State Boards Can
Be Lead Policy Actors in Preventing Youth Suicide
According to the NASBE State Policy Database on School Health, as of the 201718 school year, 25 states and the District of Columbia required or encouraged school districts to adopt suicide prevention policies.
State boards looking to develop suicide prevention policies can start by bringing together officials from the education and health sectors to encourage cross-sector collaboration. It is also important to ask specific questions about best practices, prevention efforts already under way, and statewide data on correlations between suicide rates and other variables and within student subgroups. The Hawaii state board, for example, has convened a working group of diverse stakeholders to explore the policies and factors contributing to youth suicide. The working group plans to release a report detailing its findings and policy recommendations later this year.
State boards can address student
wellness through myriad levers in partnership with state
education and health agencies, writes Blanco.
Developing research-informed suicide prevention
policy, grounded in sound implementation infrastructure,
pushes states one step closer to guaranteeing that all
students have safe, healthy, equitable learning
environments. Most important, it saves lives.
Child Being Bullied?
General Characteristics of Possible Victims
There are two types of victims: (1) the passive or submissive victim, and (2) the provocative victim. Passive/submissive victims signal to others through attitudes and behaviors that they are insecure individuals who will not retaliate if victimized. The provocative victim is a much smaller group of victims. They are characterized by having both anxious and aggressive patterns. Provocative victims are generally boys.
Passive/Submissive Victim Characteristics:
Provocative Victim Characteristics:
What Can Parents of the Victim Do?
Is Your Child a Bully?
Children who bully increase their risk for engaging in other forms of antisocial behavior, such as juvenile delinquency, criminality and substance abuse. Bullying behavior should be taken seriously. Doing nothing implies that bullying is acceptable behavior. Typical bullying behavior includes:
General Characteristics of Possible Bullies
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.
What Can Parents of the Bully Do?
False Beliefs About Bullying
The following common statements from adults and peers can perpetuate the bully/victim problem:
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 Teensand All the
Years in Between. Paramus, NJ: Prentice Hall Press.
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:
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:
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:
If you think that your teen has any of the warning signs for suicide, don't ignore them. Trust your instincts and either try to get more information or seek additional help.
Preventing Teen Suicide
In addition to all of the teens who successfully commit suicide, there are many more who attempt suicide. Experts estimate that 20 to 25% of teens admit to thinking about suicide at some time in their lives and for every suicide, there are between 5 to 45 suicide attempts.
That makes it even more important for parents, pediatricians, and everyone else that is regularly around teenagers to understand how to try and prevent suicides, such as:
You should also make sure that teens know that they can ask for help if they ever think about hurting themselves, including calling the National Suicide Prevention Lifeline - 1-800-273-TALK (8255), Crisis Text Line text "SOS" to 741741, calling their doctor, calling 911, or going to a local crisis center or the emergency room.
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 1024 Years United States,
19942012. MMWR. March 6, 2015 / 64(08);201-205.
Crisis Text Message - text SOS to
741741 free, 24/7)
Has Researchers Worried About Teen Suicide - 9/10/20
Teen and youth anxiety and depression are getting worse since COVID lockdowns began in March, early studies suggest, and many experts say they fear a corresponding increase in youth suicide.
At the end of June, the Centers for Disease Control and Prevention surveyed Americans on their mental health. They found symptoms of anxiety and depression were up sharply across the board between March and June, compared with the same time the previous year. And young people seemed to be the hardest-hit of any group.
Almost 11 percent of all respondents to that survey said they had "seriously considered" suicide in the past 30 days. For those ages 18 to 24, the number was 1 in 4 more than twice as high.
Data collection for several studies on teen mental health during the pandemic is currently underway. And experts worry those studies will show a spike in suicide, because young people are increasingly cut off from peers and caring adults, because their futures are uncertain and because they are spending more time at home, where they are most likely to have access to lethal weapons.
"Teenagers are in a developmental space where it is critically important that they have regular contact with their peers and are able to develop close and ongoing relationships with adults outside the home, such as their teachers, their coaches, their advisers," says Lisa Damour, an adolescent psychologist who is a columnist and host of the podcast Ask Lisa: The Psychology of Parenting. "And I worry very much about what it means for that to be disrupted by the pandemic."
The stressors of COVID come as youth suicide was already at a record high before the pandemic, with increases every year since 2007. Suicide is the second leading cause of death among people ages 10-24, after accidents, as it has been for many years, according to the most recent data available from the CDC.
Not having guns in the home, or keeping them safely locked away, is another overlooked factor in suicide risk. A new analysis of the latest CDC data, just released by the advocacy group Everytown for Gun Safety, found that the rate of specifically firearm suicides increased 51% for 15-24 year olds in the decade ending in 2018. Among 10- to 14-year-olds, who have a lower rate of suicide to begin with, suicide by gun increased a staggering 214% in that time frame.
Gun suicide is astonishingly lethal: Of all suicide attempts not involving guns, 94% fail, and most of those people do not try again, Everytown reports. Of all suicide attempts that do involve guns, 90% succeed. That's one reason that gun ownership correlates with the youth suicide rate, state by state. A study last year found that for each 10 percent increase in household gun ownership in a state, the suicide rate for 10- to 19-year-olds increases by more than 25 percent.
And, the presence of guns is another community risk factor that has increased during the pandemic: From March to July 2020, Everytown reports, gun sales doubled compared with the year before.
Carrson Everett, 17, says when he himself attempted suicide, the fact that his parents kept their guns safely locked away and out of reach most likely helped save his life. He says that during the pandemic, "Teenagers are already having the effect of isolation, staying at home and everything. And now there's all these new firearms in their homes and, you know, we can't tell who's safely storing their guns and who isn't. And it's very dangerous."
Everett has started his senior year of high school in Kingsport, Tenn., on a hybrid schedule. On the days that he's home, he says he wonders what he's missing out on at school. "Everyone feels isolated, and it's been very tough for everybody."
He says these past few months have been especially hard for him because he has depression and anxiety. Plus, he says he's been bullied for years for being gay, including over video chat during distance learning.
Everett is a volunteer for Students Demand Action, an anti-gun violence group that is part of Everytown. He said he's learned that gun violence isn't just a matter of crime or mass shootings, but also suicide. "I wrote an op-ed about a kid that was my age over in Cookeville, Tennessee, that had taken his own life with a firearm because he had been outed [as gay] at school. So, you know, it's very relatable for me."
Damour, the teen psychologist, explains that not having guns in the home, or keeping them safely locked away, is important especially for adolescents because "teens are impulsive."
What parents can do
She says parents need to know that suicide is preventable. A red flag is when sadness is more than a passing mood. Caregivers need to check in regularly which can be unexpectedly complicated when the whole family is spending so much time at home.
A common pattern, she notes, is parents trying to work during the day, and teenagers staying up late at night to have time to themselves. This isn't inherently a problem, Damour says, but "there's a difference between allowing privacy and allowing a teenager to hole up in their room for days at a time."
If a teen talks about harming themselves or wanting to disappear, a parent should ask directly, "Is that something you think you might really do or you think about doing? Or are you just letting me know that you're very upset right now?" And, she adds, hear them out without dismissing what they're saying.
She also says parents should look out for anger: "In teenagers, uniquely, depression can take the form of irritability. That depression in teenagers sometimes looks like a prickly porcupine. Everybody rubs them the wrong way. And that is easy to miss because sometimes we'll just dismiss that as being a snarky teenager."
If school is all-virtual, she says, parents should look for safe sports, work or volunteer opportunities that allow teens to have social time and contact with other caring adults.
Finally, Damour says she sees one bright spot: During the pandemic, she and other clinicians are finding that telemedicine therapy over video chat is working surprisingly well with adolescents.
"The teenagers that I see are often talking to me from their bedrooms, sometimes flopped over in their beds," she says. "There's something unguarded about it that's very different than having them sit in my office."
And, virtual therapy can lower barriers to access for families who might have had to travel to get accessible mental health care.
If you or someone you know is having
suicidal thoughts, reach out for help. The National Suicide
Prevention Lifeline at 800-273-8255 and the Crisis Text
Line, text SOS to 7441741, arefree and open 24 hours a
What is already known about this topic?
During 2020, the proportion of mental healthrelated emergency department (ED) visits among adolescents aged 1217 years increased 31% compared with that during 2019.
What is added by this report?
In May 2020, during the COVID-19 pandemic, ED visits for suspected suicide attempts began to increase among adolescents aged 1217 years, especially girls. During February 21March 20, 2021, suspected suicide attempt ED visits were 50.6% higher among girls aged 1217 years than during the same period in 2019; among boys aged 1217 years, suspected suicide attempt ED visits increased 3.7%.
What are the implications for public health practice?
Suicide prevention requires a comprehensive approach that is adapted during times of infrastructure disruption, involves multisectoral partnerships and implements evidence-based strategies to address the range of factors influencing suicide risk.
Beginning in March 2020, the COVID-19 pandemic and response, which included physical distancing and stay-at-home orders, disrupted daily life in the United States. Compared with the rate in 2019, a 31% increase in the proportion of mental healthrelated emergency department (ED) visits occurred among adolescents aged 1217 years in 2020 (1). In June 2020, 25% of surveyed adults aged 1824 years reported experiencing suicidal ideation related to the pandemic in the past 30 days (2). More recent patterns of ED visits for suspected suicide attempts among these age groups are unclear. Using data from the National Syndromic Surveillance Program (NSSP),* CDC examined trends in ED visits for suspected suicide attempts during January 1, 2019May 15, 2021, among persons aged 1225 years, by sex, and at three distinct phases of the COVID-19 pandemic. Compared with the corresponding period in 2019, persons aged 1225 years made fewer ED visits for suspected suicide attempts during March 29April 25, 2020. However, by early May 2020, ED visit counts for suspected suicide attempts began increasing among adolescents aged 1217 years, especially among girls. During July 26August 22, 2020, the mean weekly number of ED visits for suspected suicide attempts among girls aged 1217 years was 26.2% higher than during the same period a year earlier; during February 21March 20, 2021, mean weekly ED visit counts for suspected suicide attempts were 50.6% higher among girls aged 1217 years compared with the same period in 2019. Suicide prevention measures focused on young persons call for a comprehensive approach, that is adapted during times of infrastructure disruption, involving multisectoral partnerships (e.g., public health, mental health, schools, and families) and implementation of evidence-based strategies (3) that address the range of factors influencing suicide risk.
CDC examined NSSP ED visit data, which include approximately 71% of the nations EDs in 49 states (all except Hawaii) and the District of Columbia. ED visits for suspected suicide attempts were identified by using a combination of chief complaint terms and administrative discharge diagnosis codes. ED visits for suspected suicide attempts include visits for suicide attempts, as well as some nonsuicidal self-harm visits (4). Suspected suicide attempts were identified by querying an NSSP syndrome definition developed by CDC in partnership with state and local health departments (Supplementary Table, https://stacks.cdc.gov/view/cdc/106694). All analyses were restricted to EDs that reported consistently throughout the study period (January 1, 2019May 15, 2021) and had at least one visit for suspected suicide attempts; 41% of those that reported consistently had one or more visits for suspected suicide attempts.§ Weekly counts and rates (mean number of ED visits for suspected suicide attempts/mean total number of ED visits) x 100,000) analyzed by age group (1217 and 1825 years) and sex were plotted across the entire study period, and analyzed for three distinct periods: spring 2020 (March 29April 25, 2020; calendar year weeks 1417); summer 2020 (July 26August 22, 2020; weeks 3134); and winter 2021 (February 21March 20, 2021; weeks 811) and compared with their corresponding reference periods in 2019.¶ These time frames were selected as representative of distinct periods throughout the pandemic. Percent change and visit ratios (rate of ED visits for suspected suicide attempts during surveillance period/rate of ED visits for suspected suicide attempts during reference period) with 95% confidence intervals (CIs) were calculated to compare suspected suicide attempt ED visit rates by pandemic period and sex; CIs that excluded 1.0 were considered statistically significant. NSSP race and ethnicity data were not available at the national level for this analysis at the time it was conducted. All analyses were conducted using R software (version 4.0.5; R Foundation). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.**
Among adolescents aged 1217 years, the number of weekly ED visits for suspected suicide attempts decreased during spring 2020 compared with that during 2019 (Figure 1) (Table). ED visits for suspected suicide attempts subsequently increased for both sexes. Among adolescents aged 1217 years, mean weekly number of ED visits for suspected suicide attempts were 22.3% higher during summer 2020 and 39.1% higher during winter 2021 than during the corresponding periods in 2019, with a more pronounced increase among females. During winter 2021, ED visits for suspected suicide attempts were 50.6% higher among females compared with the same period in 2019; among males, such ED visits increased 3.7%. Among adolescents aged 1217 years, the rate of ED visits for suspected suicide attempts also increased as the pandemic progressed (Supplementary Figure 1, https://stacks.cdc.gov/view/cdc/106695). Compared with the rate during the corresponding period in 2019, the rate of ED visits for suspected suicide attempts was 2.4 times as high during spring 2020, 1.7 times as high during summer 2020, and 2.1 times as high during winter 2021 (Table). This increase was driven largely by suspected suicide attempt visits among females.
Among men and women aged 1825 years, a 16.8% drop in the number of ED visits for suspected suicide attempts occurred during spring 2020 compared with the 2019 reference period (Figure 2) (Table). Although ED visits for suspected suicide attempts subsequently increased, they remained consistent with 2019 counts (Figure 2). However, the ED visit rate for suspected suicide attempts among adults aged 1825 years was higher throughout the pandemic compared with that during 2019 (Supplementary Figure 2, https://stacks.cdc.gov/view/cdc/106696). Compared with the rate in 2019, the rate was 1.6 times as high during spring 2020, 1.1 times as high during summer 2020, and 1.3 times as high during winter 2021 (Table).
This report expands upon previous work highlighting increases in ED visits for suspected suicide attempts earlier in the pandemic among all persons (5) and suggests that these trends persisted among young persons as the pandemic progressed. Compared with the corresponding period in 2019, persons aged 1225 years made fewer ED visits for suspected suicide attempts during March 29April 25, 2020, the period that followed the declaration of the COVID-19 pandemic as a national emergency and a concurrent 42% decrease in the total number of U.S. ED visits (6). However, ED visits for suspected suicide attempts increased among adolescent girls aged 1217 years during summer 2020 and remained elevated throughout the remaining study period; the mean weekly number of these visits was 26.2% higher during summer 2020 and 50.6% higher during winter 2021 compared with the corresponding periods in 2019. The number of ED visits for suspected suicide attempts remained stable among adolescent boys aged 1217 years and among all adults aged 1825 years compared with the corresponding periods in 2019, although rates of ED visits for suspected suicide attempts increased.
The difference in suspected suicide attempts by sex and the increase in suspected suicide attempts among young persons, especially adolescent females, is consistent with past research: self-reported suicide attempts are consistently higher among adolescent females than among males (7), and research before the COVID-19 pandemic indicated that young females had both higher and increasing rates of ED visits for suicide attempts compared with males (8). However, the findings from this study suggest more severe distress among young females than has been identified in previous reports during the pandemic (1,2), reinforcing the need for increased attention to, and prevention for, this population. Importantly, although this report found increases in ED visits for suspected suicide attempts among adolescent females during 2020 and early 2021, this does not mean that suicide deaths have increased. Provisional mortality data found an overall decrease in the age-adjusted suicide rate from quarter 3 (JulySeptember) of 2019 to quarter 3 of 2020. The suicide rate among young persons aged 1524 years during this same period saw no significant change (9). Future analyses should further examine these provisional rates by age, sex, race, ethnicity, and geographic setting.
Some researchers have cautioned about a potential increase in suicides during the COVID-19 pandemic on account of increases in suicide risk factors; however, this study was not designed to identify the risk factors leading to increases in suspected suicide attempts (10). Young persons might represent a group at high risk because they might have been particularly affected by mitigation measures, such as physical distancing (including a lack of connectedness to schools, teachers, and peers); barriers to mental health treatment; increases in substance use; and anxiety about family health and economic problems, which are all risk factors for suicide. In addition, average ED visit rates for mental health concerns and suspected child abuse and neglect, risk factors for suicide attempts, also increased in 2020 compared with 2019 (5), potentially contributing to increases in suspected suicide attempts. Conversely, by spending more time at home together with young persons, adults might have become more aware of suicidal thoughts and behaviors, and thus been more likely to take their children to the ED.
The findings in this report are subject to at least nine limitations. First, these data are not nationally representative. Second, facility participation varies within and across states; however, data were only analyzed from facilities that reported consistently over the study period, thus minimizing the impact of reporting fluctuations on resultant trends. Third, differences in availability, coding practices, and reporting of chief complaints and discharge diagnoses from facilities might influence results returned by the syndrome definition. Fourth, distinguishing initial visits from follow-up visits for the same event was not possible, so the number of ED visits for suspected suicide attempts might be lower than presented. Fifth, NSSP race and ethnicity data were not available at the national level for this analysis at the time it was conducted, so analyses of differences among racial/ethnic groups was not possible. Sixth, these data likely underrepresent the true prevalence of suspected suicide attempts because persons with less severe injuries might be less likely to seek emergency care during the pandemic when many persons avoided medical settings to reduce the risk for contracting COVID-19. Seventh, the suspected suicide attempt syndrome definition excludes some, but not all, visits for nonsuicidal self-harm. Eighth, the sharp decline in all ED visits during the pandemic likely affected the number and proportion of visits for suspected suicide attempts (6). Finally, this analysis was not designed to determine whether a causal link existed between these trends and the COVID-19 pandemic.
Suicide can be prevented through a comprehensive approach that supports persons from becoming suicidal as well as persons who are at increased risk for suicide. Such an approach involves multisectoral partnerships (e.g., public health, mental health, schools, and families) and implementation of evidence-based strategies to address the range of factors influencing suicide attempts, which is a leading risk factor for suicide (3). Strategies specific to young persons include preventing and mitigating adverse childhood experiences, strengthening economic supports for families, limiting access to lethal means (e.g., safe storage of medications and firearms), training community and school staff members and others to learn the signs of suicide risk and how to respond, improving access and delivery of evidence-based care, increasing young persons social connectedness and coping skills, and following safe messaging by the media and in schools after a suicide (3). Widely implementing these comprehensive prevention strategies across the United States, including adapting these strategies during times of infrastructure disruption, such as during the pandemic, can contribute to healthy development and prevent suicide among young persons.
1 National Center for Injury Prevention and Control, CDC; 2Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
* NSSP is a collaborative program among CDC, federal partners, local and state health departments, and academic and private sector partners to support the collection and analysis of electronic health data from EDs, urgent and ambulatory care centers, inpatient health care facilities, and laboratories.
Analysis was limited to ED encounters. As of March 31, 2021, a total of 3,722 EDs covering 49 states (all except Hawaii) and the District of Columbia contributed data to the platform daily, including data from 71% of all nonfederal EDs in the United States.
§ To limit the impact of data quality on trends, all analyses were restricted to facilities with a coefficient of variation <30 throughout the analysis period January 2019May 2021 so that only consistently reporting facilities were included. Of all the EDs that met the data quality criteria, 41% had visits and thus were included in the analysis.
¶ Percent change in visits per week during each surveillance period was calculated as the difference in total visits between the surveillance period and the reference period, divided by the total visits during the reference period, times 100%. ([ED visits for suspected suicide attempts during surveillance periodED visits for suspected suicide attempts during reference period]/ED visits for suspected suicide attempts during reference period*100%).
** 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.
Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental health-related emergency department visits among children aged <18 years during the COVID-19 pandemicUnited States, January 1October 17, 2020. MMWR Morb Mortal Wkly Rep 2020;69:167580. https://doi.org/10.15585/mmwr.mm6945a3external icon PMID:33180751external icon
Czeisler MÉ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemicUnited States, June 2430, 2020. MMWR Morb Mortal Wkly Rep 2020;69:104957. https://doi.org/10.15585/mmwr.mm6932a1external icon PMID:32790653external icon
Stone DM, Holland KM, Bartholow B, Crosby AE, Davis S, Wilkins N. Preventing suicide: a technical package of policies, programs, and practices. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control; 2017. https://www.cdc.gov/suicide/pdf/suicideTechnicalPackage.pdf
Crosby AE, Ortega L, Melanson C. Self-directed violence surveillance: uniform definitions and recommended data elements, version 1.0. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control; 2011. https://www.cdc.gov/suicide/pdf/Self-Directed-Violence-a.pdf
Holland KM, Jones C, Vivolo-Kantor AM, et al. Trends in US emergency department visits for mental health, overdose, and violence outcomes before and during the COVID-19 pandemic. JAMA Psychiatry 2021;78:3729. https://doi.org/10.1001/jamapsychiatry.2020.4402external icon PMID:33533876external icon
Hartnett KP, Kite-Powell A, DeVies J, et al.; National Syndromic Surveillance Program Community of Practice. Impact of the COVID-19 pandemic on emergency department visitsUnited States, January 1, 2019May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:699704. https://doi.org/10.15585/mmwr.mm6923e1external icon PMID:32525856external icon
Ivey-Stephenson AZ, Demissie Z, Crosby AE, et al. Suicidal ideation and behaviors among high school studentsyouth risk behavior survey, United States, 2019. MMWR Suppl 2020;69(No. Suppl 1). https://doi.org/10.1097/NNR.0000000000000424external icon PMID:32058456external icon
Mercado MC, Holland K, Leemis RW, Stone DM, Wang J. Trends in emergency department visits for nonfatal self-inflicted injuries among youth aged 10 to 24 years in the United States, 20012015. JAMA 2017;318:19313. https://doi.org/10.1001/jama.2017.13317external icon PMID:29164246external icon
Ahmad FB, Cisewski JA. Quarterly provisional estimates for selected indicators of mortality, 2018quarter 3, 2020. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2021. https://www.cdc.gov/nchs/nvss/vsrr/mortality.htm
Reger MA, Stanley IH, Joiner TE. Suicide mortality and coronavirus disease 2019a perfect storm? JAMA Psychiatry 2020;77:10934. https://doi.org/10.1001/jamapsychiatry.2020.1060external icon PMID:32275300external icon
1. Numbers of weekly emergency department visits* for suspected suicide attempts among adolescents aged 1217 years, by sex National Syndromic Surveillance Program, United States, January 1, 2019May 15, 2021
The figure is a line chart showing numbers of weekly emergency department visits for suspected suicide attempts among adolescents aged 1217 years, by sex in the United States during January 1, 2019May 15, 2021, according to the National Syndromic Surveillance Program.
Abbreviations: ED = emergency department; NSSP = National Syndromic Surveillance Program.
* ED visits for suspected suicide attempts were identified by querying an NSSP syndrome definition developed by CDC in partnership with state and local health departments (https://stacks.cdc.gov/view/cdc/106694). NSSP ED visit data include approximately 71% of the nations EDs in 49 states (all except Hawaii) and the District of Columbia.
Visits for suspected suicide attempts include visits for suicide attempts, as well as nonsuicidal self-harm.
Questions or messages
regarding errors in formatting should be addressed to
teenage children died by suicide. Now these families want to
hold social media companies accountable - CNN - 4/19/22
CJ worked as a busboy at Texas Roadhouse in Kenosha, Wisconsin. He loved playing golf, watching "Doctor Who" and was highly sought after by top-tier colleges. "His counselor said he could get a free ride anywhere he wanted to go," his mother Donna Dawley told CNN Business during a recent interview at the family's home.
But throughout high school, he developed what his parents felt was an addiction to social media. By his senior year, "he couldn't stop looking at his phone," she said. He often stayed up until 3 a.m. on Instagram messaging with others, sometimes swapping nude photos, his mother said. He became sleep deprived and obsessed with his body image.
On January 4, 2015, while his family was taking down their Christmas tree and decorations, CJ retreated into his room. He sent a text message to his best friend -- "God's speed" -- and posted an update on his Facebook page: "Who turned out the light?" CJ held a 22-caliber rifle in one hand, his smartphone in the other and fatally shot himself. He was 17. Police found a suicide note written on the envelope of a college acceptance letter. His parents said he never showed outward signs of depression or suicidal ideation.
"When we found him, his phone was still on, still in his hand, with blood on it," Donna Dawley said. "He was so addicted to it that even his last moments of his life were about posting on social media."
Now, the Dawleys are joining a growing number of families who have filed recent wrongful death lawsuits against some of the big social media companies, claiming their platforms played a significant role in their teenagers' decisions to end their lives. The Dawleys' lawsuit, which was filed last week, targets Snap, the parent company of Snapchat, and Meta, the parent company of Facebook and Instagram. The suit accuses the two companies of designing their platforms to addict users with algorithms that lead to "never-ending" scrolling as part of an effort to maximize time spent on the platform for advertising purposes and profit.
The lawsuit also said the platforms effectively exploit minor users' decision-making and impulse control capabilities due to "incomplete brain development."
Donna Dawley said she and her husband, Chris, believe CJ's mental health suffered as a direct result of the addictive nature of the platforms. They said they were motivated to file the lawsuit against Meta and Snap after Facebook whistleblower Frances Haugen leaked hundreds of internal documents, including some that showed the company was aware of the ways Instagram can damage mental health and body image.
In public remarks, including her testimony before Congress last fall, Haugen also raised concerns about how Facebook's algorithms could drive younger users toward harmful content, such as posts about eating disorders or self-harm, and lead to social media addiction. (Meta CEO Mark Zuckerberg wrote a 1,300-word post on Facebook at the time claiming Haugen took the company's research on its impact on children out of context and painted a "false picture of the company.")
"For seven years, we were trying to figure out what happened," said Donna Dawley, adding she felt compelled to "hold the companies accountable" after she heard how Instagram is designed to keep users on the platform for as long as possible. "How dare you put a product out there knowing that it was going to be addictive? Who would ever do that?"
Haugen's disclosures and Congressional testimony renewed scrutiny of tech platforms from lawmakers on both sides of the aisle. A bipartisan bill was introduced in the Senate in February that proposes new and explicit responsibilities for tech platforms to protect children from digital harm. President Joe Biden also used part of his State of the Union address to urge lawmakers to "hold social media platforms accountable for the national experiment they're conducting on our children for profit."
Some families are now also taking matters into their own hands and turning to the courts to pressure the tech companies to change how their platforms work. Matthew Bergman, the Dawleys' lawyer, formed the Social Media Victims Law Center last fall after the release of the Facebook documents. He now represents 20 families who have filed wrongful death lawsuits against social media companies.
"Money is not what is driving Donna and Chris Dawley to file this case and re-live their unimaginable loss they sustained," Bergman said. "The only way to force [social media companies] to change their dangerous but highly profitable algorithms is to change their economic calculus by making them pay the true costs that their dangerous products have inflicted on families such as the Dawleys."
He added: "When faced with similar instances of outrageous misconduct by product manufacturers, juries have awarded tens of millions of dollars in compensatory damages and imposed billion-dollar punitive damage awards. I have every reason to anticipate a jury, after fairly evaluating all the evidence, could render a similar judgment in this case."
In a statement to CNN Business, Snap spokesperson Katie Derkits said it can't comment on active litigation but "our hearts go out to any family who has lost a loved one to suicide."
"We intentionally built Snapchat differently than traditional social media platforms to be a place for people to connect with their real friends and offer in-app mental health resources, including on suicide prevention for Snapchatters in need," Derkits said. "Nothing is more important than the safety and wellbeing of our community and we are constantly exploring additional ways we can support Snapchatters."
Meta also declined to comment on the case because it is in litigation but said the company currently offers a series of suicide prevention tools, such as automatically providing resources to a user if a friend or AI detects a post is about suicide.
Tech companies under pressure to make changes
Although alarms have been raised about social media addiction for years, Haugen's testimony -- coupled with concerns around kids' increased time spent online during the pandemic -- has made the issue a national talking point. But change hasn't come fast enough for some families.
Jennifer Mitchell, who said her 16-year-old son Ian died of a self-inflicted gunshot while on Snapchat, is also working with the Social Media Victims Law Center to file a lawsuit against Snap. She said she hopes it will make more parents aware of the dangers of social media and encourage lawmakers to regulate the platforms.
"If we can put age restrictions on alcohol, cigarettes and to purchase a gun, something needs to be something done when it comes to social media," she told CNN Business. Snapchat's age requirement for signing up is 13. "It's too addictive for kids."
In August 2019, Mitchell had just landed in Alaska on a business trip from Florida when she received a series of voice messages saying her son died of a self-inflicted gunshot wound. She said police later told her they believed Ian was recording a video at the time of the incident.
"After trying to get into some of his social media accounts, we found video of him [taken] on Snapchat that looked like he was playing Russian roulette with the gun," Mitchell said. "We don't know who he was sending it to or if he was playing with someone. The phone was found not too far from his body."
The emergence of wrongful death lawsuits against social media companies isn't limited to teenagers. In January, Tammy Rodriguez filed a lawsuit, alleging her 11-year-old daughter Selena struggled with social media addiction for two years before taking her own life in July 2021. (Instagram and Snapchat, the two sites her daughter is said to have used most, require users to be at least 13 years old to create accounts, but as with many social platforms, some kids younger than that still sign up.)
According to the lawsuit, Selena Rodriguez had spent more time on those social networks during the pandemic and started communicating with older men on the platforms. She responded to requests to send sexually explicit images, "which were subsequently shared or leaked to her classmates, increasing the ridicule and embarrassment she experienced at school," the suit alleged.
"Throughout the period of Selena's use of social media, Tammy Rodriguez was unaware of the clinically addictive and mentally harmful effects of Instagram and Snapchat," the lawsuit said. It also cited the lack of sufficient parental controls at the time as a contributing factor, an issue that has been a focus of some recent criticism among lawmakers.
Both Snap and Meta declined to comment on the case but referenced their resources to help its users struggling with their mental health.
"If a person walks into a bad neighborhood and is assaulted, that's a regrettable incident," said Bergman, who is also representing the Rodriguez family. "But if a tour guide says, 'Let me show you around the city or I'll show you the top sites,' and one of those [spots] is a very dangerous neighborhood where a person is assaulted, the tour guide appropriately has some responsibility for putting the tourist in harm's way. That's exactly what these platforms do."
"It's not random that teenage girls are directed toward content that makes them feel bad about their bodies. That is the way the algorithms work; it's by design," he added.
A long and uncertain legal road
Carl Tobias, a professor at the University of Richmond School of Law, believes these wrongful death lawsuits against social media companies could hold up in court despite inevitable challenges.
"The problem, at least in the traditional notion in the law, has been that it's difficult to prove addiction that then leads to taking somebody's life or doing serious damage to somebody that's self-inflicted," he said. "But judges and juries in certain situations might be more open to finding liability and awarding damages."
He said Haugen's "damning" testimony before Congress and the "seemingly troubling" data companies collect about young users, as revealed in the documents, could potentially support a ruling in favor of the plaintiffs, depending on each case.
"There's a lot of information we didn't have before," Tobias said. "When a company, entity or an individual knows they're exposing someone else to a risk of harm, then tort law and product liability law is sometimes willing to impose liability."
While he said it's "unclear" if the lawsuits will indeed be successful, the "arguments being made by plaintiffs and their lawyers in some of these cases are something the companies have to take seriously."
Individual lawsuits have been filed against social media companies in the past, but the companies typically have a broad legal liability shield for content posted on their platforms. However, Tobias said because families are now targeting how the platforms are designed, it "might persuade a court to distinguish the new allegations from other actions by defendants that judges found immune."
In the months following the leaked internal documents, Instagram has rolled out a handful of safeguards aimed at protecting its young users, including a tool called Take a Break, which aims to encourage people to spend some time away from the platform after they've been scrolling for a certain period. It also introduced a tool that allows parents to see how much time their kids spend on Instagram and set time limits, and brought back a version of its news feed that sorts posts in reverse chronological order rather than ranked according to the platform's algorithms.
Last month, dozens of attorneys general wrote a letter to TikTok and Snap calling on the companies to strengthen the platforms' existing parental tools and better work alongside third-party monitoring apps, which can alert parents if children use language that suggests a desire for self-harm or suicide.
"Your platforms do not effectively collaborate with parental control applications or otherwise provide an adequate opportunity for parental control within the platform," the letter said. "We ask that you conform to widespread industry practice by giving parents increased ability to protect their vulnerable children."
Snap told CNN Business in a response it is currently working on new tools for parents that give more insight into what their teens are doing on Snapchat and who they're talking to. TikTok did not respond to a request for comment. However, the company has expanded its safety features over the years. In 2019, TikTok introduced a limited app experience called TikTok for Younger Users which restricts messaging, commenting and sharing videos for users under age 13. In 2020, it rolled out the ability to disable direct messaging for users under the age of 16.
Bergman said he anticipates a "long fight" ahead as he plans to "file a lot of cases" against social media companies. "The only thing that's certain is the level of opposition that we're going to face from companies that have all the money in the world to hire all the lawyers," he said. "They want to do everything they can to avoid standing up in a courtroom and explain to a jury why their profits were more important than the life of CJ Dawley."
Donna Dawley said the last time she saw her son, on the day of his death, he was looking down at his phone, appearing sad. "I just wish I would have grabbed him and hugged him," she said.
"[This lawsuit] is not about
winning or losing. We're all losing right now. But if we can
get them to change the algorithm for one child -- if one
child is saved -- then it's been worth it."
The aim was to determine if suicide note themes might inform suicide prevention strategies.
The themes of 42 suicide notes from the Northern Ireland Suicide Study (major psychological autopsy study) were examined.
The commonest themes were "apology/shame" (74%), "love for those left behind" (60%), "life too much to bear" (48%), "instructions regarding practical affairs post-mortem" (36%), "hopelessness/nothing to live for" (21%) and "advice for those left behind" (21%). Notes of suicides with major unipolar depression were more likely than notes of suicides without major unipolar depression to contain the themes "instructions regarding practical affairs post-mortem" (67% versus 19%, p = 0.005) and "hopelessness/nothing to live for" (40% versus 11%, p = 0.049). Notes of suicides with a previous history of deliberate self-harm were less likely than notes of suicides without a history of deliberate self-harm to contain the theme "apology/shame" (58% versus 87%, p = 0.04). Notes of elderly suicides were more likely than non-elderly notes to contain the theme "burden to others" (40% versus 3%, p = 0.03).
The fact that three quarters of
suicide notes contained the theme "apology/shame" suggests
that the deceased may have welcomed alternative solutions
for their predicaments. Scrutiny of suicide note themes in
the light of previous research findings suggests that
cognitive therapy techniques, especially problem solving,
may have an important role to play in suicide prevention and
that potential major unipolar depressive (possibly less
impulsive) suicides, in particular, may provide fertile
ground for therapeutic intervention (physical and
psychological). Ideally all primary care doctors and mental
health professionals working with (potentially) suicidal
people should be familiar with basic cognitive therapy
techniques, especially problem solving skills training.
NFL QB shoots himself in apparent suicide attempt
Authorities were called to a motel in Calabasas, Calf, where Kramer had been staying. At first, it was described as a non life-threatening injury. However, Kramers sister told his former-wife that it was more serious.
Kramer is from California who played college ball at N.C. State. He is best known for his stint with the Lions where he led the 1991 team to a 12-4 record and a playoff win that season. He then went on to play for the Bears from 1994-1998 where he threw for over 3,000 yards and 29 touchdowns in 1995. He ended his NFL career with the San Diego Chargers in 1999. Kramer finished his career with over 15,000 passing yards and 92 touchdowns.
In 2011, Kramers 18-year old
son, Griffen, died of a drug overdose. He and his
former-wife have another son, Dillon, who is 17.
The strongest and most disturbing signs are verbal I cant go on, Nothing matters any more or even Im thinking of ending it all. Such remarks should always be taken seriously. Of course, in most cases these situations do not lead to suicide. But, generally, the more signs a person displays, the higher the risk of suicide.
Thoughts and Emotions
How We Think about Youth Suicide: Changing How We Think
Theres no question that youth suicide isand has long beena mounting problem. According to the CDC, between 2007 and 2017, the adolescent and teen suicide rate climbed steadily year over year. Suicide has now become the second leading cause of death for young people between ages 10 and 14 and 25 and 34, only behind unintentional injuries.
Over the last two years, however, researchers have been scrambling to quantify the pandemics impact on the suicide rate. Comprehensive data are still rolling in, but in November 2021, a statistic in a report from the CDCs National Center for Health Statistics grabbed headlines: between 2020 and 2021, the overall suicide rate had fallen by three percent. That wasnt all: that drop had occurred on top of another three percent drop from the year before.
While careful not to downplay the enduring seriousness of the suicide epidemic, mainstream media seized on the news. After all, these numbers seemed to defy all expectations. How had the combination of a deadly virus, social isolation, mass unemployment, political and social unrestand the marked increases in depression, anxiety, trauma, loneliness, and substance use that ensuednot led to a spike in the rate? How is it possible that instead, it led to the largest annual decline in nearly four decades?
Some media outlets pointed to the quick mobilization of preventive care and teletherapy services, government stimulus, and an increase in community connectedness and neighborly goodwill as possible explanations for the drop. Others couched these attention-grabbing statistics with the caveat that this was the overall suicide rate, and that rates among adolescents and teenagers had continued to increase, translating to more than 500 children between ages 10 and 14, and 6,000 between ages 15 and 24 who completed suicide in 2020, according to CDC figures. Adolescent and teenage girls and Black and Hispanic males in particular saw substantial spikes.
But theres a larger issue in how the recent data were reviewed and disseminated. Most outlets missed an increase in plain sight: they were reporting on suicide completions, not ideation. And ideation numbersespecially as they concern adolescents and teensare alone a major cause for alarm. For mental health professionals who specialize in suicide and suicidality, this oversight isnt just a reporting problem: its a fundamental problem in the way we think about, study, and treat suicide.
The Bigger Picture
Last October, the Substance Abuse and Mental Health Services Administration (SAMHSA) released its National Survey on Drug Use and Health, with some shocking statistics: in 2020, nearly 629,000 adolescents and teens between the ages of 12 and 17 made suicide attempts. The New York Times, The Guardian, USA Today, and many other mainstream publications took attempts into account when discussing suicides, but they neglected to mention the approximately 1.3 million adolescents who had made suicide plans, and the estimated three million who had serious thoughts of suicide.
An already strained healthcare system was left to deal with the fallout. Emergency room visits by adolescents and teenagers skyrocketed during the first seven months of lockdowns. According to CDC data, hospitals saw a 24 percent increase in mental health-related emergency visits for children ages five to 11, and 31 percent for those ages 12 to 17.
This is where the spike had occurredin ideation. But the statistics went mostly unreported. For professor, researcher, and clinical psychologist David Jobes, thats unsurprising.
Our society, the field of psychotherapy included, is preoccupied with the deaths and attempts, he says. Thats understandable, but were overly focused on behavior and trivializing the impact of ideation. We need to be much more focused on this upstream issue. If we were, wed have fewer people downstream making attempts and completing suicide.
An internationally recognized suicidologist, Jobes is Director of the Suicide Prevention Lab at The Catholic University of America, as well as a former president of the American Association of Suicidology, whos studied and written extensively about suicide. Hes also the developer of the Collaborative Assessment and Management of Suicidality (CAMS) model, described by the CAMS website as a therapeutic framework for suicide-specific assessment and treatment of a patients suicidal risk. In other words, it takes the upstream approach.
CAMS boasts eight correlational, replicated, published studies, as well as five published randomized controlled trials, all of which support the intervention. But despite its accolades, Jobes says hes received pushback for his focus on ideation. Ive had papers rejected because weve only reduced to suicidal ideation and didnt have significant findings on attempts, he says. A lot of the big, proven treatments remove attempts but dont touch ideation. Of course you want to decrease completions and attempts, but ideation is up for three million young adults and teenagerswhich reflects a clear level of despair and distress. Its our biggest problem as a nation.
The Research Problem
So why arent we focusing more on ideation? For one, all suicidenot just ideationremains relatively understudied. Over the last five years, the National Institutes of Health (NIH) has dedicated between $68 million and $140 million annually to studying suicide and between $35 million and $80 million to studying suicide prevention. While those figures might seem large, NIH spent between $327 million and $493 million on sleep research during the same period, in which it had a total budget of between 30 and 42 billion dollars.
Many NIH studies contain small sample sizes, which makes it hard to capture conclusive data for an issue as complex as suicide. Funding generally lasts four to five years, which some critics say isnt enough time to fully examine suicide or suicidality. Others say years-long suicide studies are impractical, given that some participants may complete suicide before the trial is complete, skewing the data. Of course, theres also an aversion to orchestrating and approving these trials, given the possibility that participants could die.
Studying suicidality is even more difficult when it comes to children, in part because its so difficult to spot. A 2020 study published in the Journal of Affective Disorders found that roughly one-third of children who completed suicide had no known history of suicidal ideations or self-harm. Sadly, that doesnt mean ideation in children is uncommon. A 2020 study published in The Lancet found that among children ages 9 and 10, one in 12 reported having had suicidal thoughts.
The problem preventing our society from more skillfully addressing youth suicide is threefold: ideation is overlooked by the popular press, understudied in research circles, and sometimes even willfully ignored by the clinical community.
What this means is that when researching suicidality, conclusive data that inform treatment are hard to come by, especially as they pertain to adolescents and teenagers. Case in point: a meta-analysis published in a 2020 issue of Psychological Bulletin, led by clinical child psychologist Kathryn Fox, concluded that 50 years of randomized control trials for suicide-prevention interventions have shown no increase in treatment efficacy. No wonder these studies elicit a shrug from the research community! Theyre hard to manage and fund, and even harder to justify.
So perhaps its not surprising that were hearing more about suicide completion than ideation in the popular press. Completion is easily measurable; ideation is harder to pin down. The result is a vicious cycle, in which we focus more on completion because we hear less about ideation, and we hear less about ideation because we focus more on completion.
Fear, Responsibility, and Courage
Its not just the research community and the media that are mishandling the problem of ideation. Jobes says therapists are playing a part too: theyre practicing defensively, referring out at the first sign of suicidality because they worry a suicide completion isnt far behind.
Im discouraged by how many clinicians avoid working with clients who are or may be suicidal, he says. Its not just that many clinicians dont know how to assess and treat ideation. Theres this attitude of let the psychiatrists handle this; let the real doctors handle this. Its too much for me.
More than 30,000 clinicians all over the world are trained in the CAMS model. But what drives many of them to get training in the first place, Jobes says, is the fear that if theyre not properly trained and a client self-harms or completes suicide, theyll be held liable. Many times, he adds, properly trained clinicianswho can make a differencewill still refer out.
Thats the irony, Jobes says. A person whos well-trained can do lifesaving work. We have effective, proven treatments that are much better than hospitalizing people who could easily be treated, pushing medications that dont really help with suicide risk, or circling the wagons and trying to avoid everyone whos suicidal. That doesnt help anybody, and thats when lives are lost.
Stacey Freedenthal, a therapist and professor at the University of Denvers School of Social Work, who specializes in studying and treating suicide, agrees. Theres research thats looked at the practices of therapists whose clients disclosed suicidal thoughts, and the number that rushed to call the police or send them to the emergency room is really disheartening, she says. I know hospital workers who complain that someone was sent to them when their therapist couldve just done a risk assessment.
Freedenthal says she hopes therapists can shift their thinking about ideation, especially as it pertains to adolescents, teens, and young adults. As a social worker, she says she tends to look for the systemic influences on ideation, including issues that young people are especially passionate about.
So many young people I talk to in and outside my practice have a sense of hopelessness about the state of the world today, she says. In the last couple years, theres been a lot more written about social justice issues in relation to suicidality. Poverty and unemployment are linked to suicidality. Gun violence is linked to suicidality. Climate change is linked to suicidality. Abortion bans are linked to suicidality. These are things young people care about immensely, and theyre causing a lot of fear.
Freedenthal says recognizing these connections will help therapists realize that they can treat ideationand may have already been doing soby discussing their young clients anxieties around the larger social picture. But she hopes that even if the topic of suicide doesnt come up on its own, clinicians will muster a little courage and lean into hard conversations about it. I want therapists to ask kids about suicidal thoughts, even if theyre afraid to do so, even if they dont believe their client may be having them, she says. We have a professional responsibility to do that, not just do whats convenient for us.
A Broken System on the Mend?
The problem preventing our society from more skillfully addressing youth suicide is threefold: ideation is overlooked by the popular press, understudied in research circles, and sometimes even willfully ignored by the clinical community.
The situation remains dire. Last October, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Childrens Hospital Association released a joint statement declaring a national emergency in childrens mental health and calling on government policymakers to take action.
Slowly, those government gears seem to be turning. In July, the Biden administration rolled out a reworked version of the National Suicide Hotlines Lifeline network, a free call service created in 2005 that comprises roughly 200 call centers nationwide, operating 24/7, that connect callers with trained crisis counselors.
The revamp finalizes a three-year collaboration by the Department of Health and Human Services, the Federal Communications Commission, and the Department of Veterans Affairs, which includes $432 million in federal fundingan 18-fold increase from the previous budget.
This cross-government effort has been years in the making, said FCC Chairwoman Jessica Rosenworcel of the initiative, and comes at a crucial point to help address the mental health crisis in our country, especially for our young people.
One of the most recognizable changes is the implementation of a new hotline phone number, 988. The previous number (1-800-273-TALK) and text feature (users can text SOS to 741741) will remain active, but the hope is that this addition will make it easier for people in crisis to reach the hotline.
Other goals include improved response times, the ability to handle more calls and texts, and the ability to route more calls to crisis centers in the callers vicinity. A failure to answer has long been a weakness of the network. According to a Wall Street Journal review published in July, calls to the lifeline increased 92 percent between 2016 and 2021, but one out of every six didnt reach a counselor, amounting to a whopping 1.5 million dropped calls. The average time it took for someone to answer the phone was 45 seconds, and nearly 80 percent of callers who hung up did so after waiting less than two minutes.
In 2021, the lifeline received 3.6 million calls, chats, and textsa number thats expected to more than double over the next year. The website for the lifeline reads that states are at varying degrees of readiness for the volume increases expected from moving to the new number and adds that additional state and local investment is needed to further boost the response rates and staffing capacity of call centers facing the greatest demands.
Freedenthal says the revamp is a step in the right direction. Ive found it really useful to be able to tell young people theres a simple number they can call if they need help, she says. Saying its 988 doesnt turn them off as much as if you say, Heres the number to the suicide hotline.
Jobes, meanwhile, remains cautiously optimistic, not just because the new lifeline could help more callers, but because he thinks it could shed light on what needs fixing in our larger, broken institution of mental healthcare. The hotline is great, he says. But I fear whats going to happen in the potentially lethal gap between someone calling to say, Im suicidal and a thoughtful phone counselor helping them get placed in competent care. That process can take weeks. I think the hotline will expose the fact that we dont have a good system of care for people at risk, but hopefully that awareness will help us create the infrastructure to develop better interventions.
Although the new lifeline is in its infancy, it could help solve the problem that ideation is overlooked, understudied, and ignored. Renewed media attention on the hotline is shifting the public focus away from suicide deaths and onto ideation. SAMHSA, which happens to run the lifeline and collects data on calls, could add to the body of research on ideation. And finally, the lifeline is employing counselors who will need to develop the courage to have hard, uncomfortable, and incredibly important conversations about suicide at the ideation stage.
I really believe
we can turn a corner on this, Jobes says. If we
take the time to understand and validate peoples
experiences, and we treat the thing that actually makes them
suicidal, then were really in the lifesaving
Meanwhile, lack of mental healthcare providers and costly treatments remain barriers to care for many kids. (CNN)
The efficacy of antipsychotics across different patient subgroups -- like kids, those with comorbidities, older folks, and treatment-resistant cases -- was similar to the general population, according to a meta-analysis of 537 randomized clinical trials. (The Lancet Psychiatry)
Hear what some psychiatrists had to say while weighing in on the bipolar disorder of Ye, the singer formerly known as Kanye West. (Washington Post)
A systematic review and meta-analysis found that people with non-affective psychotic disorders like schizophrenia had more than a 2.5 times higher risk for developing dementia later in life. (Psychological Medicine)
Could adding on-call addiction specialists in hospitals help save lives? (NPR)
Royalty Pharma is teaming up with Merck to test the investigational agent MK-8189 -- a potential treatment for hallucinations, psychosis, and other positive symptoms associated with schizophrenia in patients with acute episodes -- in a phase IIb trial. (Endpoints News)
mRNA communication disruption during pregnancy may be to
blame for postpartum
some women, making it a possible area for therapeutic
targeting. (Molecular Psychiatry)
Suicides jumped 29% among adolescents ages 15 to 19 over the previous decade, according to a report released Wednesday.
Adolescent suicides rose from 8.4 per 100,000 during the 2012-2023 timeframe to 10.8 deaths per 100,000 in 2018-2023, according to the new edition of America's Health Rankings Health of Women and Children Report from the United Health Foundation. Adolescent suicides also rose significantly in 10 states. The report captures 121 health measures based on the most recently available public health data from 30 different sources.
On a state-by-state basis, Nevada, Colorado, and South Carolina saw the greatest relative increases in teen suicides during the time periods studied:
In the 2018-2023 period, Alaska had the highest rate of adolescent suicides, at 40.4 per 100,000; that was approximately 8 times the rate of suicide in Massachusetts, which had the lowest ranking at 5.0.
Rhonda Randall, DO, chief medical officer at UnitedHealthcare Employer and Individual, described the rise in suicides among youth as "incredibly sobering." However, looking at the most affected subgroups provides a sense of where the opportunities and "calls to action" are, she said Tuesday during an online panel discussion.
Suicide rates were nearly five times higher among American Indian/Alaska native teenagers than among Black teens (38.9 vs 8.0 per 100,000) during 2018-2023, and teen suicides were 3.2 times higher among males compared with females during that time. (Males historically complete suicide at higher rates than females.) Comparing 2012-2023 and 2018-2023 data, suicide rates increased 28% among both females (4.0 to 5.1 per 100,000) and males (12.7 to 16.3 per 100,000) between those two time periods.
The COVID pandemic likely exacerbated the situation, said Alison Malmon, citing "the struggle, the anxiety, depression, social isolation that youth and young adults had to ... experience." Malmon, whose brother died by suicide in 2000, is the founder and executive director of Active Minds, which supports mental health awareness and education for students.
And youth and young adults weren't given "enough credit" for what they endured, Malmon said. "Being away from friends and trying to come into your own while not having that social connection and network that so many youth [and] young adults ... need," had lasting effects, she said.
At the same time, Malmon noted, the increase in mental health issues among young people began before COVID and stemmed from a range of challenges. From climate change to gun violence, they are "internalizing all of what is around them, and that is becoming a part of their well-being and their overall health," she said.
With regard to specific mental health conditions for youth ages 3 to 17, the percentage with anxiety increased from 7.5% in 2017-2023 to 9.2% in 2020-2023, while depression rose from 3.3% to 4.2%. By state, anxiety in this age group was found to be highest in Vermont (16.9%) and lowest in Hawaii (4.6%); depression was highest in Kentucky (7.3%) and lowest in Hawaii (2.4%).
Asked what surprised her most, Randall highlighted the pervasiveness of trends related to anxiety and depression. "It's rising in all sub-populations. It's rising for all genders," and for adolescents across all socioeconomic statuses, she said.
Frequent Mental Distress Increasing in Women
The report also captured trends related to women's health. Across the country, the share of women reporting "frequent mental distress" rose from 17% in 2017-2023 to 19.4% in 2019-2023 -- an increase of 14%, or more than 1.2 million women. Frequent mental distress is defined as 14 or more days of poor mental health in a month, and is reflective of "persistent, and likely severe, mental health issues," according to the report.
By demographic, the largest increases in frequent mental distress during those time periods were found among American Indian/Alaska Native women, for whom the measure increased from 17.3% to 26.6% and among college graduates, where it rose from 10.2% to 13.5%.
Mortality also jumped 21% (from 97.2 to 117.3 deaths per 100,000) for women ages 20 to 44 during the time period from 2019 to 2020.
The "interconnectedness" of families really stood out in the report, particularly as it applied to women and children, Randall said. The increase in frequent mental distress among women of child-bearing age, many of whom are mothers, has downstream impacts on their family, she said. Similarly, children who are experiencing depression, anxiety, or suicidality can impact their family's mental health, as well as that of friends and others in the community, Randall added.
The report ranked Minnesota the "healthiest state" overall for women and children, and Louisiana the "least healthy state," based on the states' physical environment, behaviors, health outcomes, and social and economic factors.
A Way Forward
In response to rising rates of suicide among young people, the American Academy of Pediatrics (AAP) changed its policy in 2022, and now recommends universal screening for suicide for anyone 12 years and older, explained Arethusa Kirk, MD, vice president of clinical strategy for United Healthcare Community & State.
AAP also recommends screening children ages 8 to 11 for suicide when clinically indicated, and assessing for suicidal thoughts in younger children if they exhibit warning signs, said Kirk. "The symptomatology really presents differently for kids," she said. "They often might not have the language to really describe their feelings."
With certain age groups, if you ask if they're depressed, they may not understand what that means, Kirk noted. "And they may actually present with more somatic symptoms, like headache or stomach ache, or just changes in mood irritability, which may come off as anger and explosive behavior when it's really underlying anxiety and depression."
Studies have shown that a significant number of people who have died by suicide visited a provider in the weeks or months before their deaths, she added. But because more than two-thirds of young people struggling with their mental health will tell friends before they tell anyone else, Malmon stressed the importance of teaching young people how to have conversations with those who may be in crisis.
model -- which
stands for validate, appreciate, and refer -- is one way to
help prevent a crisis. "This basic idea of 'I hear you, I
believe you. Thank you for sharing with me and how can I be
helpful to you?'" is something young adults respond to,
Trends in Suicide Methods Among Adolescents in the US -
From 1999 to 2020, 47 276 adolescents aged 10 to 19 years (3.0% American Indian or Alaska Native, 4.0% Asian or Pacific Islander, 11.0% Black or African American, and 82.0% White; 23.0% female and 77.0% male) died by suicide in the US. Suicide rates increased steadily for male adolescents, from 7.4 to 9.7 per 100 000 population; for female adolescents, from 1.6 to 3.6 per 100 000 population. Among male adolescents who died by suicide, firearms remained the leading suicide method (Figure), but trends differed substantially by race, with firearms increasingly accounting for deaths among racial minority youths. From 2011 to 2020, the proportion of suicide deaths involving firearms increased from 40.0% to 51.0% among Black male adolescents compared with 49.0% to 52.0% among White male adolescents (Table). Among female adolescents, asphyxiation was the leading method since 2000 (Figure). Suicide death by asphyxiation increased from 53.0% in 1999 to 2001 to 74.0% in 2017 to 2020 among American Indian or Alaska Native female adolescents compared with 37.0% to 52.0% among their White counterparts (Table).
Logistic regression models evaluating the association between race and death by asphyxiation vs other methods and between firearms vs other methods, stratified by year and sex, indicated statistically significant interactions. For instance, in 2019 to 2020, Black female adolescents had 1.43 (95% CI, 1.05-1.95) times the odds of suicide death involving asphyxiation vs all other methods compared with their White counterparts, whereas from 1999 to 2003 these odds were 1.06 (95% CI, 0.74-1.52).
This time series found that suicide deaths by asphyxiation increased over time among female adolescents who were members of minority groups, whereas firearms remained the predominant method of suicide death among male adolescents. Furthermore, the proportions of suicide deaths involving firearms among Black male adolescents increased at a much faster pace than that among other racial groups.
Prevention of suicide involving firearms through restriction of access remains urgent.4 The results of this study suggest an additional need to expand suicide prevention initiatives. Reducing access to asphyxiation means is difficult outside of institutionalized settings; thus, a focus on reducing the frequency and intensity of suicidal crises is critical. The emergence of suicide as a public health concern among Black or African American and Asian or Pacific Islander adolescents indicates a need for culturally adaptive, structurally competent approaches to ensure access to mental health services.
Limitations of this study include potential errors in suicide mortality certification and underreporting of suicide deaths, especially for members of minority groups.5 Future studies should consider assessing age, state-level differences, and trends of method of suicide deaths, including clinical characteristics and ethnicity of adolescents.6
1. Centers for Disease Control and Prevention. Multiple cause of death: 1999-2023 request form. Updated July 27, 2022. Accessed July 11, 2022. https://wonder.cdc.gov/wonder/help/mcd.html
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3. Ramchand R?, Gordon JA?, Pearson JL?. Trends in suicide rates by race and ethnicity in the United States. ? JAMA Netw Open. 2021;4(5):e2111563. doi:10.1001/jamanetworkopen.2021.11563?
4. Hunter AA?, DiVietro S?, Boyer M?, Burnham K?, Chenard D?, Rogers SC?. The practice of lethal means restriction counseling in US emergency departments to reduce suicide risk: a systematic review of the literature. ? Inj Epidemiol. 2021;8(suppl 1):54. doi:10.1186/s40621-021-00347-5?PubMedGoogle ScholarCrossref
5. Arias E?, Heron M?, Hakes J?; National Center for Health Statistics; US Census Bureau. The validity of race and Hispanic-origin reporting on death certificates in the United States: an update. ? Vital Health Stat 2. 2016;(172):1-21.PubMedGoogle Scholar
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Isometsä E, Lönnqvist J. Do means matter
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