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WARNING: "13 Reasons Why" Season 2 starts May 18, 2018. Know the facts. Have these supportive resources available for parents, students and stakeholders
You Feeling Suicidal?
Back to School Suicides
Teen Suicide & Firearms
Now a word from Pink
and Suicide Coping with
Traumatic Events and Suicide
Coping with Traumatic Events
Alcohol or drugs are
Pay particular attention if they experience:
1. Loss of a loved one
you never know
Risk factors line up like lights on
the street. For a student to go from thinking about suicide
to attempting suicide, all these lights have to turn green.
One light might be a fight with a parent. Another might be a
flunked test, a breakup, a peers 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.
afraid of the S word.
Youth and elderly suicides are on the increase in the US. And, according to The World Health Organization (WHO) over 786,000 people committed suicide around the world in 1997. This is an effective suicide rate of around 10.7 per 100,000 population per year. To put this statistic in perspective, that is the equivalent of one suicide every forty seconds, somewhere in the world.
Suicide is the ninth leading cause of death in the US with 31,204 deaths recorded in 1995. This approximates to around one death every seventeen minutes. There are more suicides than homicides each year in the US.
From 1952 to 1992, the incidence of suicide among teens and young adults tripled. Today, it is the third leading cause of death for teenagers aged 15-19 (after motor vehicle accidence and unintentional injury). Two-thirds of all suicides under 25 were committed with firearms (accounts for most of the increase in suicides from 1980 to 1992). The second most common method was hanging, third was poisoning. Suicide is increasing, particularly for those under 14 and in those over 65, while not the leading cause of death, the suicide rate is extremely high.
Young men commit suicide successfully
at a higher rate than women in all 30 countries listed
below. In the US, the ratio between men and women was 4.1:1
while in young people 15-24 the average ratio is 5.5:1 and
the ratio increases with age within this group. In white
males over 85, the suicide rate was 73.6/100,000 in 1993.
For more information: www.cdc.gov/ncipc/pub-res/10lc92c.htm
The most common signs of a suicidal person
1. Difficulties with
relationships between friends, family, and others
How to Help Someone
1. Resist trying to
help. People who feel suicidal dont 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 wont 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.
suicide is contagious, and the problem may be worse than we
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 Rileys. 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 fathers house one night when she downed a small bottle of whiskey, then sent out a series of troubling texts and Snapchat messages. Im 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 fathers gun.
When Rileys 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 fathers house. Shed shot herself in the head.
Three days later, and two days before Rileys memorial service, another Discovery Canyon Campus student killed himself. Her daughter probably knew the boy, but they werent close, Rileys mother says. Nine days later, yet another classmate committed suicide. He had been on the swim team with the boy whod just killed himself. And that wasnt 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.
Its 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 classmates suicide no longer fazes students in the area, kids say. Its become almost commonplace, says Gracie Packard, a high school junior in Rileys district. Because it doesnt 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 thats generally pretty tragic, its disheartening, says Dr. Leon Kelly, the countys deputy chief medical examiner. You feel powerless. You feel like, Another one?
Another day, another kid. Its hard.
Death on Instagram
Sociologists have long said people who form bonds are less likely to kill themselves, but sometimes the opposite is truestudies now show that one persons suicidal behavior can spur anothers, and one death can lead to more deaths.
Decades of research prove that a startling range of emotions and behaviors can be contagiousfrom 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 clustersan 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 arent 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 arent 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 its 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, youll 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 theyre romanticizing death.
Scholars are struggling to keep up with the evolving technology, and they say theres 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
Its 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 cant 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 coroners office doesnt always track where the deceased went to school, and districts are hesitant to say how many teens theyve 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 coroners 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 Rileys suicide.
Those tracking the situation are convinced its a contagion, but theyre unsure how its spreading. That makes it all the more frightening and difficult to stop. Its two years in a row weve dealt with the same sort of terrifying trend, says Kelly, the medical examiner.
Colorados 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 parents deployment can lead to increased responsibilities at home for a kid or emotional problems because of the separation and possibility of a parents death.) Some blame the high altitude, which researchers have linked to suicide.
Analysts also point out that young people dont 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 peers 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 didnt show any obvious signs of mental health problems, according to her mother, and wasnt 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 classroomshe fooled around during class, and her grades suffered, which added pressure. She kept saying she hated school; she just didnt 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 fathers 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 shed see them tomorrow.
A little more than a week after Rileys suicide, Brittni Darras, an English teacher at a different school in the area, posted on Facebook that she had learned of another students 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 didnt think anybody would miss me if I was gone.
Darras had lost a student to suicide a few years earlier. Its 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, weve really focused on one thing, and that is seeking help if you need it, says Susan Payne, the initiatives executive director. That meant putting it on the victim thats 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 daughters phone. This is the part that kills meI 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; heres what you look for; heres what you need to dothats not enough, Brewster says. It needs to be ingrained in these kids heads, because theyre 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.
Danielles was one of at least three teen suicides in the Colorado Springs area in a three-week span. Then, six weeks later, Danielles mother hanged herself in her daughters bedroom. Theyre supposed to be here, Brewster says, choking on the words. Were 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 couldnt 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 arent better by this date, then youve tried your best, and you can end it.
Her friends sensed something was wrong. Days before she planned to die, they staged an intervention. Were 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, Im not OK, its going to be one of the scariest things youll ever do, but it will be one of the best things youll 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. Ive had relatives ask me if I would call it an autoerotic asphyxia because they didnt 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 its 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 doesnt 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. Thats 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 adolescents mental health history is a bigger predictor of future suicidal behavior than his or her relationship to the suicide victim.
El Paso Countys most recent teen suicide was on September 19a hanging on school grounds. Because teen suicides there tend to spike at the end of semesterswhen students may feel as if theyre losing whatever support they had at school, Kelly saysofficials may not know until winter break if things are improving. Students arent necessarily sending panicked glances around the classroom, wondering whom this plague will strike next. They have other things to worry aboutexams, rehearsals, sports games, college applications. When it first happens, thats all that is on everyones 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 wont hide how Riley died. Im fully aware that my daughter committed suicide, and I dont know why. She has done social work, and her husband is a local middle school teacher; neither saw the signs. Since her daughters death, she hasnt 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, theres no one to say it back.
to School Suicides
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 dont 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 todays 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, itll 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 childrens 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. 5259.
Molina, J., & Duarte, R. (2006).
Risk Determinants of Suicide Attempts Among Adolescents
American Journal of Economics and Sociology, 65 (2), 407-434
I mean, thats, like, a given. Its all over the press, its all over our popular culture. It is, in fact, THE driving force behind the weighty despair in both A Christmas Carol and Its a Wonderful Life.
Except that its not true.
People attempt suicide and die more often by suicide far more often in the springtime. Thats 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 were going to worry about suicide any time of the year; if someone says he or she feels that life isnt worth living, were not going to ignore this sentiment just because its 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.
Whats going on?
Experts arent 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.
Its 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 dont 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 its 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?
Its 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 outdoorsand these changes are most pronounced in spring. Most importantly, these allergic symptoms are potent markers of inflammation, the bodys 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 seasons allergens inflict.
Theres 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.
Im 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. Wed love for the myth of winter being the worse season for suicidal behavior to be challenged. It just isnt, 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, Id 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
youre worried, ask the person youre worried
about. You wont regret it, and you might just save a
Why do suicide
rates peak in the spring?
This week, mental health experts at the Priory group said that May is the peak month for suicides in Britain. "The increase can be dramatic, with up to 50% more successful suicides in some cases," says Chris Thompson, director of healthcare at the Priory group. In Britain, about 6,300 people take their own lives each year, 90% of whom are likely to have mental health problems.
The seasonal effect is seen all over the world, with the northern hemisphere witnessing a big rise in suicides in May and June and the southern hemisphere seeing a similar rise in November. While no one has a complete explanation as to why, the leading theory is that the increase is down to the effects of sunlight on our hormones.
According to Thompson, the seasonal changes that bring most of us out of winter apathy may work against those who are coming out of severe depression. "It is a harsh irony that the partial remission which most depression sufferers experience in the spring often provides the boost of energy required for executing a suicide plan," he says. "Spring is a time for new beginnings and new life, yet the juxtaposition between a literally blooming world and the barren inner life of the clinically depressed is often too much for them to bear."
Paradoxically, says Thompson, sunlight-driven changes in levels of the feelgood chemical serotonin may make people more aggressive and, if they are depressed, they could direct that aggression at themselves. The theory gains some support from research by Canadian scientists linking seasonal changes in bright sunlight with more violent suicides.
Other researchers believe that the
influence of sunlight on another hormone, melatonin, is to
blame. Sunlight inhibits production of melatonin, which is
known to influence our behaviour.
A seasonal suicide peak in spring is highly replicated, but its specific cause is unknown. We reviewed the literature on suicide risk factors which can be associated with seasonal variation of suicide rates, assessing published articles from 1979 to 2011. Such risk factors include environmental determinants, including physical, chemical, and biological factors. We also summarized the influence of potential demographic and clinical characteristics such as age, gender, month of birth, socioeconomic status, methods of prior suicide attempt, and comorbid psychiatric and medical diseases. Comprehensive evaluation of risk factors which could be linked to the seasonal variation in suicide is important, not only to identify the major driving force for the seasonality of suicide, but also could lead to better suicide prevention in general.
Several epidemiological studies have described a seasonal variation of suicide rates, with a highly replicated suicide peak in springtime [1,2]. However, recent studies have shown that the amplitude of the spring peak is on the decline, while new small peaks are occurring at other times of the year, especially in industrialized Western countries [3,4]. In spite of it being a well replicated phenomenon, the empirical finding of seasonal peaks in suicide is poorly understood.
To date many risk factors for suicide have been reported and they can be categorized by demographic, social and clinical characteristics. Such risk factors include age, gender, rural/urban area of residence , race , month of birth , socioeconomic factors , marital status , inter-personal relationships or life events [10,11], comorbid medical conditions, current or history of psychiatric illness , allergy , and most importantly, previous suicide attempts and violent methods of prior suicide attempt [2,14]. Physical environmental factors, e.g., sunshine, temperature , chemical (e.g., air pollutants)  and biological factors such as viruses , parasites such as Toxoplasma gondii, and aeroallergens [18,19] have also been associated with suicide risk.
Among the numerous risk factors for suicide, it is important to define those that are fluctuating, modifiable, and potentially treatable. Since the seasonal fluctuation in suicide has become a recognized and significant phenomenon, it is desirable to identify variables that consistently demonstrate an association with the seasonal variation of suicidal behaviors as well as completed suicide. For example, environmental factors such as the amount of sunshine and distribution of aeroallergens vary with the seasons. Moreover, clinical variables such as allergic illness, viral infections and mood disorders also manifest seasonal variations and such variations could potentially be associated with the seasonal variation of suicide rate.
A better understanding of the underlying mechanisms responsible for the seasonal variations in suicide could lead to improved and novel suicide prevention strategies. Therefore we comprehensively evaluated published papers, focusing on the potential association between suicide risk factors and seasonal fluctuation of suicide completion in various demographic groups and geographic locations. We also discuss the presence of seasonality of suicide, the strength and the clinical implication of the association for each risk factor.
This is a comprehensive narrative review of journal papers on suicide seasonality published from 1979 to 2011. We carried out a comprehensive search of PubMed/MEDLINE (19792011) using the keywords: suicide and seasonality, cross-referenced with the terms age, gender, methods of suicide, socioeconomic status, sunshine, temperature, geographic region, comorbid disease, allergy, mental illness, infection, and cytokine. After we had identified potential publications of interest we read through the titles and abstracts and those selected were subsequently reviewed and categorized by suicide risk factors of interest. We only included articles in English. Among those, reports dealing with seasonality or monthly fluctuation were taken to review the relationship between seasonality and suicide.
3. Potential Environmental Mediators
Environmental factors have been considered as possible mediators of the seasonal variation in human behaviors and therefore may also influence suicidal behaviors. Here we review physical (i.e., bioclimatic factors such as sunshine, temperature and rainfall), chemical (i.e., pollutants), and biological (i.e., viruses, bacteria, protozoa and allergens) factors as potential triggers of suicidal behaviors in spring or fall.
3.1. Bioclimatic Factors
Bioclimatic factors have been suggested to be potential mediators of the seasonal variation in suicide, though this concept is controversial. Some researchers have documented a positive association between sunshine/temperature/humidity and suicide [20,21,22,23,24,25,26], while others dispute this relationship [27,28,29,30]. In addition, a few studies concluded that a positive association between climatic factors and seasonal variation of suicide was present only for suicide by violent methods [14,31].
Petriduo et al.  suggested that sunlight may act as a trigger of suicide. In addition, suicide rates are greater in rural areas than in urban areas [2,4,33,34] and higher among outdoor workers compared to indoor workers . Some empirical findings support the notion that the intensity of sunlight may play a role in the triggering of suicide and therefore provide a potential link to the seasonal variation in suicide. Hiltunen et al. reported the association between increased suicide mortality and the period with the longest day length (which was between May and July) i.e., late spring/early summer . Another study in Greenland reported a similar pattern. However, both studies suggested the role of latitude and other signals besides the variation in daylight, as the suicide peak of the northern area of Finland (Oulu) was delayed when compared to the southern area (Helsinki) and the strength of the suicide peak was more pronounced at higher latitudes [36,37]. A recent analysis of data from Finland suggested a correlation between solar radiation and suicide mortality  but other studies have also suggested that seasonal suicide peak in spring occurs significantly later than the interval of change in day length [39,40,41]. Furthermore, Papadopoulos et al.  hypothesized that a time lag exists for the effect of solar radiance on suicidality. In summary, seasonal changes in sunlight seem unlikely to fully account for the seasonal variation in suicide.
With regard to temperature, a study performed by Volpe et al.  found that suicide rates in Brazil not only showed a higher peak in December and January than the rest of the year, but were also significantly correlated with increasing temperature. In addition, Kim et al.  reported a 1.4% increase in suicide when temperature goes up by 1 degree Celsius. Temperature could either be a marker of seasonal change, or the mediator of it. In addition, specific meteorological conditions such as temperature and thunderstorm for the preceding day could contribute to increased risk of suicide in individuals .
Precipitation (rainfall and snowfall) is another climatic factor that shows seasonal variation and has thus been postulated to possibly be predictively associated with seasonality of suicide. When Ajdacic-Gross et al.  modeled monthly data on suicide and precipitation in Switzerland precipitation did not show any noteworthy effects on suicide frequencies. Lin et al. also examined the association between monthly suicide rates and climatic influences including atmospheric pressure, temperature, sunshine, humidity, and rainfall in Taiwan; however, they only found evidence of an association of temperature with seasonality, but reported no significant association between rainfall and seasonal peaks of suicide in spring/early summer .
3.2. Geographic Location
Chew and McCleary  comprehensively compared the seasonal variation of suicide across 28 nations and found well replicated seasonal spring peaks in suicide rates from the various nations regardless of the location of the countries. They also observed wide cross-sectional variation in degree of suicide seasonality. For instance, when comparing Canada to Portugal they demonstrated a narrow range of seasonal fluctuation in Canada (ratio of average spring to average winter = 1.08) versus wide fluctuation of seasonal suicide rates in Portugal (ratio of average spring to average winter = 1.70) implicating a more prominent seasonal spring peak in Portugal.
Consistent with the pattern in the northern hemisphere, Flisher et al.  reported a mirror image spring or summer peak of suicide and a trough in fall in South Africa, especially for less urbanized subpopulations. Similarly, studies in Australia  are concordant with studies conducted in the Northern Hemisphere in Europe [1,10,11,32,45,46,47,48] and Asia [18,49,50], identifying a seasonal spring suicide peak.
Allergy has been previously linked to suicide . The seasonality of suicide has been shown to co-occur with the seasonal peaks in ambient pollen concentration during spring (i.e., tree pollen), summer (i.e., grass pollen), and fall (i.e., ragweed) . Pollens are aeroallergens and are capable of inducing an allergic inflammatory reaction when they reach the intranasal mucosa of susceptible individuals. The inflammatory reaction induced by aeroallergens involves the production of Th2 cytokines which, in animal models, have been associated with increased anxiety-like behavior, reduced social interaction  and aggressive behavior  all of which can be considered as endophenotypes for suicidal behavior . Furthermore, the seasonal peak in aeroallergens resulting in the concomitant worsening of allergy symptoms could (via inflammatory mediators of worsening allergy symptoms) potentially worsens depressive symptoms, anxiety and impulsivity in mood disorder patients, resulting in exacerbated risk of suicidal behavior. Consistent with this notion, Manalai et al.  recently reported that in bipolar patients pollen-specific IgE positivity and worsening of allergy symptoms are associated with worsening of depression scores during exposure to aeroallergens. In addition, changes in allergy and anxiety (anxiety representing a potentially independent suicide risk factor) in patients with mood disorders exposed to seasonal peaks of aeroallergens were observed to be correlated . In essence, the current available evidence makes seasonal fluctuation of aeroallergens a possible factor involved in the underlying mechanisms responsible for seasonality of suicide. This is particularly important from a neuroimmune perspective, considering a previous study showed an increased gene expression for cytokines involved in allergic reactions in the orbitofrontal cortex (a region previously implicated histopathologically with suicide) in victims of suicide .
The human immunodeficiency virus (HIV) has been associated with suicide  but no seasonal pattern has been reported in relation to HIV-related suicide rates neither has HIV been known to manifest a seasonal pattern of infectivity. The influenza virus, on the other hand, has a seasonal pattern of infectivity. However the only report of an association of influenza with suicidal behavior  did not include an evaluation of seasonality effect on suicide. More studies on the association of seasonal viruses and suicide are needed.
Air pollutants have been correlated with rates of visits to the emergency room as well as inpatient admission rates of patients with mental illness . Recently Kim et al.  found that the rate of completed suicide in the Republic of Korea was elevated when there was an increase in the ambient particulate matter two days prior to the day of suicide. The two aforementioned studies did not take into consideration the impact of the season on elevation of suicide risk. Szyszkowicz , however, carried out an analysis of data on air pollution effect on emergency room (ER) visit for worsening depression by season and found that the highest percentage of depression-related ER visits were during periods of increased concentration of ambient particulate matter during the cold season and the finding was limited to only females. However, the findings by Szyszkowicz should be interpreted with caution (in terms of elucidation of the seasonality effects of air pollutants on depression), since the analysis did not include an assessment of an interaction between season and pollutant but rather an analysis by season was carried out. It therefore appears that the literature on the potential contribution of pollutants to the seasonality of suicide is sparse and no generalization can be made at this time.
4. Clinical Determinants: Effect of Morbidity
It has been well described that psychiatric disorders are associated with suicide and at the time of suicide completion, more than 90% of suicide victims suffer from a psychiatric disorder . Reports from Finland showed an association between time patterns of attempted suicides and psychiatric disorders (e.g., mood disorders, substance use disorders and schizophrenia-related disorders [59,60].
However, studies on the relationship between seasonal variation in the occurrence or exacerbation of mental disorders and suicide seasonal peaks are limited [45,61,62]. A study  conducted in Sweden showed a seasonal spring/early summer peaks among patients diagnosed with neurotic, stress-related, or somatoform disorder; however, only patients with symptoms severe enough to require hospitalization were studied. Consistent with this study, Brådvik et al.  demonstrated a seasonal spring peak of suicide in a study of male patients with alcohol addiction. Rocchi et al.  also reported on the seasonality of suicide completion among patients with psychiatric illnesses. Recently, Postolache et al.  reported an increased amplitude of the suicide peak in spring among victims of suicide with a history of mood disorders (see Figure 1). Another study carried out by Kim et al.  demonstrated seasonal spring/summer peak of suicide completion in depression and fall/winter peak in schizophrenia.
In addition, significant seasonal peaks were reported in allergy-related asthma, rhinitis, and atopic dermatitis. As allergy-related diseases are associated with suicide completion, seasonal changes in allergens may lead to seasonal increase in incidence and exacerbation of allergic disorders which in turn could potentially be associated with peak in suicide rates, mediated through molecular and cellular components of allergic inflammation affecting the brain . Indeed, Timonen et al.  revealed an association between prior hospitalization for atopic disorders and seasonal variation of suicide.
5. Demographic Variables
Several studies have found associations between age and seasonal variation in suicide. Maes et al.  reported that the suicide rate among younger people was increased in spring (i.e., March and April), whereas the rate within older adults was raised in late summer (i.e., August). However, Lahti et al.  observed a suicide peak in fall among adolescents, particularly for those dying by shooting. Furthermore, McCleary et al.  documented that a suicide peak was observed in younger aged individuals in winter and fall, while suicide among the very old was elevated towards the summer period. The inconsistency between studies may reflect methodological or environmental differences between studies and at the moment, no conclusion can be drawn.
Although seasonality of suicide completion is seen both in men and women, the seasonal patterns differ between genders. For example, only a single spring peak is found in men, while two peaks in spring and fall have been reported in women [4,33,34,40,68]. In England, middle aged women who had school-aged children were more likely to commit suicide in fall, which was the beginning of the school year [4,69]. Though speculative, it may be that a sudden reduction in the duration of direct contact with a dependent represents a type of suicide risk in these women. Gender effect on seasonality of suicide was also noted in Hungary where a steadily increasing prescription rate for antidepressants was associated with a decrease in national suicide rate but significantly decreased seasonality of suicide only in males . The suicide peak in spring has been considered to be a consequence of seasonal occurrence of depression-related suicides and the decreased seasonality of suicide in this Hungarian study was suggested to be a marker of lowering depression-related suicides (especially among men) as a result of increased antidepressant utilization in the population .
Seasonality of suicide attempts is also shown to be associated with gender . Studies performed in Scotland and in Oxford revealed a seasonal variation of female suicide attempts with increased rates during summer and decreased rates in winter, but no significant seasonal variation of male suicide attempts was found [72,73]. In addition, the results of the WHO/EURO Multicenter study on Parasuicides indicated that the seasonal pattern of suicide attempts in women showed a peak in spring and nadir in winter, but no significant variation of suicide attempts was observed within the male subpopulation . However, there have been negative reports as well. Mergl et al. analyzed suicide attempts in Nuremberg and Wuerzburg from 2000 to 2004 and they failed to confirm the significant gender difference in seasonality of suicide attempts . Kreitman et al. also reported no considerable gender difference in seasonality of suicide attempts in the U.S. .
5.3. Month of Birth
While several studies have reported season of birth effect on suicide or suicidal behavior [7,76,77,78], there is lack of evidence to indicate an association between month of birth and seasonality of suicide completion. Dome et al.  found a significantly increased risk of suicide completion among those individuals who were born in spring and summer, however, this study did not show any relationship between season of birth and seasonal variation of suicide. Another study which evaluated the effect of birth month on suicidal behavior in Western Australia reported a notable spring peak of deliberate self-harm and a significantly increased birth in spring within the deliberate self-harm group . However, no season-of-birth effect was observed in relation to completed suicide in the study.
5.4. Socioeconomic Factors
Socioeconomic status can affect suicide rates. Social discrepancy, disputes, socio-economic gradient (urban-rural income gradient, etc.), divorce and resulting single parent family environment can be related with seasonality of suicide. The majority of research findings indicated that the seasonal spring peaks are greater in rural areas compared to urban areas [2,4,79]. In particular, Micciolo et al.  evaluated the seasonality of suicide in Italy from 1969 to 1984 and found the suicide peaks in spring to be more notable in rural areas than in urban areas, although the suicide rates was higher in urban regions. A review by Christodoulou et al.  suggested that this phenomenon might plausibly be related to intensity of seasonal activities such as agricultural work in the rural areas. In fact, Chew and McCleary  reported that the spring peak of suicide is relatively larger in agricultural countries compared to industrial countries. They also found that the larger amount of agricultural work is significantly correlated with the greater spring peak of suicide. Ajdacic-Gross et al.  further posited that as the traditional rural society is disappearing with industrialization, the seasonal variation of suicides might be attenuated.
In addition, seasonality of suicide has been shown to be related to occupational differences. The agricultural and construction sectors usually have intense activity from spring to fall. Näyhä  found that suicide committed by people who served in technical, administrative, and service work (i.e., modern occupations) usually peaked in late fall, while people who engaged in traditional occupations (e.g., agriculture, transport, or manufacturing work) showed seasonal peaks of suicide in spring/ summer. Koskinen et al.  also examined seasonality of suicide in different occupations including farmers, forest workers, construction, and indoor workers. They documented that spring peak and winter trough of suicide pattern was observed in groups of farmers and forest workers. On the contrary, a significant summer nadir was shown within indoor workers. Moreover, in their sub-group analyses by suicide methods, 90.5% of farmers used violent methods, followed by forest workers (79.1%), construction (73.2%), and indoor workers (69.2%), indicating violent suicides decreased among indoor workers. Considering suicides by violent methods show remarkable peaks in spring [2,43,47], it is plausible to expect seasonal spring peaks with people who are more likely to spend time in outdoor settings . Migrant workers can be exposed to higher mental distress and suicide risk as dramatically depicted in the series of attempted or committed suicides in Foxconn production facilities in China between Jan and May 2010 [83,84,85]. However, seasonal variation of suicide in migrant populations needs to be further studied.
These findings seem to indicate that people who are more exposed to the outdoor environment have a greater seasonal spring peak in suicidethus, suggesting that factors driving seasonality may be more abundant in the outdoor environment. For example, increased seasonal work related-stress in farmers and increased exposure to outdoor physico-chemico-biological factors such as day length, light, temperature, pollution, pathogens or allergens may contribute to more ample seasonal suicide peaks.
6. Suicide Methods
Suicide methods can be classified as either violent (i.e., hanging, firearms, drowning, jumping, cutting, or self-immolation) or non-violent (i.e., ingestion of poisons, drugs, gases, or vapors) in terms of lethality based on the International Classification of Diseases . There appears to be seasonal variation of suicide completion by suicide methods. A number of researchers have reported seasonal variation of suicide by violent methods including hanging, jumping from a height, drowning, poisoning, and firearms [3,41,47,66,86,87]. Suicide rates by violent methods peak in spring/early summer and dip in winter, which is consistent with the general pattern of suicide seasonality. Hakko et al.  reported that suicide rates by violent methods increased by 16% in May, while it correspondingly decreased by 15% in December. The patterns of seasonal fluctuation in violent suicides are well replicated, regardless of geographical region. Studies conducted in Europe including Finland [39,88], Italy [47,68], Greece , Belgium [2,89], Greenland [37,90], Switzerland [1,81], UK , Australia, New Zealand , Asia , and the U.S. [93,94] found seasonal spring peaks in violent suicide rates. In Taiwan, however, the violent suicide peaks in summer rather than in spring .
Gender differences have been reported with the use of violent suicide methods. Lester and Frank analyzed a U.S. population-based data and reported seasonal spring peaks of suicide by poison, hanging, or firearms, in addition to seasonal autumn peaks for hanging or firearms among male victims . In contrast, in female victims, they observed seasonal variation of suicide completion with spring and fall peaks by poison or hanging and with summer/late fall peaks by firearms. Furthermore, the study conducted by Yip et al. in which they evaluated Australia-New Zealand population based data, revealed a significant seasonal variation of suicide by hanging in Australian and New Zealand in males only .
Regarding non-violent methods, Hakko et al.  found two peaks of suicide rates within the non-violent subgroup approximately a 9% increase in spring and an 8% increase in fall. However, the majority of studies did not observe any significant seasonal spring peaks in suicides by non-violent methods [2,43,68,89]. Pollen counts have been particularly related to nonviolent suicides in women .
As one of the possible mechanisms to explain the significant spring peaks of violent suicides, we can consider the role of neurotransmitters in violent behaviors. For example, serotonin concentration, is often associated with impulsive and aggressive behaviors  and tryptophan (the main precursor of serotonin) concentration in the brain shows a prominent seasonal rhythm with lower plasma levels measured in spring in comparison to other seasons . Thus, researchers have postulated that low levels of serotonin in the brain could possibly have an influence on impulsive drives, violent behaviors, and potentially result in an individual committing suicide by violent methods [68,96]. A counter argument against the proposition of serotonin mediation of violent suicide could stem from the findings from an Australian study in which hours of bright sunlight exposure were directly correlated with serotonin turnover in the brain, measured invasively . Brain serotonin turnover was seven times higher during the summer than during the winter, thus not entirely consistent with a hypothesis of a serotonergic mediation of suicide seasonality (i.e., low serotonin in spring).
A number of researchers have argued that seasonal variation of suicide by specific methods was determined by the opportunities to access the methods . Ajdacic-Gross et al.  reported that whereas firearms and knives are normally available during the whole year, poisoning (especially pesticides) occurred in the planting season and drowning and jumping are mostly used in outdoor activity season. Lahti et al.  found that suicide by shooting among Finnish adolescents occurred more frequently from August to October and its monthly pattern was positively related to the duration of daily sunshine hours, which were suggested to be related to increased firearm availability during the hunting season in addition to other psychosocial factors.
Seasonality of suicide by methods can vary across different time frames. Ajdacic-Gross et al.  looked at 120 year trends of suicide seasonality in Switzerland and determined that there was a decline of overall seasonal variation during 19692000 compared to 18811920. The most significant difference between the two periods was the attenuation of suicides by hanging and drowning, both of which previously had strong seasonal effects on suicide. Although statistically significant seasonal peaks in spring were exhibited in both periods, the strength of the association has been on the decline with regards to hanging.
Seasonal variation of suicide rates with the most common peak occurring in late spring or summer are one of the most consistent themes from environment-suicide research. In contrast, interactions between demographic factors, environmental factors and suicide methods have yielded inconsistent results.
Although the seasonal patterns of suicidal behavior are highly replicated, the underlying mechanisms are poorly understood and efforts to isolate seasonal variables, such as bioclimatic and socioeconomic variables, to assist in identifying factors mediating seasonality have often resulted in inconclusive findings.
One of the explanations for this inconsistency could be differences in methodology across studies . Obviously, all seasonality-suicide studies are inherently based on correlational studies which cannot explain causal relationships It is desirable to collect data spanning several years and including people from multiple geographical regions to avoid confounding effects from non-seasonality variables and over-generalization bias . Unfortunately, many studies assessed seasonality over a relatively short period of time with data gathered in only one country or even smaller geographic unit . Also, it will be important to establish a consistent set of multilevel variables all studies must account for when analyzing seasonal effects. For instance, in our recent study, after adjusting for the density of psychiatrists, urban vs. rural location and income, significant relationships between airborne allergens and suicide across space have been lost, suggesting a spurious relationship .
In some countries, seasonal suicide peaks have a tendency of being flattened in terms of reduced amplitude and smaller proportion of variance accounted for by the season. Recent studies using data from England and Wales , Hong Kong , Sweden , and Denmark  have demonstrated a diminishing seasonality tendency on suicides. However, this phenomenon does not apply in some other countries, such as Finland [20,39,41] and the United States , where a resilient seasonality pattern continues to be found for suicides or parasuicides. Overall, there might be a possibility that the contribution of season, while present, is so small that it can be irrelevant when other risk factors, such as gender and mental illnesses, are adjusted for. Few studies have examined seasonality in the context of other risk factors [104,105,106].
A better understanding of the mechanisms leading to seasonal peaks of suicide attempts and completions, may lead to identifying factors that could be amenable to preventative interventions and result, in the longer run, in flattening seasonal peaks of suicide and possibly, improved suicide prevention in general
Teodor T. Postolache was supported by R01MH074891 from NIH and, the American Foundation for Suicide Prevention. Jong-Min Woo was supported by the Forest Science & Technology Projects (S111111L020100) from Republic of Korea Forest Service (PI, Woo) and by the National Evidence-based Healthcare Collaborating Agency (NM 11-003). Olaoluwa Okusaga was supported by the Psychiatry Residency Training Program/St.Elizabeth Hospital, Washington DC. We also thank Uttam Raheja for his help with Figure 2. The authors thank Christine Ballwanz for her indispensable assistance.
Conflict of Interest
The authors report no competing interests.
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Legislature tackles teen suicide, what experts would like to
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 states 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 dont 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 2012-2014, according to a health department report. More than one in eight teens surveyed said theyd 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 dont 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 its 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 ones 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.
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 Hampshires 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 ones 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 apps tip feature has prevented over 20 planned school attacks this year.
I dont 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 cant 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 states 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 doesnt anticipate challenges to any of these measures.
If you go back and look at suicide prevention legislation weve run, frequently its a unanimous vote and always bipartisan. Thats because its as nonpartisan an issue as issues come, Eliason said.
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 dont 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 states 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 centers 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, were
not investing in primary prevention, said Hood. Adds
Myers, were rescuing people from the
When a Father
Dies by Suicide
By keeping this issue a secret he is giving it power to destroy his life while it spreads as a cancer into his thoughts, actions, and relationships. Isolation is the worst way to live a full life, because it convinces a person that no one needs to know, that no one really understands, and ultimately, that no one really cares. Thats not true!
If youre 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
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 well 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 nations 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 organizations 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
The American Foundation for Suicide Prevention is dedicated to saving lives and bringing hope to those affected by suicide. AFSP creates a culture thats 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 OBrien,
347-826-3577 or firstname.lastname@example.org
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 cant 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 shouldnt 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
CDCs report here.
friend is talking about suicide. What should I do?"
You Wanna Kill Yourself? Gays and Suicide."
more women suffer from depression that men do, so it seems
odd that women would commit suicide at only one-fourth the
rate of men. The key difference between the two sexes may be
that women talk out their problems. George E. Murphy, an
emeritus professor of psychiatry at Washington University
School of Medicine in St. Louis, says that women may be
protected because they are more likely to consider the
consequences of suicide on family members or others. Women
also approach personal problems differently than men and
more often seek help long before they reach the point of
considering suicide. 'As a result, women get better
treatment for their depressions,' Murphy says. To reduce the
rate of suicide in men, Murphy suggests that physicians
should be alert for risk factors in men and refer them into
treatment. Writing in the Journal of Comprehensive
Psychiatry, he says that identifying men at risk require
mental health professionals to recognize that depressed men
may understate emotional distress or difficulty with their
problems." Black Men, 3/99.
It's important for people with suicidal feelings to let themselves be assisted in overcoming deep depression. It's also a good idea to talk about your feelings with friends. No man is an island and there's nothing wrong with leaning on people who love you in times of need.
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
Clustering of Teenage Suicide
The young are heated by nature as drunken men by wine.
Aristotle made that observation 2,300 years ago, and since then, not much has changed about the way the adolescent brain behaves. But these days, researchers are beginning to understand exactly why a teenagers 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. Its 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. Its why first love really does break the heart.
Its 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 rodents 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. Dont 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. Dont make an appointment for a doctor
down the road.
adolescent suicide prevention
Sources of information
A literature review was performed using Ovid MEDLINE with the key words suicide, attempted suicide, and evaluation studies or program evaluation, adolescent.
Challenges for family physicians The following case presentation illustrates the complexity of dilemmas presented to family physicians who work with adolescents with mental health concerns. This review of adolescent suicide will equip physicians with an approach to help such patients.
Sarah, a 16-year-old patient you have not seen in several years, has booked an appointment to discuss starting birth control pills. Sarahs 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 Sarahs parents divorced last year. While taking Sarahs 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 lobjet dune révision
par des pairs Can Fam Physician 2010;56:755-60
Four of the five most popular forms of social media harm young peoples mental health, with Instagram the most damaging, according to research by two health organisations.
Instagram has the most negative impact on young peoples mental wellbeing, a survey of almost 1,500 14- to 24-year-olds found, and the health groups accused it of deepening young peoples 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 childrens and young peoples 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.
Its 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 peoples 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 peoples health experience, self-expression, loneliness, depression and emotional support.
However, the leader of the UKs 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. Its 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 childrens mental health one of her priorities, highlighted social medias 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.
Rash of Teen Suicides in Palo Alto, the CDC Sends Team to
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 2013-2014 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 Altos 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 Altobased Project Safety Net, told the Mercury News.
The inquiry will be in the form of whats 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 Nets 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.
Warning Signs and Major Risk Factors of Teenage Suicide
Although it is almost impossible to predict precisely which teenager will attempt suicide, there are warning signs that parents can look for. The American Academy of Child and Adolescent Psychiatry has assembled this list of indications. If one or more of these signs occur, parents should talk to their teenager and seek professional help.
In high-risk patientsthat is
patients who have threatened or attempted suicidethere
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.
Suicide and Self-inflicted Injury per 100,000 age 15-24,
Risk following Adversity-Related Injury
Adversity-related injuries were associated with three- to five-fold increases in the 10-year risk for suicide, homicide, and deaths related to drug and alcohol use compared to accident-related injuries. The highest risk of death from any cause was among boys treated for self-inflicted or alcohol- or drug-related injuries when they were 18 to 19 years old. Suicide risk increased for both boys and girls following a self-inflicted or drug- or-alcohol related injury, and increased for boys following a violent injury.
The researchers concluded that, given the increased long-term mortality risk among adolescents hospitalized for adversity-related injury, prevention efforts should be expanded to include a psychosocial assessment for these youth prior to hospital discharge.
Herbert, A., Gilbert, R., Cottrell,
D., & Li, L. (2017). Causes of death up to 10 years
after admissions to hospitals for self-inflicted,
drug-related or alcohol-related, or violent injury during
adolescence: A retrospective, nationwide, cohort study.
Lancet, 390(10094), 577587
Suicide in the Community: Prevalence and Correlates in One
Results. Forty-eight percent of weighted participants (n=816/1,687) reported lifetime exposure to suicide. Current depression and anxiety symptoms were higher in suicide-exposed than in suicide-unexposed individuals. Suicide-exposed individuals were twice as likely as suicide-unexposed individuals to have diagnosable depression and almost twice as likely to have diagnosable anxiety. Suicide-exposed individuals were more likely than suicide-unexposed individuals to report suicide ideation (9% vs. 5%). Closeness to the decedent increased the odds of depression and anxiety and almost quadrupled the odds of posttraumatic stress disorder.
Conclusion. Exposure to suicide
is pervasive and occurs beyond family; as such, it is
imperative to identify those with perceived closeness to the
decedent. This hidden cohort of suicide-exposed people is at
elevated risk for psychopathology and suicidal ideation.
The Role of the
School in Suicide Prevention
Parental Notification and Participation
Even if a youth is judged to be at low risk for suicidal behavior, schools may ask parents to sign a documentation form to indicate that relevant information has been provided. Parental notifications must be documented. Additionally, parents are crucial members of a suicide risk assessment as they often have information critical to making an appropriate assessment of risk, including mental health history, family dynamics, recent traumatic events, and previous suicidal behaviors. After a school notifies a parent of their child's risk for suicide and provides referral information, the responsibility falls upon the parent to seek mental health assistance for their child. Parents must:
Continue to take threats seriously: Follow through is important even after the child calms down or informs the parent "they didn't mean it." Avoid assuming behavior is simply attention seeking (but at the same time avoid reinforcing suicide threats; e.g., by allowing the student who has threatened suicide to drive because they were denied access to the car).
Access school supports: If parents are uncomfortable with following through on referrals, they can give the school psychologist permission to contact the referral agency, provide referral information, and follow up on the visit.
Maintain communication with the school: After such an intervention, the school will also provide follow-up supports. Your communication will be crucial to ensuring that the school is the safest, most comfortable place for your child.
The presence of resiliency factors can lessen the potential of risk factors to lead to suicidal ideation and behaviors. Once a child or adolescent is considered at risk, schools, families, and friends should work to build these factors in and around the youth. These include:
© 2015, National Association of
School Psychologists, 4340 East West Highway, Suite 402,
Bethesda, MD 20814; (301) 657-0270, Fax (301) 657-0275;
Suicide Prevention Shows Results
Many Teens at Risk
for Suicide Don't Get Help
Teen-ager Suicide Rates Increase
Have you seen anyone with a
semicolon tattoo? Here's what it's about.
Have you seen anyone with a tattoo of a semi-colon? If not, you may not be looking close enough. They're popping up...everywhere.
That's right: the semicolon. It's a tattoo that has gained popularity in recent years, but unlike other random or mystifying trends, this one has a serious meaning behind it. (And no, it's not just the mark of a really committed grammar nerd.)
This mark represents mental health struggles and the importance of suicide prevention.
Project Semicolon 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.
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."
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:
Suicide is also more common in bisexual and homosexual teens.
Suicide Warning Signs
According to the American Association of Suicidology, the warning signs of suicide can include:
If you think that your teen has any of the warning signs for suicide, don't ignore them. Trust your instincts and either try to get more information or seek additional help.
Preventing Teen Suicide
In addition to all of the teens who successfully commit suicide, there are many more who attempt suicide. Experts estimate that 20 to 25% of teens admit to thinking about suicide at some time in their lives and for every suicide, there are between 5 to 45 suicide attempts.
That makes it even more important for parents, pediatricians, and everyone else that is regularly around teenagers to understand how to try and prevent suicides, such as:
You should also make sure that teens
know that they can ask for help if they ever think about
hurting themselves, including calling the National Suicide
Prevention Lifeline - 1-800-273-TALK (8255), Crisis Text
Line 741741, calling their doctor, calling 911, or going to
a local crisis center or the emergency room.
National Center for Health Statistics. 10 Leading Causes of Death, United States. 2005, All Races, Both Sexes.
Suicide in children and adolescents. Greydanus DE - Prim Care - 01-JUN-2007; 34(2): 259-73.
Sullivan et al. Suicide Trends Among Persons Aged 1024 Years United States, 19942012. MMWR. March 6, 2015 / 64(08);201-205.
Text Message (Crisis TCall - 741741
and type SOS
900,000 Teens Planned Suicides While Depressed
Suicide Risk: Moving Beyond Fear to Opportunity
Ive seen the unease around youth cyber safety in my own social media feeds and online news platforms, but lets 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 theyre concerned about someones 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 wont 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, lets 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), 317.
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, 6978.
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
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. Humenskys 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.
We can't tear out a single page from our life, but we can throw the whole book into the fire. - George Sand
"If you're feeling suicidal this would be an ideal time to try what you always wanted to try but were afraid to try."