health, which undertook the survey with the Young Health Movement. She demanded tough measures “to make social media less of a wild west when it comes to young people’s mental health and wellbeing”. Social media firms should bring in a pop-up image to warn young people that they have been using it a lot, while Instagram and similar platforms should alert users when photographs of people have been digitally manipulated, Cramer said. The 1,479 young people surveyed were asked to rate the impact of the five forms of social media on 14 different criteria of health and wellbeing, including their effect on sleep, anxiety, depression, loneliness, self-identity, bullying, body image and the fear of missing out. Instagram emerged with the most negative score. It rated badly for seven of the 14 measures, particularly its impact on sleep, body image and fear of missing out – and also for bullying and feelings of anxiety, depression and loneliness. However, young people cited its upsides too, including self-expression, self-identity and emotional support. YouTube scored very badly for its impact on sleep but positively in nine of the 14 categories, notably awareness and understanding of other people’s health experience, self-expression, loneliness, depression and emotional support. However, the leader of the UK’s psychiatrists said the findings were too simplistic and unfairly blamed social media for the complex reasons why the mental health of so many young people is suffering. Prof Sir Simon Wessely, president of the Royal College of Psychiatrists, said: “I am sure that social media plays a role in unhappiness, but it has as many benefits as it does negatives.. We need to teach children how to cope with all aspects of social media – good and bad – to prepare them for an increasingly digitised world. There is real danger in blaming the medium for the message.” Young Minds, the charity which Theresa May visited last week on a campaign stop, backed the call for Instagram and other platforms to take further steps to protect young users. Tom Madders, its director of campaigns and communications, said: “Prompting young people about heavy usage and signposting to support they may need, on a platform that they identify with, could help many young people.” However, he also urged caution in how content accessed by young people on social media is perceived. “It’s also important to recognise that simply ‘protecting’ young people from particular content types can never be the whole solution. We need to support young people so they understand the risks of how they behave online, and are empowered to make sense of and know how to respond to harmful content that slips through filters.” Parents and mental health experts fear that platforms such as Instagram can make young users feel worried and inadequate by facilitating hostile comments about their appearance or reminding them that they have not been invited to, for example, a party many of their peers are attending. May, who has made children’s mental health one of her priorities, highlighted social media’s damaging effects in her “shared society” speech in January, saying: “We know that the use of social media brings additional concerns and challenges. In 2014, just over one in 10 young people said that they had experienced cyberbullying by phone or over the internet.” In February, Jeremy Hunt, the health
secretary, warned social media and technology firms that
they could face sanctions, including through legislation,
unless they did more to
tackle sexting, cyberbullying
and the trolling of young users. After Rash of Teen
Suicides in Palo Alto, the CDC Sends Team to Investigate Six young people in Palo Alto died by suicide in 2009 and 2010, and another four in 2014 and 2015. Several among them took their lives on the tracks of the Caltrain, the commuter train that runs through town and connects San Francisco and San Jose. Of high school students in Palo Alto surveyed during the 2013-2023 school year, 12 percent had seriously considered suicide in the last year. From the beginning of the following school year through March, 42 students at Henry M. Gunn High School in Palo Alto had been hospitalized or treated for “significant suicide ideation.” Overall, the suicide rate at Palo Alto’s two public high schools in the past decade is four times the national average. Following the two clusters of youth suicides in Palo Alto in recent years, the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration have sent a five-person team to conduct an epidemiological assessment, the San Jose Mercury News reports. The California Department of Public Health issued a formal request for help from the federal agency on behalf of Santa Clara County Public Health Department. “I really appreciate when we can have federal support and can leverage that expertise at a local level,” Mary Gloner, executive director of the Palo Alto–based Project Safety Net, told the Mercury News. The inquiry will be in the form of what’s called an “Epi-Aid,” or an investigation of an urgent public health problem. Over the past few months, the CDC has been working with Santa Clara County health officials to prepare for the visit, collecting data on fatal and non-fatal suicidal behavior among youth in the area between 2008 and 2015. The team was scheduled to arrive in the area Tuesday and is expected to conduct fieldwork in Palo Alto and the surrounding Santa Clara County through February 29, reviewing data and convening informal meetings with community groups to discuss suicide prevention strategies already in place and other potential programs. The main goals of the assessment, according to a fact sheet posted on Project Safety Net’s website, are to identify and track trends in suicidal behavior among youth between 2008 and 2015; examine whether media coverage met safe reporting guidelines for suicide; inventory youth suicide prevention policies, activities and protocols; compare those to national and other evidence-based recommendations; and, ultimately, use all of that information and insight to “make recommendations on youth suicide prevention strategies that can be used at the school, city, and county level.” Though “Epi-Aid” investigations are usually directed toward infectious disease outbreaks, the Santa Clara County assessment is not without precedent. In November 2014, the CDC sent a team to Fairfax, Virginia, to conduct a similar investigation of youth suicides, culminating in a 224-page report detailing its findings, provided to the Fairfax County Health Department in June 2015. According to the Mercury News, the “Epi-Aid” team that arrived in Palo Alto on Tuesday will release a preliminary report soon after it completes its field work and follow up with a more comprehensive report in several months. News of the assessment comes just a
few months after The Atlantic published a cover story by
Hanna Rosin titled “The Silicon Valley Suicides,”
which tried to understand why “so many kids with bright
prospects [are] killing themselves in Palo Alto. The
Warning Signs and Major Risk Factors of Teenage Suicide Although it is almost impossible to predict precisely which teenager will attempt suicide, there are warning signs that parents can look for. The American Academy of Child and Adolescent Psychiatry has assembled this list of indications. If one or more of these signs occur, parents should talk to their teenager and seek professional help.
In high-risk patients—that is
patients who have threatened or attempted suicide—there
are four risk factors that account for more than 80% of the
risk for suicide: major depression, bipolar disorder, a lack
of previous mental health treatment, and the availability of
firearms in the home. If these four problems were solved,
most suicides would be prevented.
Why keep a
semicolon business card in your wallet? www.TheCitizensWhoCare.org/semicolon.html Deaths by
Suicide and Self-inflicted Injury per 100,000 age 15-24,
1991-1993
Mortality
Risk following Adversity-Related Injury Adversity-related injuries were associated with three- to five-fold increases in the 10-year risk for suicide, homicide, and deaths related to drug and alcohol use compared to accident-related injuries. The highest risk of death from any cause was among boys treated for self-inflicted or alcohol- or drug-related injuries when they were 18 to 19 years old. Suicide risk increased for both boys and girls following a self-inflicted or drug- or-alcohol related injury, and increased for boys following a violent injury. The researchers concluded that, given the increased long-term mortality risk among adolescents hospitalized for adversity-related injury, prevention efforts should be expanded to include a psychosocial assessment for these youth prior to hospital discharge. Herbert, A., Gilbert, R., Cottrell,
D., & Li, L. (2017). Causes of death up to 10 years
after admissions to hospitals for self-inflicted,
drug-related or alcohol-related, or violent injury during
adolescence: A retrospective, nationwide, cohort study.
Lancet, 390(10094), 577–587
Exposure to
Suicide in the Community: Prevalence and Correlates in One
U.S. State Results. Forty-eight percent of weighted participants (n=816/1,687) reported lifetime exposure to suicide. Current depression and anxiety symptoms were higher in suicide-exposed than in suicide-unexposed individuals. Suicide-exposed individuals were twice as likely as suicide-unexposed individuals to have diagnosable depression and almost twice as likely to have diagnosable anxiety. Suicide-exposed individuals were more likely than suicide-unexposed individuals to report suicide ideation (9% vs. 5%). Closeness to the decedent increased the odds of depression and anxiety and almost quadrupled the odds of posttraumatic stress disorder. Conclusion. Exposure to suicide
is pervasive and occurs beyond family; as such, it is
imperative to identify those with perceived closeness to the
decedent. This hidden cohort of suicide-exposed people is at
elevated risk for psychopathology and suicidal ideation. The Role of the
School in Suicide Prevention Parental Notification and Participation Even if a youth is judged to be at low risk for suicidal behavior, schools may ask parents to sign a documentation form to indicate that relevant information has been provided. Parental notifications must be documented. Additionally, parents are crucial members of a suicide risk assessment as they often have information critical to making an appropriate assessment of risk, including mental health history, family dynamics, recent traumatic events, and previous suicidal behaviors. After a school notifies a parent of their child's risk for suicide and provides referral information, the responsibility falls upon the parent to seek mental health assistance for their child. Parents must: Continue to take threats seriously: Follow through is important even after the child calms down or informs the parent "they didn't mean it." Avoid assuming behavior is simply attention seeking (but at the same time avoid reinforcing suicide threats; e.g., by allowing the student who has threatened suicide to drive because they were denied access to the car). Access school supports: If parents are uncomfortable with following through on referrals, they can give the school psychologist permission to contact the referral agency, provide referral information, and follow up on the visit. Maintain communication with the school: After such an intervention, the school will also provide follow-up supports. Your communication will be crucial to ensuring that the school is the safest, most comfortable place for your child. Resiliency Factors The presence of resiliency factors can lessen the potential of risk factors to lead to suicidal ideation and behaviors. Once a child or adolescent is considered at risk, schools, families, and friends should work to build these factors in and around the youth. These include:
© 2015, National Association of
School Psychologists, 4340 East West Highway, Suite 402,
Bethesda, MD 20814; (301) 657-0270, Fax (301) 657-0275;
www.nasponline.org Student
Suicide Prevention Shows Results Many Teens at Risk
for Suicide Don't Get Help Black Male
Teen-ager Suicide Rates Increase Who Young People
Turn to for Help 
Have you seen anyone with a
semicolon tattoo? Here's what it's about. Have you seen anyone with a tattoo of a semi-colon? If not, you may not be looking close enough. They're popping up...everywhere. That's right: the semicolon. It's a tattoo that has gained popularity in recent years, but unlike other random or mystifying trends, this one has a serious meaning behind it. (And no, it's not just the mark of a really committed grammar nerd.) This mark represents mental health struggles and the importance of suicide prevention. Project
Semicolon
They describe themselves as a "movement dedicated to presenting hope and love to those who are struggling with depression, suicide, addiction, and self-injury. Project Semicolon exists to encourage, love, and inspire." But why a semicolon? "A semicolon is used when an author could've chosen to end their sentence, but chose not to. The author is you and the sentence is your life." Originally created as a day where people were encouraged to draw a semicolon on their bodies and photograph it, it quickly grew into something greater and more permanent. Today, people all over the world are tattooing the mark as a reminder of their struggle, victory, and survival. I spoke with Jenn Brown and Jeremy Jaramillo of The Semicolon Tattoo Project, an organization inspired by the semicolon movement. Along with some friends, Jenn and Jeremy saw an opportunity to both help the community and reduce the stigma around mental illness. In
2012, over 43 million Americans dealt with a mental
illness More conversations that lead to less stigma? Yes please. "[The tattoo] is a conversation starter," explains Jenn. "People ask what it is and we get to tell them the purpose." "I think if you see someone's tattoo that you're interested in, that's fair game to start a conversation with someone you don't know," adds Jeremy. "It provides a great opportunity to talk. Tattoos are interesting — marks we put on our bodies that are important to us." Last year, The Semicolon Tattoo Project held an event at several tattoo shops where people could get a semicolon tattoo for a flat rate. "That money was a fundraiser for our crisis center," said Jenn. In total, over 400 people received semicolon tattoos in one day. Even better, what began as a local event has spread far and wide, and people all over the world are getting semicolon tattoos. And it's not just about the conversation — it's about providing tangible support and help too. Jenn and Jeremy work with the
Agora
Crisis Center. So next time you see this small punctuation tattoo, remember the words of Upworthy writer Parker Molloy: "I recently decided to get a semicolon tattoo. Not because it's trendy (though, it certainly seems to be at the moment), but because it's a reminder of the things I've overcome in my life. I've dealt with anxiety, depression, and gender dysphoria for the better part of my life, and at times, that led me down a path that included self-harm and suicide attempts. No matter how we get there, the end
result is so important: help and support for more people to
also be able to say " I'm still here." Teen Suicide
and Suicide Prevention In fact, in 2014, at least 2,145 teenagers died from suicide, making it the second leading cause of death for teens -- just after unintentional injuries. Surprisingly, cancer and heart disease came in at a more distant number four and five, with about 800 and 350 deaths each. Even for preteens, children aged 9 to 12 years old, suicide is a leading cause of death, ranking as the fourth leading cause of death in 2014 with 117 suicide deaths. Teen Suicide Statistics Unfortunately, statistics show that suicide rates in teenagers are on the rise. After a trend of decreasing suicide rates from 1996 to 2007, teen suicide rates have been slowing increasing again. Why? Experts aren't sure yet, but theories include:
Another leading theory is that the rise in teen suicides may be because fewer teens are being treated with antidepressants when they have depression. This follows the 2003 FDA warning about antidepressants and suicide. However, since untreated depression is itself a risk factor for suicide, fewer teens taking antidepressants could have the unintended effect of leading to more suicides. Worldwide, about 90,000 teens commit suicide each year, with about four million suicide attempts. That means that one teenager dies from suicide about every five minutes. Suicide Risk Factors in Teens In addition to untreated depression, other suicide risk factors include:
Suicide is also more common in bisexual and homosexual teens. Suicide Warning Signs According to the American Association of Suicidology, the warning signs of suicide can include:
If you think that your teen has any of the warning signs for suicide, don't ignore them. Trust your instincts and either try to get more information or seek additional help. Preventing Teen Suicide In addition to all of the teens who successfully commit suicide, there are many more who attempt suicide. Experts estimate that 20 to 25% of teens admit to thinking about suicide at some time in their lives and for every suicide, there are between 5 to 45 suicide attempts. That makes it even more important for parents, pediatricians, and everyone else that is regularly around teenagers to understand how to try and prevent suicides, such as:
You should also make sure that teens
know that they can ask for help if they ever think about
hurting themselves, including calling the National Suicide
Prevention Lifeline - 1-800-273-TALK (8255), Crisis Text
Line 741741, calling their doctor, calling 911, or going to
a local crisis center or the emergency room. National Center for Health Statistics. 10 Leading Causes of Death, United States. 2005, All Races, Both Sexes. Suicide in children and adolescents. Greydanus DE - Prim Care - 01-JUN-2007; 34(2): 259-73. Sullivan et al. Suicide Trends Among Persons Aged 10–24 Years — United States, 1994–2012. MMWR. March 6, 2015 / 64(08);201-205. Source: www.verywell.com/teen-cutting-and-self-harm-behaviors-2633862
Want
to talk? Text Message (Crisis TCall - 741741
and type SOS Study Shows
900,000 Teens Planned Suicides While Depressed Technology and
Suicide Risk: Moving Beyond Fear to Opportunity I’ve seen the unease around youth cyber safety in my own social media feeds and online news platforms, but let’s pause to consider what the research tells us. The fact is, the science is inconclusive on the impact of social media use on mental health and suicide risk. Some research points to potential harm from certain kinds of online interactions for some youth.1,2,3 But other studies show potentially positive benefits, including providing a safe space to seek support for suicide-related feelings.2,3,4 While cyberbullying is a related, rising concern, in-person bullying remains much more common.5 Moreover, just as positive school climate initiatives have taught students to step in or go to an adult when they see bullying in person, young people can learn to be good “digital citizens” by standing up against inappropriate online behaviors and taking measures to protect their privacy. ConnectSafely has helpful resources to help parents and educators teach kids about technology safety, privacy, and security. Social media and technology can offer ways to connect authentically with others, especially for young people. Virtual connections can be a lifeline for someone who is feeling isolated in their physical community, allowing individuals to find people online who share similar experiences and can offer empathy and support. Social media is also a great way to reach a lot of people very quickly, and can serve as a powerful vehicle for spreading messages of hope, support, and recovery. It allows parents and other concerned adults to witness conversations we may not otherwise have known about, and to intervene with resources or other supports when we see someone in crisis. Social media platforms themselves have also been thinking about how to leverage technological tools to help those in crisis. For instance, Facebook has been working with suicide prevention experts for several years to help make crisis services and other resources available to users. While the research is still playing out on the pros and cons of new technology, there are things we can do today to promote potential benefits and minimize possible risks. In our suicide prevention programs and our personal lives, we can encourage kids to connect in healthy ways, and make sure they know how to reach out for support when they’re concerned about someone’s online posts. We can offer alternative options to screen time that encourage face-to-face connections and physical activity. If young people are having conversations online that concern us, we can take the opportunity to talk with them about how they are feeling, offer support, and help them reach out to peers who may be struggling. SPRC offers resources that can help, including an information sheet for teens that lists call, text, chat, and email options for finding support, as well as guidance for using technology and social media for prevention efforts. I hope we won’t let our concerns about potential risks overshadow the opportunities social media and smart devices offer to stay connected, reach out, and support each other. Since technology and social media are here to stay, let’s use them for good, building on the positive opportunities to increase social support and connectedness, while at the same time finding opportunities for in-person connections in our families, communities, and prevention initiatives. References 1 Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2017). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3–17. 2 Marchant, A., Hawton, K., Stewart, A., Montgomery, P., Singaravelu, V., Lloyd, K., . . . John, A. (2017). A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. PLoS ONE, 12(8). Retrieved from https://doi.org/10.1371/journal.pone.0181722 3 Berryman, C., Ferguson, C. J., & Negy, C. (2017). Social media use and mental health among young adults. Psychiatric Quarterly. Retrieved from https://doi.org/10.1007/s11126-017-9535-6 4 Oh, H. J., Ozkaya, E., & Larose, R. (2014). How does online social networking enhance life satisfaction? The relationships among online supportive interaction, affect, perceived social support, sense of community, and life satisfaction. Computers in Human Behavior, 30, 69–78. 5 National Center for Education Statistics and Bureau of Justice Statistics. (2011). Student reports of bullying and cyber-bullying: Results from the 2011 school crime supplement to the National Crime Victimization Survey. Retrieved from https://nces.ed.gov/pubs2013/2013329.pdf Can a Community
Program Reduce Suicidal Ideation and Behavior in Latina
Adolescents? Suicidal ideation and suicide attempts occur at higher rates in adolescent Latinas than among girls from other ethnic groups. For example, in New York City, information gathered by the Center for Disease Control (CDC, 2015) reported the rate of suicide attempts among Latina in grades 9-12 was 13 percent, compared to the 10 percent for non-Hispanic black girls, and 8 percent for whites (CDC, 2015). Nationwide, more than one in four Latinas in grades 9-12 report they have seriously considered attempting suicide in the prior 12 months. (CDC 2016). Aside from self-development and the need for increased autonomy during maturation, risk factors urban teen girls may face include poverty, high crime rates, low quality housing and schools, lack of connection with parents and peers, substance use and teen pregnancy. An additional culturally specific risk factor Latina adolescents may face is a term known as familism- the psychological conflict and tension occurring between the expected obligation to family, respect for parents, unity, and ties to cultural traditions versus individual obligations and autonomy. This tension adds a myriad of challenges, especially if the adolescent adapts more quickly to the U.S. than their parent(s). This can lead to ambitions that differ from those of their parent(s) and feelings of disconnectedness and powerlessness in relation to family. Little is known about culturally relevant interventions for Latinas. Unique contributors to suicide that need to be addressed for Latinas include the stress of living between two cultures, tension within the family, low academic support, and challenges in their neighborhood or home. Life is Precious (LIP) is a community-based after-school program specifically designed for Latina teens to facilitate positive development. LIP is modeled to promote family relationships, academic support, creative expression, and wellness. Supporting youth in these areas is needed to decrease suicidal ideation and prevent suicidal behavior. Services and opportunities provided include school support organized through homework space and computer labs; creative expression through dance, music, and art therapy with licensed therapists; and health initiatives in the form of healthy meal preparation, exercise, and planning. Counselors and social workers are present, providing support to the participants, which may involve family therapy facilitation and education services to help students stay in school Question Can a community-based social program reduce suicidal ideation and behavior in Latina adolescents? Study Over a one year period, 107 Latina adolescents aged 11-18 participated in the Life Is Precious (LIP) after-school program on weekdays and Saturday mornings in one of three locations within New York City (Brooklyn, Bronx, and Queens). Participants in this program come from a variety of referral sources such as outpatient mental health clinics, schools, hospitals, or self-referrals from the teens and their families. At program intake, demographic data and assessments of suicidal ideation, depression, mood symptoms, and family functioning were administered. Assessments captured anger, post-traumatic stress, dissociation, and sexual concerns as well. Every four months the participants were assessed on these factors. Some individuals completed up to six assessments. Results Over the course of Dr. Humensky’s study, none of the girls enrolled attempted or died by suicide. Before participating in the Life is Precious program, 17 percent reported having attempted suicide. In the general population, based on the CDC data, it is estimated that more than 14 of the 107 participants would have attempted suicide. Thus, this community-based program showed positive results with significant reductions in suicidal ideation, depressive symptoms, anger, and post-traumatic stress symptoms during participation. The greatest reduction in suicidal ideation was for Latinas who had initially reported a history of sexual abuse, and tobacco or alcohol use. Participants stated that the sense of community the program provided was more meaningful than the actual activities offered. Building connections with other girls and program staff fostered healthy communication between adolescents and their families. The mothers reported a sense of appreciation and value from LIP, and a bridging of communication with their daughters. Takeaway A community program which fosters
social and academic development, family communication, and a
sense of community can reduce suicidal ideation and attempts
in Latina adolescents. Signs of Suicide Youth Suicide Statistics [1]
Signs & Concerns [2] Signs of a suicide concern may mimic “typical teenage behaviors, so how can you know if it’s normal behavior or something more? If the signs are persisting over a period of time, several of the signs appear at the same time, and the behavior is “out of character” for the young person as you know him/her, then close attention is warranted. Take all suicide threats seriously: People who talk about suicide, threaten suicide or call suicide crisis lines are 30 times more likely than average to kill themselves. Need help now? Call 1-800-273-TALK (8255) Suicide Prevention Lifeline or text SOS to 71741 and you’ll be connected to a skilled, trained counselor at a crisis center in your area, anytime 24/7. Additional Resources:
Source: safe2tell.org/?q=parent-resource-center-suicide-and-youth
Bullying Prevention: Recommendations for Parents Is Your Child Being Bullied? Warning Signs:
General Characteristics of Possible Victims There are two types of victims: (1) the passive or submissive victim, and (2) the provocative victim. Passive/submissive victims signal to others through attitudes and behaviors that they are insecure individuals who will not retaliate if victimized. The provocative victim is a much smaller group of victims. They are characterized by having both anxious and aggressive patterns. Provocative victims are generally boys. Passive/Submissive Victim Characteristics:
Provocative Victim Characteristics:
What Can Parents of the Victim Do?
Is Your Child a Bully? Children who bully increase their risk for engaging in other forms of antisocial behavior, such as juvenile delinquency, criminality and substance abuse. Bullying behavior should be taken seriously. Doing nothing implies that bullying is acceptable behavior. Typical bullying behavior includes:
General Characteristics of Possible Bullies
What Can Parents of the Bully Do?
False Beliefs About Bullying The following common statements from adults and peers can perpetuate the bully/victim problem:
References: Lyznicki, James; McCaffree, Mary Anne and Carolyn Robinowitz. 2004. “Childhood Bullying: Implications for Physicians.” American Family Physician. 70(1). Olweus, D. (1993). Bullying at School: What We Know and What We Can Do. Cambridge, MA: Blackwell Publishers, Inc. Olweus, D., Limber, S. and Mihalic, S.F. (1999, 2002). Bullying Prevention Program: Blueprints for Violence Prevention, Book Nine. Blueprints for Violence Prevention Series (D.S. Elliott, Series Editor). Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado. Shore, K. (2001). Keeping Kids Safe: A
Guide for Parents of Toddlers and Teens–and All the
Years in Between. Paramus, NJ: Prentice Hall Press. Child Abuse:
Resources for Parents Colorado has one toll-free phone number to report child abuse and neglect 24/7, 365 days a year. Please call the Colorado Child Abuse and Neglect Hotline at 1-844-CO-4-KIDS (1-844-264-5437) to report concerns about a child’s safety and well-being. All calls are confidential and will be routed to the county where a child resides. If it is an emergency or you are witnessing a child in a life-threatening situation, call 911 immediately. You may also contact the county in which the activity is taking place. If you do not know what county you need please call the Colorado Department of Human Services at 1-844-264-5437. If you have concerns about someone you know being abused and wish to report anonymously, please make a Safe2Tell report by calling 1-877-542-7233 Additional resources to learn more about the child abuse and neglect: What is Child Abuse and Neglect? Recognizing the Signs and Symptoms Fact Sheet by the Child Welfare Information Gateway (8 page PDF) Are you a Mandatory Reporter? Information and online training on Mandatory Reporting in Colorado Colorado Child Abuse and Neglect Hotline: 1-844-CO-4-KIDS 1 Source: US National Library of
Medicine. http://www.nlm.nih.gov/medlineplus/childabuse.html Marijuana and
Youth: Facts for Parents Parents play an influencing role in a teen’s decision to use marijuana and other substances. Talking openly with your children and staying actively engaged in their lives will help prevent underage marijuana use. Help your child/youth sort out fact from myth will help them make the soundest decision on whether or not they use marijuana. The following are tips on for how to discuss marijuana with your child: [2]
If you suspect your child may be using marijuana, some common signs of marijuana use are:
A common misperception among teenagers is that marijuana is safer to use than alcohol or other drugs. When discussing marijuana with your child/teen, knowing the consequences of underage marijuana use is a helpful prevention tool. Additional Resources: Click here to download a Fact Guide for Families on Marijuana and Teens For videos, talking points and more information about Marijuana and the Teen Brain visit NIDA for Teens, the Science behind Drug Abuse Resources: 1 US Department of Health and Human Services NIH Publication 13-40362 2 American Academy of Child and Adolescent Psychiatry, www.aacap.org/Error.aspx?aspxerrorpath=/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Marijuana_and_Teens_106.aspx (broken) 3 Infographics by Good to Know
Colorado, goodtoknowcolorado.com Trauma and
Youth Traumatic events are situations that may be sudden or unexpected, involve a shocking nature of events, and produce feelings of horror, terror, or helplessness.[1] Some examples of traumatic events may include:
Research has shown that adolescents who encounter a traumatic event may experience social, emotional and even academic consequences as a result of the traumatic event. Adolescents experiencing a traumatic may be more prone to engage in risky behaviors, less likely to make realistic evaluations of danger and safety, and may experience symptoms of Post-Traumatic Stress Disorder (PTSD). [3] Children and youth may demonstrate one or many of the following post traumatic responses:
Safe2Tell Colorado Can Help The goal of Safe2Tell Colorado is to intervene at the earliest possible point in the life a young person who is struggling, helping them when they need it before the situation turns into a tragedy. Safe2Tell Colorado serves as the statewide bystander reporting tool for concerns in Colorado. The Safe2Tell solution was developed specifically to encourage those with information about a possible event or dangerous situation to report it in a way that keeps the reporter safe from retaliation or fear. If you witness a child or youth who has experienced a traumatic event and is engaging in risky or harmful behavior, you can make an anonymous Safe2Tell Colorado report alerting a team of caring committed adults of the situation. Safe2Tell Colorado reports create interventions for youth and children who are struggling and provides the accountability and follow-up required to ensure action is taken on every concerned received. To make a safe, anonymous report to Safe2Tell Colorado: Call 1-877-542-7233 Additional Resources: If YOU are struggling and need someone to talk to, you can call the statewide Colorado Crisis and Support Line at 844-493-TALK (8255). Additional information on how to assist youth struggling after a traumatic event, action plans and area specific resources and information:
Publications:
1 Cohen, Mannarino, and Deblinger, Treating Trauma and Traumatic Grief in Children and Adolescents, The Guilford Press, 2006, p.3, 2 National Child Traumatic Stress Network: Understanding Traumatic Street in Adolescents: A Primer for Substance Abuse Professionals, June 2008, p. 1 3 National Child Traumatic Stress
Network: Understanding Traumatic Street in Adolescents: A
Primer for Substance Abuse Professionals, June 2008, p.
4 
0:44Parents can influence their tween and teen’s decision making about alcohol use by having continual, deliberate conversations about the dangers and risk of underage drinking. In fact, discussing the dangers of underage drinking with parents has increased 62% since 2003 (asklistenlearn.org) and the results is that underage drinking is at an all-time low. Most parents think it is extremely important to have early conversations about alcohol as a way to combat peer pressure & delay potential experimenting (Source: Ipsos, November 2012). Parents can start the discussion about alcohol with their children and continue the conversation throughout middle school, high school and college. Get tips to start the conversation
about alcohol with your tweens and teens and ways to help
them say no at http://asklistenlearn.org/parents/ Reporting
Concerns All information reported through calls, web report, or mobile app are sent to school teams and law enforcement, as necessary, for investigation and follow-up. What Safe2Tell Colorado Can/Cannot Do For You:
What You Can Do to Advocate For Your Child:
Source: https://safe2tell.org/?q=reporting-concerns
Resources for
Parents Bullying Safe Communities Safe Schools Information for Parents on Bullying Stop Bullying Now Information for Parents (US Department of Human Services) Mental Health Colorado Crisis Services provides confidential and immediate support, 24/7/365. If you are in crisis or need help dealing with one, call this toll-free number 1-844-493-TALK (8255) to speak to a trained professional. Visit http://coloradocrisisservices.org/ for additional information. Mental Health First Aid Colorado Suicide Second Wind Fund - The Second Wind Fund will match children and youth at risk for suicide with licensed therapists in their communities. If a financial or social barrier to treatment is present, the Second Wind Fund will pay for up to 12 sessions of therapy from one of their specialized network providers. Suicide Prevention Resource Center Colorado Office of Suicide Prevention SAMSHA Suicide Prevention and Post-Suicide Coping Resources Trauma and Children/Youth Helpful Information for Parents and Students following a Traumatic Event U.S. Department of Education Tips for Helping Students Recovering from Traumatic Events Colorado School Safety Resource Center List of Trauma Resources The National Child Traumatic Stress Network National Institute of Mental Health Domestic Violence Colorado Coalition Against Domestic Violence? Child Abuse and Neglect The state of Colorado has developed a state-wide hotline (1-844-CO-4-KIDS) for reporting suspected cases of abuse and neglect. All calls are confidential and will be routed to the county where a child resides. For more information, visit co4kids.org. National Clearinghouse on Child Abuse and Neglect Information Nation Coalition Against Domestic Violence Parenting Resources Parent Toolkit - The Parent Toolkit provides parents videos, resources and tips to support their child's academic, health & wellness and social & emotional development. Advocacy & Resources for Children with Disabilities The Council of Parent Attorneys and Advocates, Inc. (COPAA) Center
for Parent Information and Resources Killing themselves Behavior Increased alcohol or drug ue Mood Depression If you know someone needing help or
exhibiting these of other warning signs, make a report o
Safe2Tell at 877-542-7233 of Safe2Tell.org
What to expect
when you call/chat/text a crisis line What happens?
The crisis line will not share your information unless there are signs of abuse, neglect, or they are worried about harm to yourself or others. Please go to the organization’s website to learn more about their privacy policies. FULL
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