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.

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
Are highly sexually active.

Pay particular attention if they experience:

1. Loss of a loved one
2. Divorce or separation of their parents
3. Any major transition – new home, new school.
4.Traumatic life experiences, like living through a natural disaster
5.Teasing or bullying
6. Difficulties in school or with classmates

However, you never know

Young people don’t always know how to get through stressful times. Adults tend to end their lives because of major life stressors, but for an adolescent, the breaking point is often less significant.

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.

You may be afraid to ask your child if they are having suicidal thoughts, assuming that you will put the idea in their head. Don’t worry. Either they are already having suicidal thoughts, in which case it may be a big relief to talk about it. If they haven’t, talking about it openly will allow them to bring the subject up again if this changes. And please note that even children younger than 12 do commit suicide.


Teen Suicide

Youth suicides are on the increase in the US. 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. Suicide is increasing, particularly for those under 14.

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 ; www.nosuicide.com:80/stats.htm ; www/nimh.nih.gov/ ;www.nosoidice.com

The most common signs of a suicidal person

1. Difficulties with relationships between friends, family, and others
2. Feelings of isolation, or feeling unloved by others
3. Feeling like you can’t solve the problems you face
4. Impulsive and/or aggressive behavior when faced with a problem
5. Alcohol and/or drug abuse
6. Severe depression and persistent pessimism
7. Suicidal thoughts

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

Lucrecia Sjoerdsma knew what to watch for: the lingering moodiness, the sudden disinterest in what once brought joy. But her daughter, Riley Winters, a ninth-grader at Discovery Canyon Campus High School in Colorado Springs, Colorado, was always smiling—the 15-year-old used whitening strips because she loved showing off her perfect teeth. “Her smile really matched her personality,” Sjoerdsma says. A petite girl with brown hair that went just past her shoulders, Riley seemed to be a happy, goofy kid and a kind young woman who could sense when others were down and find a way to cheer them up. Riley liked hiking and rock climbing. She spoke of joining the military or becoming an archaeologist, a physical therapist or a dental hygienist. She had plenty of time to decide.

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.


Is a brief MI intervention helpful to adolescents hospitalized for suicidal behavior who also use alcohol?


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.


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.


  • For adolescents, alcohol use can be a significant risk factor for suicide
  • Both interventions – Alcohol and Suicide Intervention for Suicidal Teens (ASIST) and an enhanced Treatment as Usual (TAU) helped adolescents who made a suicide attempt and led to reduced suicidal ideation and alcohol use
  • Interventions that address both alcohol use and suicidal behavior may be helpful to adolescents
  • The brief motivational interviewing intervention Alcohol and Suicide Intervention for Suicidal Teens (ASIST) can be used by clinicians in hospital settings

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.

Back to School Suicides

Back to school suicides. No, it’s not the name of the latest band. Worryingly, it is a heavily underreported, and barely understood or investigated, yet wholeheartedly devastating new age phenomenon. Having more than tripled since the 1950s, a recent study may indicate that the rise in youth suicide is strongly linked with attending school, lending a macabre tone to the seemingly innocent phrase “back to school blues”.

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?


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

So, we all know that suicide attempts, suicidal thinking and even the tragedy of dying by suicide increase around the winter holidays.

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.


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?

Psychiatrists have been scratching their chins over this one for years. Counterintuitively, the arrival of spring and the long sunny days it ushers in, mark a staggering rise in suicide rates.

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

Suicide is a preventable public health issue and experts know a lot about what works to stop it. But preventing teens from taking their own lives requires action by myriad actors, from legislators to general practitioners and others.

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

When a boy loses his father to suicide at an early age, he may go through that type of devastating loss and the ripple effects can be crippling not to mention what it does to a young boy who looks up to his father as a role model.

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)

NEW YORK (JANUARY 2, 2018) – On December 21, 2017, the CDC released the most recent data related to suicide for the year 2016. According to these data, suicide is still the tenth leading cause of death and the rate of suicide in 2016 increased by 1.8 percent. In 2015, the last year the CDC released mortality data, there were 44,193 suicide deaths; in 2016 there were 44,965, an increase of 772 additional deaths. Dr. Christine Moutier , the Chief Medical Officer of the American Foundation for Suicide Prevention , the nation’s largest suicide prevention organization released this statement about the new data:

“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

  • Men die by suicide 3.57 more times than women
  • White males account for seven out of ten suicides
  • Among people in middle age (45-54) the rate of suicide slightly decreased
  • In the second highest risk age category of those 85 years old and older, there was a small decrease in the suicide rate
  • All other age groups increased slightly (except 45-54 and 85 and older)
  • Related to race, Caucasian people have the highest rate of suicide
  • The suicide rate among Caucasian people decreased slightly
  • There was an increase in the suicide rate among Alaska Native and American Indian people
  • More than half of suicide deaths were by firearms, 51 percent (from just under 50 percent last year)
  • For young people between the ages of 15-24, the suicide rate went from of 5.3 suicide deaths per 100,000 to 5.4 suicide deaths per 100,000

To view these most recent CDC data on suicide: afsp.org/about-suicide/suicide-statistics/ . For safe reporting: afsp.org/about-suicide/for-journalists/

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 rate for girls has doubled since 2007, according to the CDC

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?"

If you've ever asked yourself this, you're not alone. TeensHealth gives the answers to questions that teens like you ask us all the time. Check to see if we've answered one of yours in Q & A.

"So You Wanna Kill Yourself?  Gays and Suicide."

Gay men are six times more likely to attempt suicide than their straight counterparts and the numbers increase exponentially during the holidays. This story appears in the Dec/Jan 99 issue of Genre and examines the issues behind why they are taking their own lives, and offers some solutions to the holiday blues. (Also see our own # 7 Happy Holidaze A report from P-FLAG (Parents and Friends of Lesbians and Gays) states that in a study of 5,000 gay men and women, 35 percent of gay men and 38 percent of lesbians have considered or attempted suicide. The statistics are even higher among gay teens: The Department of Health study indicates that gay youth are up to six times more likely to attempt suicide than straight teens, and gay teenagers account for up to 30 percent of all teenage suicides in the nation.

"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.
Source:  HealthScout,

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 available locally. Dial 411 for your city's Suicide Prevention Hotline, or try your local Gay & Lesbian Center, which offers referrals for counseling, domestic violence and suicide prevention. Crisis Text Line is available 24/7 by texting "SOS" to 741741

Time-Space Clustering of Teenage Suicide

The occurrence of time-space clusters was examined in national mortality data on suicide among adolescents aged 15–19 years obtained from the National Center for Health Statistics Mortality Detail Files for 1978–1984. The analyses indicated that overall significant time-space clustering occurred among 15–19 year olds. The authors thus believe that they have documented for the first time that outbreaks of suicide occur more frequently than expected by chance alone. The occurrence of suicide dusters among teenagers appeared to vary considerably by state and year of investigation. There is some indication that there has been an increase In teenage clusters in more recent years.

Teens’ brains make them more vulnerable to 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 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

Teen suicide has increased 4-fold in the past 40 years1 and is now the second leading cause of death in this age group.2 The number 1 risk factor for youth suicide is the presence of mental illness.3,4 Because youth do not usually present to their family physicians with psychological symptoms as the chief complaint,5 physicians need to be on alert for symptoms and risk factors that suggest the development of psychiatric illness and suicide risk. This article will review such risk factors and provide information and resources to assist family physicians in assessing and managing youth at risk of suicide and mental illness.

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'

Poll of 14- to 24-year-olds shows Instagram, Facebook, Snapchat and Twitter increased feelings of inadequacy and anxiety

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

Take a walk around Palo Alto, California, on a sunny afternoon, and it can seem like a place where nothing ever goes wrong. The sky is a vibrant blue, flowering bushes spill over from well-tended lawns and the temperature is just right. But all is not well in this Silicon Valley town.

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

Each year, thousands of American teenagers are diagnosed with clinical depression. If ignored or poorly treated, it can be a devastating illness for adolescents and their families. A new book, Understanding Teenage Depression, provides the latest scientific research on this serious condition and the most up-to-date information on its treatment. Drawing on her many years of experience as a psychiatrist working with teenagers, Dr. Maureen Empfield answers the questions parents and teens have about depression. Maureen Empfield, M.D., is director of psychiatry at Northern Westchester Hospital Center in Mt. Kisco, New York, and assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons. She is the author or coauthor of more than a dozen publications for the professional market. Nicholas Bakalar is a New York-based writer and editor.

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.

  • Unusual changes in eating and sleeping habits
  • Withdrawal from friends, family, and regular activities
  • Violent actions, rebellious behavior, or running away
  • Excessive drug and alcohol abuse
  • Unusual neglect of personal appearance
  • Marked personality change
  • Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • Loss of interest in pleasurable activities
  • Not tolerating praise or rewards
  • Complaints of feeling “rotten inside”
  • Giving verbal hints such as “Nothing matters,” “It’s no use,” or “I won’t be a problem for you much longer”
  • Putting his or her affairs in order by giving or throwing away favorite possessions or belongings
  • Becoming suddenly cheerful after an episode of depression

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.
Source: Maureen Empfield, M.D. and Nicholas Bakalar


  • Persons under 25 account for 15% of all suicides.
  • Between 1952 and 1995, the incidence of suicide among adolescents and young adults nearly tripled.
  • Many who make suicide attempts never seek professional care immediately after the attempt.
  • Suicide was the eighth leading cause of death of all Americans, the third leading cause of death for 15-24 year olds, behind unintentional injury and homicide.
  • More men than women die by suicide. The gender ratio is 4:1.
  • 73% of all suicide deaths are white males.
    80% of all firearm suicide deaths are white males.
  • Nearly 3 of every 5 suicides were committed with a firearm. Among persons 15-19, firearm-related suicides accounted for 62% of the increase in the overall rate of suicide.
  • The risk for suicide among young people is greatest among young white males although the suicide rates increased most rapidly among young black males.
  • Although suicide among young children is a rare event, the dramatic increase in the rate among persons aged 10-14 underscores the urgent need for intensifying efforts to prevent suicide among persons in this age group..
  • More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza, and chronic lung disease, combined.

Why keep a semicolon business card in your wallet?

Two sided business card


Suicide is preventable. It is not chosen and it is momentary. It happens when pain exceeds the resources for coping with pain. You're not a bad person, or crazy, or weak, or flawed, if you feel suicidal. It doesn't even mean that you really want to die. If you have ever seriously considered suicide but didn't end your life with a period, use a semicolon to make a statement like "; I'm still here." or "; my story isn't over." Talking or calling a crisis line isn't a sign of weakness. It shows real strength to ask for help. And it shows real strength to be an ally. Help reduce the stigma around depression and suicidal ideation. Learn the early warning signs and wear a semicolon button signifying you've been there and are willing to listen to someone in crisis. And if you're in crisis now, call the National Hopeline 24/7 at 800-273-TALK (8255)


Note: The semicolon above fills one side of the actual business card

Deaths by Suicide and Self-inflicted Injury per 100,000 age 15-24, 1991-1993

Note that religious and social strictures against suicide may result in some underreporting in some nations. i.e., China is believed to represent over 46% of the suicides in the world. And, no information is currently available on Denmark and France.

Ranked by

Ranked by

Ranked by


Ratio M/F
Highest Ratio M/F











Czech Rep


























New Zealand








Russian Fed















Source: WHO, World Health Statistics Annual 1993 and 1994, 1994 and 1995, Center for Disease Control, National Center for Injury Prevention and Control; National Institute for Mental Health.


Mortality Risk following Adversity-Related Injury

A study in England assessed mortality risk among adolescents following an accident- or adversity-related injury (i.e., self-inflicted, drug- or alcohol-related, or violent injury). Researchers examined data from adolescents ages 10 to 19 who were admitted to the hospital for accident- or adversity-related injury and compared their risk of death in the decade after discharge. They discovered that adolescents with an adversity-related injury had a higher risk of suicide and drug- or alcohol-related death compared to those with an accident-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
www.sprc.org/news/mortality-risk-following-adversity-related-injury?utm_source=Weekly Spark 11/17/17&utm_campaign=Weekly Spark November 17, 2017&utm_medium=email


Exposure to Suicide in the Community: Prevalence and Correlates in One U.S. State

Suicide has been identified as a major public health issue. Exposure to suicide (i.e., knowing someone who died by suicide) is far more pervasive than previously considered and might be associated with significant adverse outcomes. As suicide becomes more commonly discussed in the public arena, a compelling need exists to determine who is exposed to suicide and how this exposure affects those left behind. This study estimated the proportion of the population exposed to suicide and delineated factors that predict significant psychiatric and psychosocial morbidity following that exposure.

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

Children and adolescents spend a substantial part of their day in school under the supervision of school personnel. Effective suicide and violence prevention is integrated with supportive mental health services, engages the entire school community, and is imbedded in a positive school climate through student behavioral expectations and a caring and trusting student/adult relationship. Therefore, it is crucial for all school staff members to be familiar with, and watchful for, risk factors and warning signs of suicidal behavior. The entire school staff should work to create an environment where students feel safe sharing such information. School psychologists and other crisis response team personnel, including the school counselor and school administrator, are trained to intervene when a student is identified at risk for suicide. These individuals conduct suicide risk assessment, warn/inform parents, provide recommendations and referrals to community services, and often provide follow up counseling and support at school.

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:

  • Family support and cohesion, including good communication.
  • Peer support and close social networks.
  • School and community connectedness.
  • Cultural or religious beliefs that discourage suicide and promote healthy living.
  • Adaptive coping and problem-solving skills, including conflict-resolution.
  • General life satisfaction, good self-esteem, sense of purpose.
  • Easy access to effective medical and mental health resources.

© 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

Attempts declined by 40 percent where progam was used.

Many Teens at Risk for Suicide Don't Get Help

Receiving psychological or emotional counseling can help teens who are suicidal cope with their problems, but most teens in trouble don't get those services, say researchers from San Francisco, California, and Melbourne, Australia.

Black Male Teen-ager Suicide Rates Increase

The rate of suicide by gun among black male teen-agers nearly quadrupled between 1979 and 1994 before falling off somewhat in the late 1990s, according to a study.

Who Young People Turn to for Help


; my story isn't over

Have you seen anyone with a semicolon tattoo? Here's what it's about.

One small character, one big purpose.

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 was born from a social media movement in 2013.

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 . Mental illness is not uncommon, yet there is a stigma around it that prevents a lot of people from talking about it — and that's a barrier to getting help.

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. Founded in 1970, it's one of the oldest crisis centers in the country. Through The Semicolon Tattoo Project, they've been able to connect even more people with the help they need during times of crisis. (If you need someone to talk to, scroll to the end of the article for the center's contact information.)

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.

But here I am, years later, finally fitting the pieces of my life together in a way I never thought they could before. The semicolon (and the message that goes along with it) is a reminder that I've faced dark times, but I'm still here."

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

Suicide is one of the leading causes of death in older children and teens.

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.


Experts aren't sure yet, but theories include:

  • increase access to guns
  • increase use of alcohol
  • the influence of Internet social networks, such as Facebook
  • increased rates of suicide among older teens who are serving in, or returning from Iraq

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:

  • Being bullied/cyberbullied
  • Dropping out of school
  • Excessive drug and alcohol abuse
  • Unusual neglect of personal appearance
  • Marked personality change/mood disorders/chronic anxiety
  • Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • Loss of interest in pleasurable activities
  • Stressful events, including relationship breakups, family problems, etc
  • Not tolerating praise or rewards
  • Complaints of feeling “rotten inside”
  • Giving verbal hints such as “Nothing matters,” “It’s no use,” or “I won’t be a problem for you much longer”
  • Child abuse.
  • Sexual assault.
  • Previous suicide attempts
  • Genetics -- family history of suicide or psychiatric conditions
  • Putting his or her affairs in order by giving or throwing away favorite possessions or belongings
  • Becoming suddenly cheerful after an episode of depression
  • Certain medications, including antidepressants, Strattera (atomoxetine), a medication for ADHD, and Accutane (isotretinoin), which is used to treat teens with severe nodulocystic acne, and antiseizure drugs, such as Tegretol (carbamazepine), Depakoke (valproate), and Lamictal (lamotrigine)

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:

  • having thoughts of committing suicide, threatening to hurt himself, looking for a way to hurt himself, writing about dying, and other types of suicidal ideation
  • increased substance abuse, including abuse of alcohol and drugs
  • feelings of purposelessness or that they have no reason to live
  • anxiety symptoms
  • feeling trapped like there is no way out of current situations or problems
  • feelings of hopelessness
  • a withdrawal from friends and family and usual activities
  • feeling uncontrolled anger and rage or wanting revenge against someone
  • acting reckless and impulsive
  • having dramatic mood changes

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:

  • recognizing the risk factors and warning signs for suicide
  • calling the National Suicide Prevention Lifeline if you need advice on talking to your teen who you think may have suicide warning signs
  • seeking professional help, such as your pediatrician, a child psychiatrist, a psychiatric hospital, or emergency room if you think your child is going to hurt himself
  • making sure that guns and medications aren't easily available in your home if your teen might be suicidal
  • getting teens professional help if they have depression and/or anxiety, which are often thought to be the biggest risk factors for suicide

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.
Sources: American Association of Suicidology. Suicide Warning Signs Fact Sheet.
Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2014) National Center for Injury Prevention and Control, CDC (producer). Available from
www.cdc.gov/injury/ wisqars/index.html

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

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Find a therapist that's a good fit for you with this health tool.

Text Message (Crisis TCall - 741741 and type SOS

Study Shows 900,000 Teens Planned Suicides While Depressed

Approximately 900,000 American teens 12-17 years old had made a plan to commit suicide during their worst or most recent episode of major depression, and 712,000 attempted suicide during such an episode, a new federal study reports.

Technology and Suicide Risk: Moving Beyond Fear to Opportunity

Communication has changed in the 10 years since I started at SPRC, especially in our virtual lives. On my ride to work on the commuter rail these days, most of the passengers are texting, checking news updates on tablets, and working on laptops, when just a few years ago we might have been reading books or newspapers. As social media and smart devices have become dramatically more central in our lives, I’ve heard concerns about how these changes might affect suicide risk, especially among youth. But instead of approaching these changes with fear, I would encourage the suicide prevention field to embrace them as new opportunities for promoting dialogue, fostering supportive connections, and spreading messages of hope.

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.


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

Source: www.sprc.org/news/technology-suicide-risk-moving-beyond-fear-opportunity?utm_source=Weekly%20Spark%203/2/18&utm_campaign=Weekly%20Spark%20March%202,%202018&utm_medium=email

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


Can a community-based social program reduce suicidal ideation and behavior in Latina adolescents?


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.


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.


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.

Suicide and Youth

Signs of Suicide

Concerns and threats of suicide are increasingly becoming the top reported concern to Safe2Tell Colorado. Suicide of youth is a growing epidemic with more teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, COMBINED.

Youth Suicide Statistics [1]

  • Suicide is the SECOND leading cause of death for ages 10-24.
  • 80% teens who attempt suicide have given clear warning signs.
  • 17% of students 9-12 grade have seriously considered attempting suicide in the previous 12 months.

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?

A child is bullied or victimized when he or she is exposed, repeatedly and over time, to negative actions by one or more other students. Children oftentimes will not tell their parents that they are being victimized.

Warning Signs:

  • Comes home from school with torn, damaged, or missing clothing, books, and belongings.
  • Has unexplained bruises, injuries, cuts, and scratches.
  • Does not bring classmates or other peers home after school and seldom spends time in the homes of classmates or peers.
  • Seems isolated from peers and may not have a good friend to share time with.
  • Appears to be fearful about attending school, walking to and from school, or riding the bus.
  • Has poor appetite, headaches, and stomach pains (particularly in the morning).
  • Chooses a longer, "illogical" route for going to and from school.
  • Asks for or takes extra money from family (money that may go to a bully).
  • Appears anxious, distressed, unhappy, depressed or tearful when he or she comes home from school.
  • Shows unexpected mood shifts, irritability, or sudden outbursts of temper.
  • Has sleeping or eating problems.
  • May lose interest in school work and experience a decline in academic performance.
  • Talks about or attempts suicide.

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:

  • Physically weaker than their peers (particularly boys).
  • Display "body anxiety." They are afraid of being hurt, have poor physical coordination, and are ineffective in physical play or sports.
  • Have poor social skills and have difficulty making friends.
  • Are cautious, sensitive, quiet, withdrawn, and shy.
  • Cry or become upset easily.
  • Are anxious, insecure, and have poor self-esteem.
  • Have difficulty standing up for or defending themselves in peer groups.
  • Relate better to adults than to peers.

Provocative Victim Characteristics:

  • Exhibit some or all of the characteristics of passive or submissive victims.
  • Are hot tempered and attempt to fight back when victimized – usually not very effectively.
  • Are hyperactive, restless, have difficulty concentrating, and create tension.
  • Are clumsy, immature, and exhibit irritating habits.
  • Are also disliked by adults, including teachers.
  • Try to bully students weaker than themselves.

What Can Parents of the Victim Do?

  • Encourage your child to share his/her problems with you. Ensure him or her that this is not tattling. Know that your child may be embarrassed, ashamed, and fearful. Listen attentively and reassure him/her that he/she will not have to face the problem alone.
  • Praise and encourage your child. Help him or her take pride in his/her accomplishments and differences. A confident child is less likely to be targeted by bullies.
  • Search for talents and positive attributes that can be developed in your child. This may help a child to assert himself or herself.
  • Help your child develop friendships. Stimulate your child to meet and interact with new peers. A new environment with new peers can provide a new chance for a victimized child.
  • Encourage your child to make contact with calm and friendly children in his or her class (or in other classes). This may require the school's assistance.
  • If your child’s own behavior (i.e., provocative victim) is contributing to being bullied, try to help your child change his or her behavior without suggesting that he or she is responsible for being victimized. Try to help improve your child’s social skills.
  • Motivate your child to participate in physical activity or sports. Physical exercise can result in better physical coordination and less "body anxiety." This, in turn, can increase your child’s self-esteem and improve peer relations.
  • Maintain contact with your child’s school. Keep a detailed record of bullying episodes and related communication with the school. Help develop a plan of action for the school to follow. Monitor the situation by maintaining communication with the school and your child.
  • Seek help from a mental health professional.
  • Make a report of bullying to Safe2Tell Colorado, a safe and anonymous way for you or your child to report threats, harmful behaviors, or dangerous situations.

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:

  • Physical Attacks: hitting, kicking, pushing, choking
  • Verbal Attacks or Harassment: name calling, threatening, taunting, malicious teasing, rumor spreading, slandering
  • Social isolation, intentional exclusion, making faces, obscene gestures, manipulating friendship relationships

General Characteristics of Possible Bullies

  • Boys are more likely than girls to be bullies. However, girls are more likely to engage in other forms of harassment, such as cyber bullying.
  • May be physically bigger and stronger than their victims.
  • Have strong needs to dominate and control their peers.
  • Are hot-tempered, easily angered, impulsive, and have a low frustration tolerance.
  • Have difficulty conforming to rules.
  • Are defiant and aggressive toward adults and authority figures. Even adults may be frightened of the bully.
  • Are good at talking themselves out of situations.
  • Tend to have a relatively positive view of themselves (average or better than average self-esteem).
  • Are more likely than their peers to engage in other antisocial behaviors.
  • Are more likely to be less popular (particularly primary school students).
  • Are more likely to have negative attitudes toward school and get lower grades (particularly junior high school students).

What Can Parents of the Bully Do?

  • Make clear to your child that you take the bullying seriously, and will not tolerate such behavior in the future.
  • Develop a consistent family rules system. Use praise and reinforcement for rule-following behavior. Use consistent, non-hostile, negative consequences for rule violation. Set a good example for your child by following these rules yourself. If your child observes aggressive behavior by you, he or she is more likely to act aggressively toward peers.
  • Spend more time with your child. Monitor and supervise your child’s activities. Know your child’s friends, where they spend their free time, and what they do with that free time.
  • Build on your child’s talents and help him or her develop less aggressive and more appropriate reaction behaviors.
  • Maintain contact with your child’s school. Support the school’s efforts to modify your child’s behavior. Enlist help from the school to try and modify your child’s behavior.
  • Seek help from a mental health professional.

False Beliefs About Bullying

The following common statements from adults and peers can perpetuate the bully/victim problem:

  • "Being bullied builds character."
  • "Bullying is part of growing up."
  • "Kids will be kids" or "Boys will be boys."
  • "What did you do to him to make him treat you that way?"
  • "You just have to toughen up." or "You just have to learn how to stand up for yourself."
  • "Hit him back. He won’t bother you again."
  • "I was bullied in school and I turned out fine" or "I was a bully in school and I turned out fine."
  • "No kids are bullied in this school."
  • "Only children who are different get bullied."
  • "Only children in large schools/classes get bullied."


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

Child abuse is defined as” doing something or failing to do something that results in harm to a child or puts a child at risk of harm.” Abuse can take many forms including physical, sexual, emotional, or neglect (not providing for a child's needs). Children suffering from abuse can experience greater emotional than physical damage. Effects of child abuse may include depression, substance abuse, thoughts of suicide, violence, or abuse of others.

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

The most readily abuse substance among US teens is marijuana. The high availability, perception of lessen harm, media and peer influences are a few of the reasons that marijuana use is rising among youth and teens. In fact, over 45% of U.S. teens will have tried marijuana at least one in their lifetime by the time they finish high school. [1]

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]

  • Ask what your child or youth knows about using marijuana. Listen carefully, pay attention, and do not interrupt. Avoid making negative or angry comments.
  • Talk about the risks and consequences of smoking marijuana
  • To help ensure your child fully understands the effects of marijuana, ask them what they thing the effects and consequences are of using marijuana and other drugs.
  • Be honest with your child about your own experiences with drugs and your reasons behind your own usage, paying attention not to glamorize marijuana or other drugs. A key component also is discussing the negative results and dangers that resulted from you or your friends' drug use.
  • Visit Good To Know Colorado site for more information and tips on talking to your child/teen about marijuana use in Colorado. [3]

If you suspect your child may be using marijuana, some common signs of marijuana use are:

  • Being hungry and eating more than usual
  • Dizziness
  • Acting nonsensical for no reason
  • Red eyes or use of eye drops
  • Increased irritability
  • Lack of interest or motivation in usual activities
  • Trouble recalling things that just occurred
  • A smell on clothes, or the use of incense or other deodorizers
  • Owning clothing, posters, or jewelry encouraging drug use
  • Having pipes or rolling papers
  • Stealing money or having money that cannot be accounted for Marijuana use among teens can have negative and long-term health effects:

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:

For information and facts about Marijuana in Colorado, visit the Good to Know Colorado site of the Colorado Department of Public Health and Environment

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


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

Helpful Information for Parents and Students following a Traumatic Event

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:

  • Physical, sexual or emotional abuse
  • Neglect
  • Witnessing or being the direct victim of interpersonal violence (domestic, dating violence)
  • Witnessing or being the direct victim of community violence (gang violence, riots, school shootings)
  • Severe motor vehicle and other accidents
  • Medical trauma including severe injury or life threatening illness
  • Natural and human-made disasters
  • Sudden death of a loved one or peer
  • Exposure to war, terrorism or refugee conditions. [2]

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:

  • Anxiety and/or Anger
  • Suicidal Thoughts or Feelings
  • Depression
  • Substance Abuse
  • Fear
  • Frequent mood changes
  • Truancy
  • Fighting
  • Impaired concentration and problem solving abilities
  • Withdrawal from relationships
  • Difficulty communicating
  • Poor school performance

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:


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

Teens and Drinking


Parents 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

Safe2Tell Colorado is available 24 hours a day, 7 days a week for parents and students to report concerning, threatening or suspicious behavior or situations. Safe2Tell Colorado is completely anonymous by Colorado State Law (C.R.S. Section 24-31-601 et seq.) Identifying information on reporters is not collected and there is no caller id. To make an anonymous report about one of these concerns or any other concerning behaviors or threats complete the online web report form, download the Safe2Tell Colorado mobile app, or call 1-877-542-7233.

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:

  • Safe2Tell Colorado is a way for students to report threats to their safety or the safety of someone else in a way that keeps them safe.
  • Safe2Tell Colorado helps increase awareness when school staff and/or administrators may not be aware that a situation has or is occurring for the purpose of prevention, early intervention, education, and awareness.
  • If you choose to make a Safe2Tell Colorado report in order to advocate for your child’s safety, the report will be sent to the school administrative team and/or law enforcement, if needed.
  • Safe2Tell Colorado does not notify the Reporting Party of the report outcome. All outcome information is private and autonomous to Safe2Tell Colorado.
  • If you have previously reported the situation to your school staff and are not satisfied with the outcome, Safe2Tell Colorado is not able to enforce a different outcome. Please find the venue within your school district for escalating these concerns.
  • Safe2Tell Colorado is not a resource for keeping a “record” of your school or child’s history.

What You Can Do to Advocate For Your Child:

  • Attempt to keep lines of communication open with your child’s teacher, your school’s administrative staff, and your school's superintendent’s office.
  • Always keep the best interests of the child at the forefront of the conversation.
  • Please remember privacy laws protect EVERY student. No one is entitled to know the disciplinary outcome of another student.
  • Ask your school/school district if there is a preferred protocol or resource staff dedicated to parents who need assistance advocating for their child.
  • If your child has an IEP, contact Colorado Department of Education for more resources at: www.cde.state.co.us.

Source: https://safe2tell.org/?q=reporting-concerns

Resources for Parents

Resources for ParentsThe following links are for resources and publications to connect parents and guardians to information regarding specific topics that may be concerning to their student or themselves. For more information about Safe2Tell Colorado, you may call our administrative office at 720-508-6800. NOTE: The administrative phone number is NOT an anonymous report line. Do not leave or report private, confidential, or anonymous information on this line.


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


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

Yellow Ribbon International

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

Warning Signs of Suicide


Killing themselves
Having no reason to live
Being a burden to others
Feeling trapped
Unberable pain


Increased alcohol or drug ue
Looking for a way to kill themselves
Acking recklessly
Withdrawing from acitivites
Isolaitng from family and friends
Sleeping too much or toolittle
Visiting or calling people to say goodbye
Giving away prized possissions


Loss on interest

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

If this is your first time calling a support line for help, you may have questions. Someone will be there to listen and support you.

What happens?

  • The person will ask your name and how they can help
  • They may ask for other personal information to help you but you’re never required to share
  • They will keep what you say confidential
  • They will listen to you with compassion
  • They will not judge you or tell you what to do
  • They may give you ideas about where to find more help or how you can find a counselor

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.


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