Teen Suicide-2
Youth Learn More The Garrett Lee Smith Suicide Prevention Program provides grants to support suicide prevention in campus, state, and tribal communities. For more on this program, see our Grantees page. Learn more about suicide prevention in School settings. For more on other groups and settings, see our Populations and Settings pages. See All Resources Related to Youth (below) for a full list of materials, programs, trainings, and other information available from SPRC. Use the filters on the left to narrow your results.
Source: www.sprc.org/populations/youth?utm_source=Weekly+Spark+3%2F15%2F19&utm_campaign=Weekly+Spark+March+15%2C+2019&utm_medium=email
New
Youth Warning Signs: Experts Release Consensus Derived List
of Warning Signs for Youth Suicide To address this gap in knowledge, a panel of national and international experts convened to resolve this problem and help the public better understand the way youth think, feel, and behave prior to making life-threatening suicide attempts and inform them about how to effectively respond. The main goal was to determine what changes immediately preceded suicide attempts or deaths that are supported by research and rooted in clinical practice by experts and for the first time we can now confidently put forward that these are the warning signs that a young person might be at risk of suicide. The newly agreed upon list of warning signs and additional resources for how to respond to recognized risk was released today (9/9/15) and can be found at: www.youthsuicidewarningsigns.org Youth Suicide Warning SIgns 1.Talking about or making plans for
suicide. Withdrawal from or changing in social connections/situations How to Respond If you notice any of these warning signs in anyone, you can help! 1. Ask if they are ok or if they are
having thoughts of suicide Prior to the meeting, the experts reviewed and analyzed all available literature and conducted a survey of youth suicide attempt survivors, as well as those who lost a youth to suicide. The panel was then convened and consisted of researchers with extensive experience working with suicidal youth, public health officials, clinicians with decades of individual experience helping suicidal youth, school teachers, and various other stakeholders including individuals representing national organizations focused on suicide prevention. Following the consensus meeting, focus groups with youth and adults were held to gain their input on the findings and dissemination plans. The following organizations were involved. Aevidum Contact: Dr. Dan Reidenberg at dreidenberg@save.org or (952) 946-7998 or Dr. Michelle Cornette at cornette@suicidology.org Source: Suicide Awareness
Voices of Education, www.prnewswire.com/news-releases/experts-release-consensus-derived-list-of-warning-signs-for-youth-suicide-300140396.html Talking to
Teens about Suicide Many parents wonder whether they should talk about suicide with their teenagers—and if so, what they should even say. Kerri Nickerson of EDC’s Suicide Prevention Resource Center says that talking about suicide and mental health can actually help promote help-seeking and resilience among teenagers. Here, she offers parents some important, practical tips for beginning this discussion. Q. The popular Netflix show 13 Reasons Why has many parents wondering how to talk to their teens about suicide—or even if they should. Is there any danger in parents bringing up this subject? Nickerson: No. There’s a myth that talking about suicide can plant the seed of suicidal thoughts or somehow increase a person’s risk of attempting suicide. That’s simply not true, and there’s very solid research on this. One of the positive outcomes from 13 Reasons Why is that it provides an opportunity for parents to have a meaningful dialogue with their teenager about suicide and the importance of mental health. Q. So how should parents talk to teenagers about suicide? Nickerson: I think there are three things to keep in mind. First, try to establish an open and honest dialogue about behavioral and mental health with your teenager. If you notice changes in his or her sleeping habits, mood, or relationships, it’s good to ask about those. Those early conversations help pave the way for more difficult ones about suicide. Second, parents should talk about suicide directly. You don’t want to skirt around the issue, especially if you have seen some potential warning signs. “Have you ever thought about suicide?” is a perfectly appropriate question, and it allows the teenager to answer honestly. Avoid asking leading questions such as, “You’re not thinking about suicide, are you?” because that places a certain judgment on the teen’s answer, and makes them less likely to answer in the affirmative if he or she has considered it. And third, think about your responses ahead of time. If your child says, “Yes, I have thought about suicide,” it’s important that you know how you want to respond. That’s the moment to talk about next steps—such as connecting with a mental health provider or calling the National Suicide Prevention hotline—to make sure your child gets the mental health support he or she needs. Q. Why do these conversations help teens? Nickerson: There are lots of benefits to parents engaging in these conversations. One benefit is that they build connectedness, which is a known protective factor against suicide. Connectedness refers to the number of meaningful relationships a teen has with caring adults, caregivers, or peers—people in their life who would take conversations about suicide and mental health seriously. It’s a really important factor. So much so, that in 2011, the Centers for Disease Control and Prevention identified connectedness as its strategic direction for addressing suicide. Q. How do conversations about suicide fit into an overall strategy that can reduce teens’ suicide risk? Nickerson: Because suicide is complex, no one strategy will prevent all suicides. Instead, it’s important for communities, health professionals, parents, and other loved ones of youth at risk for suicide to work together. However, some research indicates that programs that give people the tools to talk about suicide can reduce suicide. Take gatekeeper trainings, for example. These programs train school staff, parents, and teens on how to recognize the warning signs for suicide and how to refer at risk people for help. Communication is a key part of gatekeeper trainings. In fact, a 2015 study suggested that these programs contributed to a significant reduction in youth suicide. One of the findings from this study, though, was that after gatekeeper trainings stopped, the reduction in suicides was no longer seen. So it shows that programs that promote talking about suicide can save lives, especially when combined with other suicide prevention strategies, but those programs must be sustained over time. Q. What are some ways that schools and communities can build a culture where teenagers seek out help if they are considering suicide? Nickerson: Schools and communities that adopt several approaches to suicide prevention are the most likely to succeed. Schools should have policies in place for what to do when a student at risk for suicide is identified or when teachers, staff, or students are concerned about a student. Schools should also have clear policies for what to do if a student death were to occur. Schools are also in a unique position
to promote help-seeking and positive mental health of their
students. One way some schools, and those working with
schools, have done this is to create communication campaigns
as part of their comprehensive suicide prevention strategy
and use messaging that focuses on promoting hope and
help-seeking. Stories about teenagers who were struggling
and reached out for help successfully or a particular
teenager who helped a friend in need can be really powerful.
They can also counter the narrative that teenagers
can’t do anything about suicide. Many teenagers
encounter struggles in their lives—but stories of hope
and resilience show that help is available and recovery is
possible. Safety
Plan for youth having thoughts of suicide
A safety plan can help keep you safe, if you are feeling overwhelmed and having thoughts of ending your life. Making a plan like this will help you to understand yourself better, keeping you safer. It’s important to share this plan with your parents and people close to you, so they can support you. If your needs or triggers change, revise your safety plan with your counsellor or therapist. If you don’t have one, call your local Youth Crisis Line for help. If you’re still having trouble keeping yourself safe, you can always come back. Some youth like to get creative with their safety plans. Use art, music, scrapbooking or writing-whatever helps you to express yourself! My triggers What are some things that set me off?
How can I manage my triggers?
My warning signs What are my warning signs that tell me I’m starting to get overwhelmed? (for example, withdrawing from others or sleeping more)
My coping strategies What are some helpful things that will take my mind off the problem? (for example, going for a walk, calling a close friend to just vent, watching a movie, sleeping) Reasons for living Who are the people or animals I live for? (for example: mother, father, brother, sister, friends, relatives or pets) What are other things I have to live for? (for example: remembering that things will get better one day, future goals like school, career, travel or family goals) Sometimes, when people are feeling sad, they have a hard time seeing the reasons for living. If this is the case for you right now, what are some reasons that others might point out for you? My support network Who are main people that I can turn to for support if I am overwhelmed? (people to whom I can say, "Hey, I’m not feeling good right now, I really need someone to talk to… I don’t need advice, I just need you to listen… Can we talk?") Think about people in your life who can support you...
Crisis plan and resources If no one is available, what are the local telephone crisis lines in my area? Check the ones you like best. Text
Talk
Source: www.cheo.on.ca/en/Suicide-Safety-Plan
Preteen
suicides are rare, but numbers are on the rise Jamel Myles died Thursday of suicide, the Denver Office of the Medical Examiner said Monday. His mother said on Facebook that he had been bullied by classmates. "Please we are all the different and thats what makes us the same because we all have 1 thing in common we're all different thats what makes this world beautiful," Leia Pierce wrote in the post. "I want justice for my son and every kid who is bullied.. I want bullying to end I never want to hear someone else go thru this pain," Leia Pierce wrote in her public Facebook post. The Centers for Disease Control and Prevention reports that the teen suicide rate rose by more than 70 percent between 2006 and 2016. Suicide was the 10th leading cause of death for elementary school-aged children in 2014, the CDC reported. The death rate among 10- to 14-year-olds more than doubled from 0.9 per 100,000 in 2007 to 2.1 per 100,000 in 2014. Suicide is a particular concern among LGBTQ youth. Pierce told KUSA-TV that her son was bullied because he was gay. Denver Public Schools said late Monday it was "deeply committed to ensuring that all members of the school community are treated with dignity and respect, regardless of sexual orientation, gender identity, or transgender status. It is critical that our students receive all the supports they need to learn and thrive in a safe and welcoming environment." The district said it has policies and training to prevent and stop bullying, and that it fully respects gender identity, "including use of preferred pronouns and restrooms." Three out of four LGBTQ youth have searched online for information about depression, a survey this year of 14- to 24-year-olds by Hopelab found. That was more than double the percentage of straight youth who searched for the information. The percentages who looked for information on anxiety were was similar: 75 percent of LGBTQ youth, compared to 36 percent of their straight peers. Social media is a big part of the problem, says psychologist Benjamin Miller, chief strategy officer at the nonprofit Well Being Trust, which was a partner of Hopelab for the study. Preteens and teens are "not given enough time to process heavy and emotional issues every day," Miller says. "How do you process that as a teenager when you're still trying to learn coping skills?" he asks. "It’s an even bigger problem if you are 6 to 12 years old." There's a "significant relationship" between peer victimization and suicidal ideation, researchers reported in JAMA Pediatrics in 2014. The authors analyzed 34 studies, with participants ranging from 9 to 21 years. The suicide rate among black children aged 5 to 12 appears to be roughly double that of white children of the same age group, researchers funded by the National Institute of Mental Health reported this year. In contrast, the rate of suicide for black adolescents was half that of white adolescents. She asked that his name be spread "with love and justice for all like he wants." Miller says the rising rates speak to
a need for more school mental health services and "to where
we are as a society, and our lack of hope and feelings of
despair." Report Details
Oregon Teen Suicide Rate The Oregon Health Authority's 2016 Youth Intervention and Prevention Plan Annual Report says those 38 suicides accounted for 45 percent of the suicides reported among youth 24-and-under. The report says Oregon went from having the 12th-highest youth suicide rate in the nation to the 16th in 2015. The report shows there were 695 hospitalizations of youth 24-and-under in 2015 for self-inflicted injury/attempted suicide. Nearly 17 percent of eighth-graders and 18 percent of 11th-graders statewide who took the Oregon Healthy Teens Survey in 2017 reported they had seriously considered suicide over the previous 12 months. For more information about preventing
youth suicide click here. Talking About
Suicide in Schools AFSP As a clinical psychologist at the University of Pennsylvania’s Center for the Treatment and Study of Anxiety and a member of the Anxiety and Depression Association of America (ADAA), I value bringing awareness about mental health issues to the public. We know that talking about suicide and suicide prevention in productive ways is very important for both the individuals suffering from suicidal ideation, and the people who so desperately want to help them. Suicide can affect everyone. The good news is, there is room for all of us to get involved with suicide prevention. School-based interventions that involve students, faculty, and parents are one way we can promote and implement suicide prevention efforts. This work can begin with school administrators, but can easily extend to students and parents as well. So how do we start talking about suicide in our schools? And what are productive ways in which to do this? One way is to create small groups for students to discuss difficult issues like mental health problems, family difficulties, interpersonal challenges, and painful emotions. This is especially important as it is more likely that a student will report something to another student rather than to an adult. Helping establish relationships between students and faculty can also serve as a preventative measure with regard to suicidal ideation, violence, bullying, etc. Preventative measures should include promoting help-seeking, emotional well-being, and networks of social support and “connectedness” among students, faculty, and parents. After-school clubs and relationship-building activities are also ways to connect students to each other and provide alternatives to negative behaviors and isolation. How do we implement preventative interventions? It’s important to enhance resilience and life skills among children and adolescents. Sponsoring mindfulness and stress reduction workshops can help individuals take control in managing their mental health. Providing information about self-help tools, coping, and emotion regulation, and connecting students to apps they can use on their phones that assist in building these skills can help in the management of life stress and mental health challenges. Incorporating lessons about empathy, forgiveness, and behavior management into curriculums can help expand one’s insight and understanding. Other helpful interventions include showing kids how to reach out, encouraging them to do so, making care available and ensuring that a suicide hotline number (Editor: And the Crisis Text Line 741741) is easily accessible. Teaching bullying prevention is also important, as it is linked to a variety of mental health issues, not just suicide. What else can we do? Identify students at risk! This includes prior attempts, misuse of drugs, family history of suicide, chronic illness or disability, and lack of access to mental health care. School-based screening programs that protect student identity while identifying the presence of suicidal ideation and risk factors can also help with suicide prevention. These screenings should include parents, school personnel, and students in this process in a collaborative way. Screening should be done with efforts to educate and reach out to students regarding suicide in order to empower individuals to be aware of their own mental health as well as signs of people suffering around them. Making concerted efforts to reach LGBTQ groups in schools is also critical, as stress from discrimination is a known risk factor for LGBTQ youth. It is important to educate students, parents, and faculty as to the warning signs of suicide. These include but are not limited to suicide notes or plans, making final arrangements, preoccupation with death, changes in behaviors, thoughts, and/or feelings. How do we manage death by suicide? In the event that someone dies of suicide in the school, plans for the presence of extra mental health counselors, grief groups, etc. should be established so that students and parents and faculty can talk, healthily process their feelings, and support each other. So what do we do now? Start the conversation! The point is
that social support and connection are key factors that
buffer against suicide. In school and out, we should all
strive to find more ways to communicate and connect about
our own struggles and personal challenges…even when it
is hard or uncomfortable. Why Do Adolescents
Attempt Suicide? A suicide attempt is defined as “a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die” (Silverman, Berman, Sanddal et al., 2007, p. 273). Fortunately, suicide among teenagers is infrequent. However, teens have a relatively higher rate of suicide attempts than adults. Much of suicide research is concerned with who attempts suicide rather than why they do so. For both researchers and clinicians to gain a better understanding of what contributes to an individual’s suicide attempt, Dr. David Klonsky of the University of British Columbia, along with Dr. Alexis May now at Wesleyan University, developed the Inventory of Motivations for Suicide Attempts (IMSA), based on several widely accepted theories of suicide. QUESTION: Why do adolescents attempt suicide? STUDY In the present study, Dr. Klonsky utilized the IMSA to assess suicide attempt motivations of 52 adolescents ages 12-17 years (mean age 14.8 years) who were hospitalized at a psychiatric inpatient unit after a suicide attempt. Eighty-five percent of the sample were female. The average age of the initiation of suicidal ideation was 12 years old. The percentage of participants reporting only one suicide attempt was 67. The IMSA includes 10 five-item scales plus four additional items. The scales are based around feelings of:
The first six of these scales reflect internal factors (intrapersonal) while the final two scales reflect factors associated with communication (interpersonal). The middle two scales, Impulsivity and Problem-Solving, aren’t strongly associated with either factor and are considered separately. Participants were asked to identify feelings they’ve experienced, based on a series of statements, each beginning with the phrase, “I attempted suicide because…” For instance, “I attempted suicide because I wanted to die,” which highlights the intent behind the attempt; or “I attempted suicide because… I felt overwhelmed and in too much pain from humiliation,” which implicates psychache as a driving factor. The study participants then rated their agreement with four additional general statements about suicide on a scale of zero (not at all important) to four (most important), based on how they felt leading up to their suicide attempt. To assess if adolescents’ reports of suicide attempts were accurate, another suicide scale, the Columbia-Suicide Severity Rating Scale, was also administered. RESULTS Describing their motivations at the time of their attempt, 98 percent of participants endorsed the item “I attempted suicide because I wanted to die,” though there were varying levels of degree of intent to die. The three strongest motivators for suicide attempts in this teen sample were Psychache, Hopelessness, and Escape. The weakest motivator was Interpersonal Influence. These results were similar to those of Klonsky’s previous study of adult suicide attempt survivors, which used the IMSA to assess motivations for attempts. Burdensomeness was found to be a stronger motivator for adolescents than for adults. Interpersonal Influence, the least important motivator for adults, perhaps surprisingly, appears to be even less important to adolescents. Internal motivators, for teens, were more strongly associated with suicidal behaviors than external motivators. This means that at the time of the suicide attempt most people perceived that suicide was the only way to end their own emotional or psychological struggles. These results oppose the idea that youth attempt suicide solely for attention or to obtain the help of others. Rather than engaging in suicidal behavior to gain the help of others, the study made evident that teens more often attempt suicide because they are in emotional pain, feel hopeless, and do not believe there can be any resolution to their problems. TAKEAWAYS
Reference Silverman MM, Berman AL, Sanddal ND,
O’Carroll PW, Joiner TE. Rebuilding the Tower of Babel:
A Revised Nomenclature for the Study of Suicide and Suicidal
Behaviors Part 2: Suicide-Related Ideations, Communications,
and Behaviors. Suicide and Life-Threatening Behavior. 2007;
37(3):264–277. Teen Suicides:
What Are the Risk Factors? Temperament, family and
community all play a role One of the myths about suicidal talk, and actual suicide attempts, in young people is that they are just a bid for attention or “a cry for help.” Kids who talk or write about killing themselves are dismissed as overly dramatic—obviously they don’t mean it! But a threat of suicide should never be dismissed, even from a kid who cries “Wolf!” so many times it’s tempting to stop taking her seriously. It’s important to respond to threats and other warning signs in a serious and thoughtful manner. They don’t automatically mean that a child is going to attempt suicide. But it’s a chance you can’t take. When thinking about this, it helps to understand what factors make a young person more or less likely to consider or attempt suicide. What do we know about young people who try to kill themselves, or who actually die by suicide? Let’s take a look at both the risk factors—things that increase the likelihood that a child will engage in suicidal behavior—and the protective factors, or things that reduce the risk. If a child has a lot of risk factors and hardly any protective factors you need to be extremely concerned about him. On the other hand, if he has a fair number of risk factors but a lot of protective factors you may be somewhat less concerned, although you still, of course, need to be concerned. Here are some key suicide risk factors:
But what about protective factors, things that can mitigate the risk of engaging in suicidal behavior? Here are some key protective factors:
So what do you do if your child fits the profile of someone at risk for youth suicide? Warning signs of suicide to be alert to include changes in personality or behavior that might not be obviously related to suicide. When a teenager becomes sad, more withdrawn, more irritable, anxious, tired, or apathetic—things that used to be fun aren’t fun anymore—you should be concerned. Changes in sleep patterns or eating habits can also be red flags. Acting erratically, or recklessly is also a warning sign. If a teen starts making really poor judgments, or he starts doing things that are harmful to himself or other people, like bullying or fighting, it can be a sign that he is spinning out of control. And, finally, if a child is talking about dying, you should always pay attention. “I wish I was dead.” “I just want to disappear.” “Maybe I should jump off that building.” “Maybe I should shoot myself.” “You’d all be better off if I wasn’t around.” When you hear this kind of talk, it’s important to take it seriously—even if you can’t imagine your child meaning it seriously. What to do? The first thing to do is talk. For more information and resources on
suicide, see the APA’s suicide help
page. Youth Risk
Behavior Surveillance — United States, 2017 Results: Results from the 2017 national YRBS indicated that many high school students are engaged in health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 39.2% of high school students nationwide (among the 62.8% who drove a car or other vehicle during the 30 days before the survey) had texted or e-mailed while driving, 29.8% reported current alcohol use, and 19.8% reported current marijuana use. In addition, 14.0% of students had taken prescription pain medicine without a doctor’s prescription or differently than how a doctor told them to use it one or more times during their life. During the 12 months before the survey, 19.0% had been bullied on school property and 7.4% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 39.5% of students had ever had sexual intercourse and 9.7% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 53.8% reported that either they or their partner had used a condom during their last sexual intercourse. Results from the 2017 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. Nationwide, 8.8% of high school students had smoked cigarettes and 13.2% had used an electronic vapor product on at least 1 day during the 30 days before the survey. Forty-three percent played video or computer games or used a computer for 3 or more hours per day on an average school day for something that was not school work and 15.4% had not been physically active for a total of at least 60 minutes on at least 1 day during the 7 days before the survey. Further, 14.8% had obesity and 15.6% were overweight. The prevalence of most health-related behaviors varies by sex, race/ethnicity, and, particularly, sexual identity and sex of sexual contacts. Specifically, the prevalence of many health-risk behaviors is significantly higher among sexual minority students compared with nonsexual minority students. Nonetheless, analysis of long-term temporal trends indicates that the overall prevalence of most health-risk behaviors has moved in the desired direction. Interpretation: Most high school
students cope with the transition from childhood through
adolescence to adulthood successfully and become healthy and
productive adults. However, this report documents that some
subgroups of students defined by sex, race/ethnicity, grade
in school, and especially sexual minority status have a
higher prevalence of many health-risk behaviors that might
place them at risk for unnecessary or premature mortality,
morbidity, and social problems (e.g., academic failure,
poverty, and crime). Teen suicide is
soaring. Do spotty mental health and addiction treatment
share blame? The young men were as different as the areas of the country where they lived. But they shared one thing in common: A despair so deep they thought suicide was the only way out. The suicide rate for white children and teens between 10 and 17 was up 70% between 2006 and 2016, the latest data analysis available from the Centers for Disease Control and Prevention. Although black children and teens kill themselves less often than white youth do, the rate of increase was higher — 77%. A study of pediatric hospitals released last May found admissions of patients ages 5 to 17 for suicidal thoughts and actions more than doubled from 2008 to 2015. The group at highest risk for suicide are white males between 14 and 21. Experts and teens cite myriad reasons, including spotty mental health screening, poor access to mental health services and resistance among young men and people of color to admit they have a problem and seek care. Then there's the host of well-documented and hard to solve societal issues, including opioid-addicted parents, a polarized political environment and poverty that persists in many areas despite a near-record-low unemployment rate. And while some adults can tune out the constant scroll of depressing social media posts, it is the rare teen who even tries. Then there's the simple fact they are teens. "With this population, it's the perfect storm for life to be extra difficult," says Lauren Anderson, executive director of the Josh Anderson Foundation in Vienna, Va., named after her 17-year-old brother who killed himself in 2009. "Based on the development of the brain, they are more inclined to risky behavior, to decide in that moment." That's very different from how even a depressed adult might weigh the downsides of a decision like suicide, especially how it will likely affect those left behind. And sometimes life is so traumatic, suicide just seems like the best option for a young person. Carmen Garner, 40, used to walk across busy streets near his home in Springfield, Mass. when he was a teen, hoping to get hit by a car to escape life with drug addicted parents. "Our students are dying because they are not equipped to handle situations created by adults — situations that leave a child feeling abandoned and with a broken heart," says Garner, now a Washington elementary school art teacher and author. "Our students today face the same obstacles I faced 30 years ago." After the leaves fall November is an especially difficult time in the Adirondack mountains resort town where her family lives, says Laurie Schmid, Tayler's mother. As the seasons change, the trees are bare, it's bitter cold and the small community has shrunk after summer residents leave their lakefront cottages. In the weeks before he took his life the day before Thanksgiving 2014, Tayler seemed sullen but his family chalked it up to "teenage angst and boredom and laziness." It was likely "masking his depression he was dealing with the last few years of his life," she says. As her son moved through his teenage years, Schmid says she became less focused on getting her son in to see his pediatrician annually, because he didn't need shots and wasn't as comfortable with a female doctor. Besides, he got annual physicals at school to compete on the school soccer and track teams. Among the "what ifs" that plague her now is the question of whether the primary care doctor who had treated Tayler all his life would have picked up on cues about possible depression a new doctor missed. She had even tried to get Tayler to see a mental health counselor, even though finding one in their area of upstate New York wasn't easy. Once Schmid and husband Hans settled on one, Tayler refused to go. One positive has risen out of the pain. There are far more resources and awareness about mental health and the need for counseling in her area now, thanks in part to the family's advocacy through the "Eskimo Strong" group it started. A local counseling center even has an office at the high school now. Schmid speaks to schools and parents regarding signs of depression, to encourage counseling, and provide information for suicide hotlines and text lines. Her oft-repeated motto is "Say Something" and "Talk to Someone." Mental illness also needs to be covered by insurance at the same level as physical illness, says psychiatrist Joe Parks, Missouri's former medical director for mental health services. There need to be more psychiatrists and they also need to be part of primary care clinics, Parks said. At his community health center in Columbia, Mo., he screens those who may be suicidal and taught others to do it, too. Such "accountable care" was envisioned, but not fully realized, under the Affordable Care Act. Children and teens who aren't covered by their parents' insurance can at least rely on Medicaid's Children's Health Insurance Program. That's hampered by low reimbursement rates that mean few psychiatrists accept it, however. So, even children who receive mental health treatment, Parks said, may be in environments dominated by family members with drug, alcohol or domestic abuse issues. "Wouldn’t you expect that to increase depression in children?" he says. Suicide chic? If super skinny — or muscular — models aren't enough to depress a teen, flipping through social media feeds can prove misery loves at least digital company. Teens regularly post about hating their lives and wanting to kill themselves, so much in fact that Parks says it's almost like a competitive "race to the bottom." On one hand social media provides a place to vent and get advice, but on the other hand, as Anderson said, “if everyone is commiserating over everyone, is it really helpful?" Because teens are interacting in a way that isn't face to face, there’s less of a connection, so it’s hard to understand what, if anything, to say when someone says they want to die. Teens say they will see a post about depression or suicide ideation and sometimes just pass it off as relatable dark humor. A recent post in one Baltimore teen's Facebook feed: "Alright, so I will literally pay anyone to shoot me in the head. Who wants a go at it? Please." She included a smiley face emoji. Blacks do kill themselves Two African American preteen Washington charter school students killed themselves in the space of about two months recently, drawing attention to something not commonly thought of as a problem. "There’s been a lot of discussion about how suicide is potentially thought of as a white person’s issue," says Craig Martin, global director of mental health and suicide prevention at the men's health charity Movember Foundation. "As a result of that, less is being done in black communities to look at the issue of depression." There's also a more pronounced stigma in the African American community surrounding mental health issues. African American men have fewer mental health issues but more serious types when they are present. And they are far less likely to seek treatment, says New York City psychiatrist Sidney Hankerson. Then there's the trauma that comes with living amidst multi-generational poverty and addiction. A version of the much-publicized opioid epidemic in often-rural white communities has plagued inner city black families since long before Garner was a boy. Garner thought "normal" meant watching his mother shoot heroin and his aunts and uncles smoke crack. "I lived with rapists, murderers and drug dealers and gangsters," he said. Now, his students are his motivation. They and his family remind "me I don't have to try to kill myself anymore," Garner says. On a Monday night, Karen Ruf went to a Bible study and J.C. took his grandmother out for unlimited shrimp on a Red Lobster gift card. When he got home, he talked to some friends at about 7:30 p.m. No one heard anything different in J.C.’s voice. Karen returned around 9:15 p.m. to a quiet house. She called for her son, no answer. She came downstairs and found his body. Ruf knew J.C's death wasn’t an accident because her son left his phone unlocked so she could find his note: “Everything has a time. I decided not to wait for mine. They say we regret the things we do not do. I regret it a lot.” Schmid's son Tayler also left something on his phone. A video suicide note that talked about the depressive thoughts he was having. Hans and Hansen Schmid watched it. Laurie says she hasn't been able to: "That's not how I want to remember him." The Natinoal Prevention phone line
(800) 273-8255 and the natinoal crisis text line 741741
offer emotional support and resources in an effort to
prevent suicides and suicide attempts. Back in
Session: How to take care of your mental health in the
classroom In and Out This is one which seems simple, as though we have been doing it all our lives. From the moment we saw light, we took a breath! But breathing can be the quickest way to retake control of your situation. When we focus on our breathing, the rest of the body has a break. It restores what many of us crave during an anxiety attack, control. We can control this one, immensely vital part of our lives. If you feel your minds spinning out of control, close your eyes and breathe. In for 6 seconds, hold for 4, out for 8. 6-4-8. Or any combination that works for you, just keep it consistent. Tell yourself in those moments, “I am resilient. I am strong.” Or breathe in sync with this gif! Breathe until you feel your mind clearing and repeat as often as you need. You are in control. Six ways to practice grounding Body: Lay on the ground, press your toes into the floor, squeeze playdough Put those hands to work There is something immensely soothing about having something to play with! When I had to give speeches (my least favorite part of being a student leader), I would roll around a stone I found at my favorite beach in Maine. A friend of mine has a small pack of play dough she will bring to class. A tactical tool is enough to keep the mind and body focused. The best tip for this- find what works. For some, it’s a malleable toy, like clay or dough. For some, it’s a fidget spinner or cube (leave all the memes about it behind, they are useful! And pretty). Some may friend comfort in doodling or pen clicking. Playing with hair elastics, as many of our SAC members do! Or you may be me and have a small stone or trinket that has both comforting texture and sentimental value to you. For you, it is whatever works! Get those hands busy and keep that mind clearer. Senses all around When I have immense stress in class and I find myself pulling away from a lecture, what helps me is reconnecting with the world around me. This is a technique called grounding, which is using your senses to draw you back into the now. This can be done either mentally or graphically. I find that seeing words on a paper helps me to see things more concretely, so I often will write down my grounding steps. This what I use- (and examples as I am writing this) 5 things you can see. (Desk, lobby of my Residence hall, coffee, scissors, residents) You do you In the end, I can’t tell you what will work for you! Only you can! I didn’t one day wake up and decide “I’m going to practice grounding today when I get overwhelmed in my classes!” Use the subconscious things that you do already as your basis. Think back to what helped you in those moments of fear, think about what got you to feel more in control. And use that. Don’t compare your ways of destressing in class to others. Everyone comes to the table with different skills. Be willing to learn and ask questions, but don’t compare or derogate your own methods. The classroom can be stressful,
triggering, overwhelming. Some days it is a struggle to get
through a lecture. But with these tips, as well as your own
home brewed skills, we will break the stigma of college
mental health from within the classrooms. Welcome back to
school, stigma fighters, and here’s to a great
year. Coping With A
Parent’s Suicide How to help the children who are left
behind As with all traumatic events, the way in which kids are supported in processing their feelings about the loss affects how successfully they will recover. Children are very resilient, and while a parent’s suicide will never stop being an important event in their lives, with help they can recover their emotional health and vitality. When children experience the sudden death of a parent, they go through what we call traumatic grieving. This kind of death is not just a painful thing to assimilate; it triggers an emotionally complicated or conflicted process. Healthy grieving When a death is shocking and disturbing it generates frightening thoughts, images, and feelings a child may want desperately to avoid. In the case of a suicide, children may have feelings toward or about their parent that they feel are unacceptable, that they want to deny. So they try to block them out, by not talking or thinking about the person they’ve lost, who they may feel has betrayed them, or rejected them. But to grieve in a healthy way, it’s necessary to think about the person you’ve lost, and allow yourself to feel sadness and pain. Kids need to be able to remember the parent they’ve lost as a loving person despite his or her flaws. Even more than an accidental death, a suicide generates horror, anger, shame, confusion, and guilt—all feelings that a child can experience as overwhelming. The biggest risk to a child’s emotional health is not being able, or encouraged, to express these feelings, and get an understanding of what happened that he or she can live with. When a mother who has been depressed commits suicide, for instance, we want that understanding to be that she suffered from a mental illness, a disorder in her brain that caused her death, despite the efforts of those who loved her to save her. Researchers at Johns Hopkins Children’s Center found that children who are under 18 when their parents commit suicide are three times as likely as children with living parents to later commit suicide themselves. This highlights the vital importance of providing support to children who are grieving. Not only are we treating the trauma of sudden parental loss, we are also trying to break the suicide cycle in families. Supporting children What do children need most in the aftermath of a suicide? First, they require simple and honest answers to their questions. They need to know that their feelings are acceptable: anger at a mother or a father who committed suicide is normal, and it doesn’t mean a betrayal of the love you have, or the terrible loss you may be feeling. If the person who died has been mentally ill for a long time, a child might actually feel relieved at the death, and that, too, he or she needs to be allowed to feel. After a suicide, children need to know that they’re not to blame. Being natural narcissists, kids tend to put themselves at the center of the narrative: If I had behaved better, if I had come home right after school, if I had tried harder to cheer Mom or Dad up, etc., this wouldn’t have happened. What we want them to understand is that the parent was ill. We did our best to help, but it didn’t succeed. This isn’t an understanding that’s achieved in one conversation; it’s something that has to be worked on over time. It helps children recover to keep their lives as normal as possible—to return to routines as soon as possible, to return to school and regular activities. Signs of trauma When should you worry about a child failing to recover in a healthy way? Though it’s difficult to distinguish problem behavior from the expected process of grieving, there are some key things to look for. With a “regular” traumatic experience, like being close to an accident, an attack, a disaster, we expect signs of recovery in about a month. But the timetable for grieving is less clear, so the recovery process can take longer. If a child’s sadness and withdrawal from normal activities don’t dissipate over time, and they begin to cause impairment—refusal to go to school, changes in sleep habits, a decrease in appetite, irritability—they can be cause for concern. The biggest sign that someone is not grieving in a natural way is a disturbed relation to the memory of the loved one. This can include avoiding places or situations that might remind a child of the parent who died, emotional numbing, or selective amnesia about the traumatic loss. On the other hand, it can manifest as intrusive thoughts about the event. These all get in the way of the process of forming memories of a parent that’s part of the healthy grieving process. Who is at most risk for suffering long-lasting trauma? Children with avoidant personalities or extreme anxiety will more easily fall into an unhealthy coping style. Children who have experienced other traumas are also more likely to respond poorly, given the “practice” they have had. Kids who lack strong support networks—both within the family and within the community at large—suffer more. And girls, for reasons we don’t fully understand, appear three times more likely to have traumatic reactions to disturbing events. Finally, when we imagine a child’s experience of the loss of a parent to suicide, we need to recognize that the family may have been struggling with mental illness, and often addiction, for years, which must surely have taken a toll. The most important thing to keep in mind is that the antidote to traumatic grief is honesty, loving support, and the continuation of the family in its strongest possible form. Read More: Helping
Children Cope With Grief The
Teacher’s Role When Tragedy Strikes: Healing for
students dealing with tragedy begins in the classroom When death intrudes in the lives of children in a school community, the classroom is one of the key settings in which kids will experience grief and anxiety, and struggle to come to terms with their feelings. I wish I could give you words that would protect the youngsters in your class from grief and fear. But since that’s not possible, I offer some thoughts and guidelines, based on my experience, to help you help them process their feelings in a healthy way. Acknowledge the loss When a tragedy involves a school community—especially when the lives of students or teachers are lost—it’s likely that it will be in the classroom where the loss may be felt most keenly. Some kids may be very uncomfortable with that awareness. That means it’s particularly important for you to acknowledge the loss and give your students an opportunity to express their feelings about the traumatic event. Give kids time to talk Though there may be a school-wide meeting or service on helping children cope, for many kids in the classroom will be the most important setting for asking questions, sharing feelings, and offering memories. Studies have found that children are more able to get comfort from adults they know well, and even from other children, than from crisis experts who are not familiar to them. Studies also show that adults listening to children is more important in this kind of situation than knowing the perfect thing to say to them: A comfortable and safe setting where kids are allowed to be sad and upset and confused is the most valuable thing you can offer. Encourage questions We recommend that you convene a group discussion, in whatever style is familiar to your kids, and let them know that you’re sad, and many others are sad, and that when a tragedy happens and we lose friends and classmates, it’s important to talk about how we feel and how we want to remember them. You should invite, but not force, questions, and answer them as simply as possible, in a developmentally appropriate way. Address safety concerns Since young children are egocentric, it’s likely that some of your students will be worried about their own safety. Could the same thing happen to them? If it was a fire, reassure them that house fires are very rare in this day and age, and remind them about safety measures like fire drills that are taken in schools. If it was an act of violence, you can stress, again, efforts by their parents and teachers to make sure they are safe. If they ask questions you can’t answer, it’s okay to tell them you don’t know. Return to routine After you’ve given them plenty of time to formulate their questions, express their feelings, and respond to each other, it’s important to go back to your regular routine. That’s not only because you’re trying to model healthy resilience, but because routine is deeply comforting for children. Memorialize the lost Keep in mind that the first time you talk about a tragic event that affects your children won’t be the last time. Coming to terms with loss takes time, and will involve transitioning to positive ways to memorialize those who were lost, as a classroom and as a school. In your conversation (and subsequent ones) you can suggest ways the class might remember friends and classmates they miss: write stories about things you did together, draw pictures, plant trees, raise money to donate to children in need. It’s helpful to remind children that a person continues to live on in the hearts and minds of others. And doing something that benefits other children not only helps them feel good about themselves, but helps them learn a very healthy way to respond to grief in the future. Teach and model resilience Remember that, as with everything you do as a teacher, you are teaching, and modeling, and allowing children to devise for themselves ways to handle challenges in a positive way. It’s a skill that will be as important in their lives as reading and writing, and worth your efforts to nurture when kids are in crisis. Read More: Helping
Children Cope With Frightening News Source: childmind.org/article/teachers-role-tragedy-strikes/
Supporting
Children After the Suicide of a Classmate: Responding
to a painful loss in the healthiest way possible
Grieving and coming to terms with a disturbing death take time, and there’s nothing we do can do to bypass or hurry the process. But by giving kids opportunities to share their feelings we can help them rebound in a healthy way. And by talking about suicide openly and matter-of-factly, as the result of an emotional illness, we can help kids put it in a realistic and useful perspective. Read our guide Helping
Children Cope With Grief for
more information. Top 10 Causes of
Death for Americans Ages 15 to 24 1. Accidents Accidents account for 41 percent of deaths among people in the 1524 age group. Motor vehicle accidents alone account almost a quarter of all deaths of these young adults. The good news is that the motor vehicle death rate has been going down in recent years as cars have become safer. To protect yourself, wear your seat belt, drive defensively and avoid risky behaviors that may lead to accidents. 2 Suicide Suicide accounts for 18 percent of deaths among people of this age group. Sadly, most people who commit suicide feel like it is their only way out of a helpless feeling situation. However, there are many resources for people with suicidal thoughts. If you are experiencing depression or other mental health issues, seek help. With talk therapy and medications, you can find that life is worth living. In fact, most people who attempt suicide say they regret it. Interviews with 29 people who survived a suicide attempt jumping off the Golden Gate Bridge say they regretted the decision the moment they jumped. If you or someone you know is in crisis, call 1-800-273-TALK (8255) or text "SOS" to 741741 right away. This free hotline is available 24 hours a day. 3. Homicide Sixteen percent of deaths among people age 15 to 24 are due to homicide. In 2015, 87 percent of all homicides against people of all age groups in the U.S. were committed with firearms, and gun violence is more common in urban and poor communities. Unfortunately, you cannot necessarily control where you live or what other people do. However, you can do your best to protect yourself by avoiding dangerous and confrontational situations and seeking help for domestic violence. 4 Drugs and Alcohol Fifteen percent of the deaths of in this age group were induced by drugs or alcohol. Abusing drugs and alcohol may be a rite of passage into adulthood, but it is risky. In addition to the chance of an overdose, it also greatly increases risky sexual behavior and the odds of contracting HIV and other sexually transmitted diseases. Preventing drug and alcohol abuse is the focus of many programs, both aimed at encouraging parents to discuss these issues with their kids and peers to influence each other. 5 Cancer Cancer deaths account for 5 percent of deaths among the 15 to 24 age group. Unfortunately, there is no proven way to prevent cancer, and this percentage includes many childhood cancers that are not preventable.? 6 Heart Disease Three percent of people who die when they are 15 to 24 die of heart disease. Exercise and a healthy diet can help to prevent and reverse heart disease, however, many young people who die of heart disease were born with it. 7 Congenital Conditions Congenital illnesses, some inherited from parents, such as cystic fibrosis or maternally-transmitted HIV, account for 1.5 percent of deaths among this age group. A healthy pregnancy can help prevent many of these conditions. 8 Chronic Lower Respiratory Disease Chronic lower respiratory disease accounts for 0.7 percent of deaths in this age group. Reduce your risk by not smoking or quitting smoking. 9 Stroke While most people think of strokes as only occurring in older adults, they can occur in anyone at any age. Stroke is responsible for 0.6 percent of deaths among people ages 15 to 24.? Exercise, not smoking, and having a healthy diet can help prevent stroke. However, the cause of strokes, even in people who are very healthy, often cannot be identified. 10 Flu and Pneumonia You may not think that the flu or pneumonia is very dangerous if you are in your teens or early twenties, but 0.6 percent of deaths in the 15 to 24 age group are attributable to flu and pneumonia—184 deaths in a year. This number can rise dramatically in a year with pandemic flu. Get a flu vaccine every year and wash your hands regularly. Be sure to talk with your doctor about extra precautions to take if you have a compromised immune system due to illness or other reasons. Source: www.verywell.com/top-causes-of-death-for-ages-15-24-2223960
Youth suicide
rates are rising. School and the Internet may be to
blame A new study found that children’s hospital admissions of patients 5 to 17 years old for such thoughts or actions more than doubled from 2008 to 2015. The study looked at 32 hospitals using data from the Pediatric Health Information System (PHIS) When patients are hospitalized, doctors consider family history, worldview, and social environments. School systems are becoming “more and more challenging,” said Dr. Dan Nelson of the Cincinnati Children’s Hospital Medical Center. Nelson, medical director of the center's child psychiatry unit, noted concerns about weapons and bullying. News about the increased in suicide-related hospitalizations of children and teens comes amid an ongoing outbreak of youth suicide in Hamilton County, where Cincinnati is located. In 2014, the county saw four suicides of people 18 and under. In 2015, there were five. In 2016, there were 13. So far this year, seven. The most shocking was the January death of 8-year-old Gabriel Taye, who killed himself two days after peers knocked him unconscious in a restroom at Cincinnati's Carson Elementary School. A security camera video shows other students touched and kicked Gabriel until an administrator arrived and roused him. A Cincinnati homicide detective described it as bullying that bordered on criminal assault. The study on hospitalizations from Vanderbilt University comes in the wake of a national Centers for Disease Control and Prevention report from November. The CDC found the suicide rate for children age 10 to 14 doubled from 2007 to 2014. Suicide overtook motor vehicle accidents as a cause of death in that age group, the report showed. 'A seasonality to suicide' The Vanderbilt study found that children’s hospitals saw higher rates of suicidal patients during the fall and the spring, but not during the summer. “There is a seasonality to suicide,” said Dr. Gregory Plemmons, the lead author on the study. “If you look at adult data, most adults tend to commit suicide in summer and the spring, we noticed that our biggest time (for children) was in the fall.” Plemmons, an associate professor at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, said he’s seen the increase of young suicidal patients first-hand. “We’re definitely seeing it in our hospital,” he said. “We’ve actually had to hire extra people to support this population.” In addition to a rise in suicidal thoughts, Plemmons has seen young people engaging in “more dramatic ways” of harming themselves. “Hanging and suffocation seem to be around in a way they weren’t before,” he said. Kids' media getting 'more and more graphic' Nelson, the doctor at Cincinnati Children’s, said he’s amazed at how much information youth has access to — some of which can be traumatizing. In addition to things like cyberbullying, he said, kids can now easily access information about how to hurt themselves. “The media that children are exposed to gets more and more sophisticated and more and more graphic and so kids get exposed to more and more things,” he said. Hamilton County Prosecutor Joe Deters has said his office wants to examine a computer that Gabriel owned for any clues to his suicide. Although the CDC says that the majority of young people report little to no involvement in electronic aggression, it is still an emerging public health problem. (24 page PDF) Any form of bullying, whether face-to-face or online, is known to be connected to depression and suicidal behaviors in young people. The CDC found youth who observe bullying behavior without participating in it report feeling more helpless and less connected to parents and schools than those who have not witnessed bullying. On May 12, Cincinnati Public Schools released the video footage of the incident involving Gabriel along with a timeline of events. The statement on CPS’s website said staffers were not aware that he had been knocked down until a student notified them that “a boy is laying on the ground outside of the bathroom.” Gabriel's mother said school officials initially told her that her son had fainted. CPS said they are now reviewing procedures regarding adult supervision in the restrooms with faculty and staff. “We are committed to student safety and ensuring that all CPS schools foster a positive, learning environment,” the statement said. When a young patient is hospitalized for suicidal thoughts or behaviors, physicians at Cincinnati Children work on developing coping skills and a safety plan. That means working with parents —and schools to ensure the child gets the help they need after they leave the hospital. “Education is really important,” Vanderbilt's Plemmons said. “Schools play a role, parents play a role.” Warning signs of suicide People who are wrestling with thoughts of suicide give off indicators. Here are a few things to watch for, and if you see them, ask if help is needed immediately.
Video:
Previous reporting: Video: Footage shows incident with
8-year-old two days before suicide. Student beat him, others
kicked him while he lay unconscious. Later, he killed
himself at 8 years old Youth suicides rising in Hamilton
County.. - 8:20 Signs of Suicide
in Middle Schools The impact of the SOS program on the prevalence of suicidal behaviors among middle school students with prior suicidal ideation is a finding unique to this study, and the researchers note that it needs replication. When the effect on all the children was analyzed, children who participated in SOS were not significantly less likely to report suicidal behaviors than children who had not participated in SOS. There were also no significant differences in help-seeking behaviors between children who had participated in the program and children who had not. This study involved fifth- to eighth-grade students at middle schools with a relatively high percentage of students with parents in the military. These schools were chosen because “high military impact” schools like these may, in the words of the authors, “be in particular need of efficacious suicide prevention efforts because many risk factors for adolescent suicide are consequences of, or inherent in the experience of, parental deployment.” Such risk factors include family conflict and depression and anxiety in both the children and their non-deployed parents. This summary is from: Schilling, E.,
Lawless, M., Buchanan, L., & Aseltine, R. H. (2014).
“Signs of Suicide” shows promise as a middle
school suicide prevention program. Suicide and
Life-Threatening Behavior 44(6), 653-657 Chilling
Study Sums Up Link Between Religion And Suicide For Queer
Youth Faith is supposed to be a source of strength for believers, especially during times of struggle and sorrow. However, a new study suggests that religiosity may be linked to negative feelings among queer individuals ? including increases in suicidal behaviors. The study, published in the American Journal of Preventive Medicine last month, is a chilling revelation of the ties between suicide and theology that doesn’t affirm queer identity. “Religious groups who stigmatize LGBT people should be aware of the potential damage they can do to an individual and families, and honestly the damage they do to themselves as an organization,” study co-author John R. Blosnich told HuffPost. Blosnich, of West Virginia University’s Injury Control Research Center, said that for decades, studies have indicated that religion generally protects people against thoughts of suicide. But the research has also shown that religion specifically doesn’t have that impact on those who identify as lesbian, gay, bisexual or questioning. In order to study religiosity and suicidal ideation among sexual minorities, Blosnich and his fellow researchers turned to data collected by the University of Texas at Austin’s Research Consortium. The consortium produces national, large-scale studies on the mental health of college students. Its latest 2011 study surveyed 21,247 students aged 18 to 30 years old. Out of this group, about 2.3 percent identified as lesbian or gay, 3.3 percent identified as bisexual and 1.1 percent said they were questioning their sexuality. (About 0.2 percent identified as transgender, which was too small of a sample to analyze.) The students were asked to rate how important their religious or spiritual beliefs were to their personal identity. They were also asked a number of questions about whether they had ever seriously considered or attempted suicide. Analyzing this data, the research team found that while 3.7 percent of heterosexual young adults reported recent thoughts of suicide, the percentages were significantly higher among queer youth. Those questioning their sexuality had the highest rate of recent thoughts about suicide at 16.4 percent, followed by bisexual individuals (11.4 percent) and lesbian or gay individuals (6.5 percent). Five percent of heterosexual youth reported attempting suicide in their lifetimes, compared to 20 percent of bisexual youth, 17 percent of questioning youth and 14 percent of gay or lesbian youth. Notably, the study authors found that religion may have acted as a protective factor against suicide attempts among heterosexual youth. Each increase in the level of importance of religion among straight youth was associated with a 17 percent reduction in recent suicide attempts. On the other hand, for lesbian and gay youth, increasing levels of religious importance were associated with increased odds of recent suicidal ideation. In fact, lesbian and gay youth who said that religion was important to them were 38 percent more likely to have had recent suicidal thoughts, compared to lesbian and gay youth who reported religion was less important. Religiosity among lesbians alone was linked to a 52 percent increased chance of recent suicidal ideation Questioning youth who said religion was important to them were nearly three times as likely to have attempted suicide recently, compared to questioning youth who reported religion was less important. For bisexual individuals, the importance of religion was not significantly associated with suicidal ideation or suicide attempts. Overall, sexual minorities were also more likely than straight youth to report that religion was not important to them. Blosnich said that sexual minorities who have greater religious belief may experience conflict between their faith and their sexual identity. “It can be very scary to be caught in a space where your religion tells you that you are a ‘sinner’ just for being who you are,” he told HuffPost. “Sexual minority people may feel abandoned, they may experience deep sadness and anger, and they may worry what this means for their families ? especially if their families are very religious too.” Studies conducted by the Centers for Disease Control and Prevention have also found that lesbian, gay and bisexual youth seriously contemplate or attempt suicide at higher rates than heterosexual youth. Blosnich said he’s not sure if societal changes since 2011 ? most notably the national legalization of same-sex marriage ? would lead to different results today. Large-scale surveys that ask about suicidal behavior, sexual orientation and religion are “very rare,” he said, which is why the team used the 2011 data. That survey looked only at college students, which means the findings may also not be generalizable to the broader LGBQ community. The authors noted that the original data also did not include questions about whether respondents’ religions advocated stigmatizing beliefs about sexual minorities. "There are some serious questions we have to begin asking ourselves if maintaining one interpretation of our sacred text is demonstrably linked to bodily harm and spiritual devastation for an entire group of people." - Amelia Markham, a queer Christian activist While several mainline Protestant and even evangelical leaders have begun to embrace a more inclusive theology, some of America’s largest religious denominations still hold non-affirming views of queer sexuality. Roman Catholic Church doctrine views gay and lesbian relationships as “intrinsically disordered.” The largest Protestant denomination in the U.S., the Southern Baptist Convention, sees marriage as exclusively reserved for one man and one woman and actively rejects equating gay rights with civil rights. While these conservative denominations instruct believers to treat lesbian, gay and bisexual individuals with love, most encourage queer people to either remain celibate their entire lives or enter into mixed-orientation marriages. Amelia Markham is a queer Christian activist with The Reformation Project, which works for the inclusion of LGBTQ people in the Christian church. They think Blosnich’s study demonstrates that for many queer people, non-affirming theology is at best problematic and at worst lethal ? “no matter how kindly or compassionately” it is articulated. A number of Christian leaders are working toward a more nuanced view of queer sexuality, Markham said, but more needs to be done. “There are some serious questions we have to begin asking ourselves if maintaining one interpretation of our sacred text is demonstrably linked to bodily harm and spiritual devastation for an entire group of people,” Markham said. “That is something I hope religious folks across the board would begin to think and pray more critically through.” In Utah, where the Church of Jesus Christ of Latter-day Saints is based, researchers have documented a recent spike in teen suicides. Some advocates for LGBTQ Mormon teens have asserted that the spike is connected to the church’s policies on queer sexuality, although research hasn’t confirmed this link. The Mormon church views queer relationships as sinful. In November 2015, it declared that Mormons in such relationships were to be considered apostates. Diane Oviatt, a Mormon mother with a gay son, is part of Mama Dragons, a group of parents who have banded together to advocate for their queer children. She believes that non-affirming theology has a “direct” effect on suicidal ideation among LGBTQ youth and young adults. The Mormon church prioritizes marriage and formation of a “traditional” family, she said, and LGBTQ Mormons struggle with the fact that they don’t fit into that mold. “There is absolutely no room for homosexuality anywhere in the doctrine,” she told HuffPost. “Our kids are stripped of hope and faced with the notion that they, by virtue of their sexual identity, are ruining their celestial ‘forever’ family and will be separated from them in the hereafter if they choose a same-sex partner.” The only options left to queer Mormon teens are celibacy or mixed-orientation marriages, “both of which have extremely high levels of dissatisfaction and despair,” Oviatt said. What LGBTQ kids need, she said, are religious communities that accept them wholeheartedly. The Naming Project is one such community. The Christian ministry, which seeks to create safe spaces for LGBTQ youth, organizes an annual summer camp in Minnesota for teens of any sexual orientation, gender identity or gender expression. Project director Ross Murray said that ministries like his aim to provide support and affirmation to youth who may feel rejected by their own faith communities. When more religious groups affirm LGBTQ teens as their “whole and authentic selves,” he said, it will lead to healthier adult LGBTQ people of faith. “When religious communities are affirming and supportive of identity, including sexual orientation and gender identity, then the people within those communities are going to develop into much healthier and better-functioning individuals who understand themselves and how they relate to the rest of the world,” Murray said. As a child growing up in a non-affirming church, Isaac Archuleta said he experienced depression, anxiety, low self-esteem and substance abuse. Today, he identifies as bisexual and serves as the interim executive director of the Q Christian Fellowship. As a Colorado-based psychotherapist, he focuses on providing therapy to LGBTQ clients and their religious familie Archuleta said he believes mental health providers should always affirm their clients’ sexual orientation and gender identity. Counselors who, for religious reasons, do not truly accept their LGBTQ clients end up promoting the shame from which their clients need to be rescued. They’re “working against love even though they preach a message of love,” he said. Studies like the one conducted by Blosnich’s team are necessary, Archuleta argued, to help educate the non-affirming church. “The most devastating effect for children in non-affirming religious environments, in my opinion, is an identity distortion that teaches the child to feel valueless as a relational being,” Archuleta said. “When a child feels unwelcome, too damaged for relationships, we strip them of their very purpose and sense of worth.” “For a religion to have such a capacity and the willingness to maintain that maladaptive power is, in my opinion, antithetical to the God of love.” If you or someone you know needs help,
call 1-800-273-8255 for the National
Suicide Prevention Lifeline.
You can also text SOS to 741741 for free, 24-hour support
from the Crisis
Text Line. Outside the U.S.,
please visit the International
Association for Suicide Prevention
for a database of resources. 'Alarming'
rise in children hospitalized with suicidal thoughts or
actions A steady increase in admissions due to suicidality and serious self-harm occurred at 32 children's hospitals across the nation from 2008 through 2015, the researchers found. The children studied were between the ages of 5 and 17, and although all age groups showed increases, the largest uptick was seen among teen girls. "We noticed over the last two, three years that an increasing number of our hospital beds are not being used for kids with pneumonia or diabetes; they were being used for kids awaiting placement because they were suicidal," said Dr. Gregory Plemmons, presenter of the study and an associate professor of pediatrics at Monroe Carell Jr. Children's Hospital at Vanderbilt. Sensing a trend, Plemmons and his colleagues conducted the research to see what was happening across the country, he said. "And it confirmed what we were feeling: that the rates have doubled over the last decade." Peaks in fall and spring Plemmons looked at administrative data from 32 children's hospitals to identify the total number of emergency department and inpatient visits over eight years ending in 2015. He found 118,363 children between the ages of 5 and 17 with a discharge diagnosis of suicidality or serious self-harm. "We didn't look at completed suicides, and we didn't look at actual numbers of total suicides. All we actually could look at were those kids that were admitted to a children's hospital with a diagnosis of suicide ideation or a suicide attempt," Plemmons said. Slightly more than half, 59,631 children, were between the ages 15 and 17, and nearly 37% were between 12 and 14. Children 5 through 11 -- a total of 15,050 kids -- represented nearly 13% of the total. Increasing suicide rates among children mirror adult numbers, Plemmons said. Children's numbers more than doubled over the study period, increasing from 0.67% of children admitted to hospitals in 2008 to 1.79% in 2015. Annually, the 15-to-17 age group averaged an increase of 0.27%, the 12-to-14 age group averaged 0.25%, and the-5 to-11 age group averaged 0.02%. In 2008, about 60% of all children and teens hospitalized as a result of suicidal thoughts or attempts were girls, and, by 2015, that number had increased to 66%, said Plemmons. While he did not break down age groups, he said the Centers for Disease Control and Prevention reported that suicides had tripled in girls, ages 10 through 14, between 1999 and 2014. "Females are more likely to attempt, but males in general are more likely to succeed," said Plemmons. Plemmons noted one "really interesting" finding he has not seen elsewhere. "When we looked at the number of kids awaiting placement or admitted at one time, month by month, there is a huge difference in the months," he said. "Certainly, the month of the year that is the lowest for suicidal thoughts and ideation is July. And we see those numbers creep back up right when school starts." Peaks can be seen in the fall and the spring, with a lull in the summer. The reason children think about or attempt suicide is the "million-dollar question," Plemmons said. "Family history of depression or suicide, family violence, child abuse, gay and lesbian youth, history of bullying -- those are all risk factors that have been reported. We didn't look at any of those specific factors in our study." School drives a lot of this behavior, he said, and he wonders whether it might represent the overall influence of "social media and socialization in general. ... We know that school's a stress just like a job is a stress, so it may just be that removal of that situation allows some kids to cope a little bit better." One of the predominant theories behind teen suicide is cyberbullying, Plemmons said. "It's anonymous today, I think that's a big difference. Years ago, you knew who (the bullies) were." Additionally, girls are entering puberty about a year earlier "than they historically have, and puberty in itself is a risk factor for suicide." A lack of coping skills? Avital K. Cohen, a licensed psychologist who was not involved in the research, believes that a variety of factors contribute to the rising trend seen in this study. "Our expectations of children have changed pretty significantly in the last several decades," Cohen said, although she doesn't have research to support her opinion. Same-sex marriage laws might decrease teen suicide attempt rates, says study "Many parents try to protect their children from experiencing failure when they are young; thus, when they experience it later in life, they may not have developed the resources and/or coping skills they need to manage it," she said. A bigger emotional response is triggered, which "might contribute to increases in suicidal expression." She also believes that social media contributes to an increase in anxiety and depression, and cyberbullying is a phenomenon "that I don't know that any of us fully understand." It's unclear what the long-term implications might be when kids have grown up in a world of social media that begins when their parents post pictures and videos of them as infants and toddlers, she said. David Palmiter, a professor of psychology at Marywood University in Scranton, Pennsylvania, said "there's kind of a deeper issue here that most of the kids that need mental health care don't get it." "Approximately 20% to a third of the kids who need care get it, but the large share don't," said Palmiter, who also was not involved in the research. "And those who do get care, usually they have had to suffer for a few years before they get it, and often, the care is not necessarily evidence-based." Even though the percentage of suicidal kids may be "alarming," the study doesn't prove that rates of suicidality are on the rise, Palmiter said. "To do that, you need more research." Still, he believes the research is important in that it suggests that efforts to educate the public about identifying problems are paying off, with parents and teachers recognizing kids who need help. "If anything, parents have to get better at recognizing the symptoms of depression, the lack of joy, the concentration problems, the isolating behaviors that occur," Palmiter said. "Historically, we've wrongfully thought that suicidality becomes an issue in adolescence, and we haven't really looked at younger children so much," he said. "And we now know that's not right. You can have kids under the age of 12, under the age of 10, thinking about attempting or even completing suicide." The youngest suicides Carl Tishler, an adjunct associate professor of psychology and psychiatry at The Ohio State University, said that when it comes to suicidality, there are significant differences between teens and those younger than 11. "The younger the child, typically, the more disturbed the child is," said Tishler, who did not participate in the research. "With these little kids, a lot of times, they come into the emergency room, and it looks like an accident." Suicide deaths on the rise in kids Children under 6 who complete or attempt suicide are "pretty damaged kids," he said, explaining that the "one thing that jumps out" in case studies of these young children is how "they've been dramatically exposed to domestic violence." "They will do things like jump out of window; they will jump off a balcony; they will run into traffic. One of the cases actually was a little kid who dressed up and was playing Superboy or Superman and managed to hang himself on a window cord." Among children between 7 and 11, hangings or suffocations are more likely, he said. "When you look at it on the outside, it looks like a normal child playing and jumped off his bed and he hurt himself," he said. Dig a little deeper, and "you find out the kid's father died of suicide" or that some other serious family trauma occurred. "It was definitely a suicide attempt, and the kid wasn't able to verbalize that they wanted to die." "Some of these little kids will verbalize they want to die, that they don't want to live anymore, or they want to go to sleep and not wake up and stuff like that," he said. Health care providers staffing emergency departments are more sophisticated now, Tishler said, so they are asking questions and looking for chidlren who are attempting suicide. "You just don't know. You have to be pretty tuned in to what you're dealing with and not say, 'Oh, a child under age 6 doesn't understand the permanence of death,' " he said, paraphrasing an "old theory" that children never attempt suicide. Tishler also said that with "an
estimated 12 to 15 million children on psychotropic
medications," any time doses begin or get increased or
decreased, "it may cause a change in emotional state which
may reduce impulse control." This could contribute to
suicidal urges. Suicide
deaths on the rise in kids The death rate data, published in the US Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, measured children's fatalities due to motor vehicle traffic injury, homicide and suicide between the years 1999 and 2014. On a positive note, the number of deaths due to motor vehicle traffic, or car crashes, has improved significantly through the years, the report says. In 2014, vehicle fatalities decreased by 58% from 1999, when there were 4.5 deaths per 100,000 children, to 1.2 deaths in 2014. Deaths from homicide have also declined over the same time period, though less dramatically, decreasing from 1.2 fatalities in 1999 to 0.8 in 2014. Conversely, the suicide death rates fluctuated from 1999 to 2007 but rose sharply after 2007. The lowest rate of suicide fatalities was 0.9 deaths per 100,000 kids in 2007, but that number doubled to 2.1, or 425 deaths, in 2014. Dr. Lisa Boesky, a private clinical psychologist and author who studies adolescent suicide, says younger kids will often take their own lives impulsively. All teens should be screened for depression, task force recommends Young kids may attempt to harm themselves for different reasons than teens. Most of the time, bad relationships between family and friends provoke kids to hurt themselves, Boesky says. On the other hand, a 14-year-old may kill herself because of a fight with her boyfriend. When looking for the warning signs for suicide in kids, "many people look for signs of depression," Boesky explained. "Teens (who attempt suicide) typically show mood swings and depression, but younger children are much more likely to suffer from (attention-deficit hyperactivity disorder). "Many people, including medical professionals, think suicide is a teenage problem," Boesky said. "But suicide can happen at very young ages, and we have to talk about this problem with all children." How do we prevent suicide in kids? Though it can be more difficult to predict suicide in children, Boesky notes several warning signs. Any increased sadness, irritability or anger should be monitored. Guardians should also pay attention to children who suddenly lose interest in their friends or activities, or begin to isolate themselves more. Finally, adults should tune in to what kids are saying. Take heed if they start saying mean or derogatory things or if they say things like, "I wish I were dead" or "I wish I could go to sleep forever." "These sayings are not normal," Boesky emphasized. For parents, if children start displaying these behaviors, Boesky advises talking to the kids about their feelings and questioning why they feel that way. If the actions worsen, parents may want to contact a pediatrician or counselor. She added, "Although it is important to talk to your children, it is even more important to listen." There is very little research regarding suicide in children in the 10 to 14 age group and younger, according to Boesky. She hopes that the CDC's report will highlight the problem of suicide rates increasing in kids and that both medical professionals and parents will be better prepared to prevent harm before it happens. "This is a wakeup call for more
research on why young children are taking their lives and
how we can intervene," Boesky said. Suicides
under age 13: One every 5 days His mother, Cornelia Reynolds, found his body that afternoon in his bedroom. His family sued his school district last week, alleging that he'd been bullied and that the school didn't inform his relatives. "Gabriel was a shining light to everyone who knew and loved him," his mother said in prepared statement released to the news media. "We miss him desperately and suffer every day." Suicides among US children under 13 are rare, but perhaps more frequent than you think. And 8 is hardly the youngest. More than 1,300 dead since 1999 From 1999 through 2015, 1,309 children ages 5 to 12 took their own lives in the United States, the Centers for Disease Control and Prevention says. That means one child under 13 died of suicide nearly every five days, on average, over those 17 years. The frequency was higher from 2013 to 2015 -- once every 3.4 days -- thanks mostly to a 54% spike in the suicides of 11- and 12-year-olds compared to the three years prior. That jibes with the CDC's announcement of a recent rise in suicide rates in ages 10-14. Still, some perspective: Suicides before the teen years are infrequent compared to other groups. There were 0.31 suicides per 100,000 children ages 5-12 during those 17 years. Compare that to 7.04 suicides per 100,000 people ages 13-18, or 17.39 per 100,000 for ages 18 to 65. Child suicide rates rise with age. But, yes, the CDC has recorded suicides of 5-, 6- and 7-year-olds. From 1999 to 2015 (the most recent year for data), those numbers were two, four and eight, respectively. Why does it happen? Suicides for elementary school-age children have been little examined, but a study published last year in the journal Pediatrics saw some differences in factors from suicides in older children. That study examined suicides in 17 states from 2003 to 2012, and broke down the factors among ages 5-11 and 12-14. 'Alarming' rise in children hospitalized with suicidal thoughts or actions Relationship problems -- such as arguments or other issues with friends and relatives -- were the most common factor for both groups. Given their ages, the problems, naturally, were more likely to involve boyfriend/girlfriend issues in the older group. Documented mental health problems were equally prevalent in both groups (about 33%). But differences in the types of mental issues were intriguing. Attention-deficit disorder was more common in the 5-11 group, whereas the 12-14 set was more likely to have had been diagnosed with depression, lead study author Arielle Sheftall said. That might mean the younger kids are more susceptible to responding impulsively to problems, said Sheftall, a research scientist at the Center for Suicide Prevention and Research at Nationwide Children's Hospital in Ohio. "I think having (the) information that we are seeing ADD/ADHD in kids (5-11) dying by suicide may help us to intervene differently in that age group," Sheftall said. Most are boys By far, most children under 13 who kill themselves are boys: 76% of those who died in 1999-2023 were male. GET HELP That dovetails with research showing most of those taking their own lives across all ages are male. That same research, however, shows females attempt suicide more frequently. But Sheftall said it's not yet clear how many boys and girls ages 5-12 attempt suicide. Separate research presented in May showed the number of children ages 5-17 who were hospitalized for suicidal thoughts or actions in the US doubled over nearly a decade. A growing racial divide? Sheftall's team found something else: 36.8% of the 5-11 set who died by suicide were black -- nearly double the rate reported in the same demographic group between 1993 and 2002. The researchers were keen to see whether there were differences in precipitating circumstances among races, citing previous research showing that "black youth may experience disproportionate exposure to violence or traumatic stressors," and are "less likely to receive services for depression, suicidal ideation and other mental health problems." But "when potential racial disparities in precipitating circumstances ... were examined in the current study, few differences were found," the authors wrote. Experts: More research is needed Sheftall said more research is needed, both to understand the increase in suicide rate in black children, and to determine whether and how suicide prevention efforts should be tailored to preteens. Pre-13 suicides have been understudied, Sheftall said, largely because it's hard to imagine children this young want to kill themselves. "That's why we're making an effort to
say, 'Yes, this is occurring. Now, what can we do to help?'
"
Teen suicide is
soaring. Do spotty mental health and addiction treatment
share blame? The young men were as different as the areas of the country where they lived. But they shared one thing in common: A despair so deep they thought suicide was the only way out. The suicide rate for white children and teens between 10 and 17 was up 70% between 2006 and 2016, the latest data analysis available from the Centers for Disease Control and Prevention. Although black children and teens kill themselves less often than white youth do, the rate of increase was higher — 77%. A study of pediatric hospitals released last May found admissions of patients ages 5 to 17 for suicidal thoughts and actions more than doubled from 2008 to 2015. The group at highest risk for suicide are white males between 14 and 21. Experts and teens cite myriad reasons, including spotty mental health screening, poor access to mental health services and resistance among young men and people of color to admit they have a problem and seek care. Then there's the host of well-documented and hard to solve societal issues, including opioid-addicted parents, a polarized political environment and poverty that persists in many areas despite a near-record-low unemployment rate. And while some adults can tune out the constant scroll of depressing social media posts, it is the rare teen who even tries. Then there's the simple fact they are teens. "With this population, it's the perfect storm for life to be extra difficult," says Lauren Anderson, executive director of the Josh Anderson Foundation in Vienna, Va., named after her 17-year-old brother who killed himself in 2009. "Based on the development of the brain, they are more inclined to risky behavior, to decide in that moment." That's very different from how even a depressed adult might weigh the downsides of a decision like suicide, especially how it will likely affect those left behind. And sometimes life is so traumatic, suicide just seems like the best option for a young person. Carmen Garner, 40, used to walk across busy streets near his home in Springfield, Mass. when he was a teen, hoping to get hit by a car to escape life with drug addicted parents. "Our students are dying because they are not equipped to handle situations created by adults — situations that leave a child feeling abandoned and with a broken heart," says Garner, now a Washington elementary school art teacher and author. "Our students today face the same obstacles I faced 30 years ago." After the leaves fall November is an especially difficult time in the Adirondack mountains resort town where her family lives, says Laurie Schmid, Tayler's mother. As the seasons change, the trees are bare, it's bitter cold and the small community has shrunk after summer residents leave their lakefront cottages. In the weeks before he took his life the day before Thanksgiving 2014, Tayler seemed sullen but his family chalked it up to "teenage angst and boredom and laziness." It was likely "masking his depression he was dealing with the last few years of his life," she says. As her son moved through his teenage years, Schmid says she became less focused on getting her son in to see his pediatrician annually, because he didn't need shots and wasn't as comfortable with a female doctor. Besides, he got annual physicals at school to compete on the school soccer and track teams. Among the "what ifs" that plague her now is the question of whether the primary care doctor who had treated Tayler all his life would have picked up on cues about possible depression a new doctor missed. She had even tried to get Tayler to see a mental health counselor, even though finding one in their area of upstate New York wasn't easy. Once Schmid and husband Hans settled on one, Tayler refused to go. One positive has risen out of the pain. There are far more resources and awareness about mental health and the need for counseling in her area now, thanks in part to the family's advocacy through the "Eskimo Strong" group it started. A local counseling center even has an office at the high school now. Schmid speaks to schools and parents regarding signs of depression, to encourage counseling, and provide information for suicide hotlines and text lines. Her oft-repeated motto is "Say Something" and "Talk to Someone." Mental illness also needs to be covered by insurance at the same level as physical illness, says psychiatrist Joe Parks, Missouri's former medical director for mental health services. There need to be more psychiatrists (66 page PDF) and they also need to be part of primary care clinics, Parks said. At his community health center in Columbia, Mo., he screens those who may be suicidal and taught others to do it, too. Such "accountable care" was envisioned, but not fully realized, under the Affordable Care Act. Children and teens who aren't covered by their parents' insurance can at least rely on Medicaid's Children's Health Insurance Program. That's hampered by low reimbursement rates that mean few psychiatrists accept it, however. So, even children who receive mental health treatment, Parks said, may be in environments dominated by family members with drug, alcohol or domestic abuse issues. "Wouldn’t you expect that to increase depression in children?" he says. Suicide chic? If super skinny — or muscular — models aren't enough to depress a teen, flipping through social media feeds can prove misery loves at least digital company. Teens regularly post about hating their lives and wanting to kill themselves, so much in fact that Parks says it's almost like a competitive "race to the bottom." On one hand social media provides a place to vent and get advice, but on the other hand, as Anderson said, “if everyone is commiserating over everyone, is it really helpful?" Because teens are interacting in a way that isn't face to face, there’s less of a connection, so it’s hard to understand what, if anything, to say when someone says they want to die. Teens say they will see a post about depression or suicide ideation and sometimes just pass it off as relatable dark humor. A recent post in one Baltimore teen's Facebook feed: "Alright, so I will literally pay anyone to shoot me in the head. Who wants a go at it? Please." She included a smiley face emoji. Blacks do kill themselves Two African American preteen Washington charter school students killed themselves in the space of about two months recently, drawing attention to something not commonly thought of as a problem. "There’s been a lot of discussion about how suicide is potentially thought of as a white person’s issue," says Craig Martin, global director of mental health and suicide prevention at the men's health charity Movember Foundation. "As a result of that, less is being done in black communities to look at the issue of depression." There's also a more pronounced stigma in the African American community surrounding mental health issues. African American men have fewer mental health issues but more serious types when they are present. And they are far less likely to seek treatment, says New York City psychiatrist Sidney Hankerson. Then there's the trauma that comes with living amidst multi-generational poverty and addiction. A version of the much-publicized opioid epidemic in often-rural white communities has plagued inner city black families since long before Garner was a boy. Garner thought "normal" meant watching his mother shoot heroin and his aunts and uncles smoke crack. "I lived with rapists, murderers and drug dealers and gangsters," he said. Now, his students are his motivation. They and his family remind "me I don't have to try to kill myself anymore," Garner says. On a Monday night, Karen Ruf went to a Bible study and J.C. took his grandmother out for unlimited shrimp on a Red Lobster gift card. When he got home, he talked to some friends at about 7:30 p.m. No one heard anything different in J.C.’s voice. Karen returned around 9:15 p.m. to a quiet house. She called for her son, no answer. She came downstairs and found his body. Ruf knew J.C's death wasn’t an accident because her son left his phone unlocked so she could find his note: “Everything has a time. I decided not to wait for mine. They say we regret the things we do not do. I regret it a lot.” Schmid's son Tayler also left something on his phone. A video suicide note that talked about the depressive thoughts he was having. Hans and Hansen Schmid watched it.
Laurie says she hasn't been able to: "That's not how I want
to remember him." Why
are so many of my teen patients cutting themselves? We need
to fix this now. I must be a terrible doctor. That was one possibility I thought of to account for the six teenage patients of mine who over a recent three-month period presented to emergency rooms for depression and suicidal thinking. They were all between 14 and 16. Four of the six were girls. All of the girls had been actively self-mutilating, colloquially known as “cutting.” Four of the six were admitted to an in-patient psychiatric ward as significant and immediate “dangers to themselves." In other words, they were deemed by the psychiatrist in the emergency room as a potentially dangerous suicide risk. I’ve been in practice for 40 years. I’d guess over those decades I averaged about two or so hospital admissions a year. I’ve been extremely fortunate that none of the children and teens I’ve actively managed have ever killed themselves. I’ve always felt I’ve been on the overly cautious side in sending these kids to ERs for evaluations. But I know I’ve also been just lucky — as when that wayward, distraught boy I knew gave the loaded gun he held to his head to his mother, and hadn’t pulled the trigger. So six emergencies in three months was unusual for me. Besides questioning my abilities, I had been noticing for a while how children’s coping had changed over the decades. I had wondered if it was just my experience until I read about a study that appeared in the Journal of American Medical Association last November. The researchers looked at national rates of self-inflicted injuries (primarily poisoning and self-mutilation) between the ages of 10 and 24 that were evaluated in emergency rooms from 2001 to 2015. They examined 43,138 emergency room visits for self-harm. The overall rate for ER visits for self-harm (measured per 100,000 population) went from 201.6 to 303.7, an increase of 51%. But more striking than this overall increase was who was doing the bulk of the overdosing and cutting, and when did it really get out of control. It turns out that rates of self-harm for boys and young adults have not changed very much in 15 years. The big increases are in girls aged 10 to 14 and 15 to 19. The rates for the younger girls increased by 166% and older group by 62%. Overall poisonings had only increased by 19% over this period, but injury from sharp objects increased by 152%. Notably the vast bulk of the increase in cutting started in 2009. Since then, the rate of cutting by younger girls has increased by 18.8% a year. So it wasn’t just me being a bad doctor after all. I had sensed changes in my local area and wondered if this could be a national trend. This had happened to me once before in the early 1990s with ADHD. I now believe that depression and cutting are decimating our kids nationwide, especially girls. The researchers were understandably cautious in speculating upon the reasons for this disturbing trend, which they said “warrant(s) further study.” I am not bound by the same constraints. We cannot wait for further study to address this mounting epidemic. Indeed, there are so many factors that go into the making of a national psychiatric disorder epidemic that studying it scientifically is an enormous challenge. But I am especially struck by the 2009 start of the major increase in teenage girls’ self-harm. Facebook became available to children age 13 or over in 2006. MySpace was one of the most popular social media sites between 2005 and 2008, when it was overtaken by Facebook. Instagram went online in 2010 and Snapchat in 2011. These last two are, to my best information, the current apps of choice for teens communicating with one another on their mobile devices. Teenagers are probably the greatest users of social media and are certainly the most ill equipped to limit the dangers it can pose to their emotions, self-image and self-esteem. Teens are more than ever involved with themselves and their peers, to the exclusion of their parents and teachers. In this hothouse atmosphere of exaggerated drama, many teens are losing control of their emotions, getting quite depressed and suicidal, and they cut to relieve their stress. Google “how to cut yourself” and check out the first five website citations. The Internet has created these special communities of interest. The irony of our concerns about our children killing themselves (teenage suicide rates continue to creep up) is that talk of depression and suicide is constantly in the air these days on high school and even middle school campuses. Honestly, I go so far back that I can remember when an unhappy eight-year old would threaten to hold his breath until his parents changed their minds. Now the kids are saying they will kill themselves! Of course, there are many other factors that are creating this unhappy atmosphere for our children. Parents are unlikely to immediately change the social, economic and political conditions of our country overnight. However, parents can ask their teenagers to turn over their cell phones, iPads and laptops at 9 p.m., to be retrieved the next morning before heading off to school. Parents also can work at disengaging themselves from their own online activities — especially around dinner time, so they can eat a meal with their kids and without electronics. And that includes the old-fashioned TV (does anyone watch it anymore?). As I said, I’ve been lucky in
that not one of my patients has committed suicide yet. But
unless we take a close look and change our electronic
habits, I fear my luck will run out. After spike in
kid suicides, new Virginia law puts focus on prevention As suicides have risen in Virginia — including a 29 percent increase among children in 2016 — Gov. Ralph Northam has signed legislation calling on state officials to report how they are addressing the problem. House Bill 569, introduced by Delegate Wendy Gooditis, D-Clarke, requires the Department of Behavioral Health and Developmental Services to report annually its progress and activities on suicide prevention. The report will go to the governor and General Assembly. The bill is of special significance to Gooditis, who was elected in November to represent the 10th House District, which includes parts of Clarke, Frederick and Loudoun counties. During the first two weeks of her candidacy, Gooditis lost her brother to alcoholism and post-traumatic stress disorder. “He had a number of suicide attempts. It was part of the reason I was running in the first place. I found him dead two weeks after I announced my candidacy,” Gooditis said. “At that point, I don’t think anyone would’ve penalized me for quitting. But I had met so many who needed help, I couldn’t quit. I had to run and try to get the seat to try to speak for people who need someone to speak for them.” Northam signed Gooditis’ bill last month — about the time that the state’s Office of the Chief Medical Examiner released its latest annual report on causes of death in Virginia. Compiled by Kathrin Hobron, a forensic epidemiologist, the study provides statistical details on deaths that occurred in 2016, including homicides, suicides, accidents and other causes. The report states that it “reveals several trends of which the citizens and leaders of Virginia should be aware.” Those trends include a spike in suicide rates for children (defined as 17 and younger) in Virginia. In 2016, the rate was the highest it has been in at least 18 years. In 1999, the report said, 23 children in Virginia committed suicide — a rate of 1.3 suicides per 100,000 population. In 2015, 35 children committed suicide in the state. In 2016, the number jumped to 45 child suicides — or 2.4 suicides per 100,000 children. “Child suicides are very similar to adult suicides as they occur more frequently in males (roughly 62 percent) and whites (roughly 78 percent). White males have the highest rate of child suicide,” the report stated. Twenty-two — almost half — of the 45 child suicides in Virginia in 2016 involved firearms, usually handguns. That was the most common method of child suicide, followed by asphyxiation. Under Virginia law, it is a misdemeanor to “recklessly leave a loaded, unsecured firearm in such a manner as to endanger the life or limb of any child under the age of fourteen.” Even so, some children manage to obtain a gun and commit suicide each year. Gooditis said in an interview that she was familiar with the medical examiner’s report. It further demonstrates that something must be done, she said. “It’s just horrific. We have to intervene and teach (children) ways of handling their emotions so those emotions don’t take over,” Gooditis said. The number of suicides of Virginians of all ages also has increased in recent years. In 2016, it reached 1,156 — up from 1,097 the previous year. By comparison, there were 884 suicides statewide in 2006. In 2017, the General Assembly passed a bill requiring the Department of Behavioral Health and Developmental Services to issue a one-time report about its suicides prevention measures. HB 569 builds on that legislation by having the agency report on its efforts every year. In its report last year, the department updated the governor and the General Assembly on projects such as the Lock and Talk Virginia Campaign, which aims to reduce suicides by restricting individuals’ access to firearms and poisons when they are in a mental health crisis. The agency also discussed its efforts to educate the public on how to recognize and respond to suicidal warning signs. Under the bill Northam signed into law
March 19, the Department of Behavioral Health and
Developmental Services must issue such a report by Dec. 1
every year. It's Teen
Health Week. Why I care and why you should too Sure, suicide rates are soaring, the opioid epidemic is spreading from rural to suburban and urban areas and school shootings occurred at a rate of about one a week before the Parkland, Fla. shooting last month. Teens' stress levels are sky high. I have a 17 year old daughter who is awaiting word from all of the seemingly countless colleges she applied to. We live in Fairfax County, Va., one of the most affluent in the country and where pressure to excel has been met with several teen suicides in the past few years. I co-founded the Urban Health Media Project last year and help train high school students in Washington and Baltimore to report in their communities on health and social issues, which are far worse than i ever knew. And I'm no naive suburbanite. I grew up just minutes from downtown New Haven and have lived in or right outside Washington since I got out of college. The good news: Teens are speaking up, speaking out and making a difference. That's obvious from the Parkland students' successful state house lobbying and last week's national school walk out. Like most parents, some of the students' mothers and fathers cringe - or worse - at how much their teens want to share about what's going on in their lives. That's especially true about mental health challenges, which remain stigmatized across racial, ethnic and socioeconomic lines. But there's great promise in their willingness to be open about their challenges. It's when we know we aren't alone that we make it possible to get help - and to, in turn, help others. So speak out about how to improve the
mental and physical health of our teens, even if you're not
a teen and don't have one at home. Suggest an activity for
your school or your child's. And use the hash tag
#2018teenhealth. . VIRGINIA:
These teens saw how poor mental health hurt their peers. So
they got a law passed. There’s the raft of Advanced Placement classes, a dozen during his four years at Monticello High School in Virginia’s Albemarle County. There are the extracurriculars — tutoring and Model United Nations and student council and cross-country. During his junior year, there was the stress that accompanied all of it — stress that, at times, made him ask: “What is the point of all of this?” The 18-year-old witnessed distress among his peers, too — troubling Facebook and Instagram posts, bullying that went unaddressed, students without a place to turn. So Johnson and two other Albemarle County students, Alexander Moreno and Choetsow Tenzin, sought to fix that. They lobbied for more mental health resources in their schools before setting their aim higher: a law requiring mental health instruction for Virginia’s ninth- and 10th-graders. The legislation sailed through the House and Senate and was signed into law by Gov. Ralph Northam (D) last month. National statistics align with the students’ experience: Up to 1 in 5 adolescents between the ages of 13 and 18 live with a mental disorder, according to the U.S. Centers for Disease Control and Prevention. A study published in the March issue of the Journal of the American Academy of Child & Adolescent Psychiatry (The Effectiveness of School-Based Mental Health Services for Elementary-Aged Children: A Meta-Analysis) found that half of U.S. children who receive mental health services get them at school. The Albemarle teens hope to reduce the stigma they said surrounds seeking help for mental health. They also want to better equip students with skills and resources to cope with mental health struggles. “We know how private and how difficult it can be to deal with a mental illness, and we know that people are not going to always want to talk about what they’re going through,” Moreno said. “But we do want to make it okay for people who are going through something .?.?. to go and seek out resources.” It will be up to Virginia’s Board of Education to determine how the mental health mandate is carried out, but, under the law, the board must consult with mental health experts and update state standards. Moreno and Tenzin first tackled the topic at a summer institute for high school students at the University of Virginia. They felt the issue was too pressing to let fade. “The problem itself is very real,” said Tenzin, who attends Albemarle High School. “We deal with it daily, in our own schools.” The pair teamed with Johnson, who also participated in the institute, and worked through the fall and winter, holing up in coffee shops to plan. The students first focused on countywide initiatives, working to ensure resources addressing substance abuse, relationship violence and other issues were better publicized. They pushed Albemarle Public Schools Superintendent Pam Moran to include $160,000 in next year’s proposed budget to add a mental health professional to the school system. In the fall, the school district will introduce a freshman seminar intended to help students navigate issues that may arise during high school — a seminar shaped with input from the three students. “Mental health is critical in a day and age where our young people have all kinds of forces in play in their lives that can create levels of stress, anxiety,” Moran said. The teenagers caught the attention of state Sen. R. Creigh Deeds (D-Charlottesville), who has focused on improving the state’s mental health system since he was stabbed by his mentally ill son, who then killed himself. Deeds, struck by the students’ empathy, knowledge and research, sponsored a Senate version of the students’ bill. Del. Rob Bell (R-Albemarle) introduced a companion bill in the House. “When young people are at that age when there’s a lot of bullying, when they get it and they understand, I want to encourage that,” Deeds said. “We focus so much on the physical health, we forget the brain is part of the body, too.” Charles Pyle, a state Education Department spokesman, noted that the state’s Standards of Learning already include some mental health education but also said that the law provides an opportunity for the state to revisit those standards and identify gaps. Johnson, the Monticello student, said the current standards only touch on mental health and aren’t comprehensive. The Albemarle County students have their own ideas for what they would like to see emerge from the law. They want to understand the science behind mental health, let students know where they can turn in times of trouble and shed negative connotations associated with talking about mental well-being. “The problem isn’t that
students are doing too much,” said Moreno, a senior at
Western Albemarle High School. “The problem is that
students are doing too much, and they don’t have
individuals in place that can help them deal with the stress
and anxiety that come with that. A bad day turns into a bad
week and turns into a bad month.” What’s
wrong, and how do we help? Getting children the right
mental-health support. A new study in the March issue (The Effectiveness of School-Based Mental Health Services for Elementary-Aged Children: A Meta-Analysis) of the Journal of the American Academy of Child and Adolescent Psychiatry found that more than half of the children in the United States who receive mental-health care now get it in school settings, and that if school-based personnel are properly trained and supported, such services can be effective. But many schools in high-poverty communities don’t have the resources to hire, train and support people who can provide these services to kids. This post is a primer for parents about how they could approach finding help for a child with a mental illness. It was written by Rosalind Wiseman, a parenting educator and best-selling author of books including “Queen Bees and Wannabes,” a look at high school social cliques that became the basis for the Tina Fey-written movie “Mean Girls.” She has written a number of other books, including “Queen Bee Moms and Kingpin Dads,” and a novel for young adults titled “Boys, Girls and Other Hazardous Materials.” She created the Owning Up Curriculum, a program that teaches children and adults to take responsibility for unethical behavior whether they are bystanders, perpetrators or victims, and she runs an organization she founded called Cultures of Dignity, which works with communities to direct conversations about the physical and emotional well-being of young people. We used to think that only “at-risk” kids had mental-health problems. But if you are raising or educating children today, it’s understandable to worry about their emotional and psychological well being. The U.S. Centers for Disease Control report what many parents and people in education already know: “At risk” kids can be any kid, in any neighborhood, in any family. I work with children and teens around the country, and our children are remarkably resilient. But just think for a moment about what many of them are experiencing. Middle school students in Dallas shared with me last week that they think about school shootings every day. High school students in every state where I work say they are crushed with anxiety trying to “keep up.” The National Survey on Drug Use and Health shows that 56 percent more teens experienced a major depressive episode in 2015 than 2010. Forty-six percent more 15-to-19-year-olds committed suicide in 2015 than in 2007 — and 2½ times as many 12-to-14-year-olds killed themselves. These are terrifying statistics for any parent. Yet it’s complicated. Kids will tell you “I’m fine” when they’re not. Or they can be inconsolable one day and then put it behind them the next. The process can make you feel as if you’re losing your mind. And no one can prepare you when you really worry about your kids, including those times when you can’t sleep at night because you know what the problem is but you don’t know how to help them, or they’re miserable but won’t tell you why. You can be so torn between love, anger and frustration that it’s hard to know how to get the help they need. You need a road map to help you and your child through the process. Here are four fundamental principles to always keep in mind:
These principles also mean letting go — probably during a time you want to hold on as tight as you can. You have a special relationship with your child; that means when your child is upset, angry, frustrated or sad, they shouldn’t be dealing with your emotional reactions to their problems. Your anger, anxiety or advice to fix the problem can be a distraction or even exacerbate the problem, and that’s why you are sometimes not the best person to give them advice. Ironically, the fact that we are parents sometimes stops us from being the best resource for our children. Our love and anxiety blind us to the most effective course of action. Finding a professional Choosing a mental-health professional takes a lot of effort. When you find one, you can be so grateful that you immediately sign your child up — whether or not the person is a good fit for them. As desperate to fix the problem as you may be, slow down. How you approach finding the right person and including your child in the process will go a long way in making your child feel that seeking help is worthwhile. What if your child doesn’t want to see anyone? Many young people I work with don’t want to be seen going into a counselor’s office at school. Likewise, many are reluctant to see a therapist. It’s scary to ask for help, in part because mental-health problems are still often seen as a character weakness. Some of the high-achieving young people I work with tell me they don’t want to get professional help because it will hurt their chances of being considered for leadership positions in school. No matter what the reason, if you are facing a wall of resistance, here’s what you can say: Everyone goes through times in life where problems or feelings are just too big to handle on your own. It’s not weak to ask for help. It actually takes a tremendous amount of courage. You’re going through a tough time, and you need to talk to someone who knows more about how to handle these problems that we do. I know I can’t force you to talk to someone, and I know some therapists aren’t good at their jobs. I am asking you to do this: I’ll do some research and find a few people in the area who work with people your age. I’ll give you a list of people to choose from and you make the choice of who you want to see. You don’t need to see them forever. Just check it out a few times and see if you can find someone you think is worth your time. We will just take this one step at a time. How do you find an expert your child will connect with?
In addition, here are some guidelines to help you: Be aware of where you are. Even if you’re only there to pick up your child, don’t wait in the outside office area. Your child will think you are eavesdropping on their conversation — even if you aren’t. It’s also possible that you aren’t the first thing your child wants to see after a session, so just wait outside or in the car. If you have to talk to the therapist, inform your child when you’re doing it and ask them how you should so they feel respected. Respect their privacy. Assure your child that while you would like to know how the process is working for them, you won’t ask them a “million” questions after a session. If your child wants to tell you something, that’s awesome. And whatever they do say, don’t take it personally. That’s hard, but remember that listening is being prepared to be changed by what you hear. You may learn a lot. Our children are often our greatest teachers. Find resources and support for yourself. Taking care of yourself and having a place to process your own feelings is critical. You’re not just doing this for your child’s welfare, you’re doing it for your own as well. None of this takes away how scary this
experience can be, but be assured that you are making it
better by getting them the help they need, how they need it.
Remember that these are the moments when your child needs
you to be by their side (maybe giving them a little bit of
space) as they walk down this difficult path, knowing that
they are loved, listened to and supported. Momo
challenge: Does creepy internet meme promote suicide in
children? Momo is an internet character that has been linked to several suicides around the world. The latest round of unsettling internet challenges has taken a potentially dangerous turn, with multiple “kid-friendly” videos teaching children how to commit suicide or encouraging them to commit high-risk acts. A trend called the “Momo Challenge” has been stirring up fervor in recent weeks, even though the character — a gaunt, terrifying doll that asks the viewer to participate in challenges that range from innocuous to deadly — has been appearing around the internet for at least a year, according to international police agencies and news outlets. Momo, with its bulging eyes and stringy hair, reportedly appears on sites or apps like WhatsApp, Facebook and Youtube, sometimes in conjunction with kids’ videos meant to depict the popular game Fortnite or kids show character Peppa Pig. The actual visage of Momo depicts a sculpture called “Mother Bird,” made by a Japanese special effects company called Link Factory, which is not associated with the challenge itself. The person or people masquerading as the character encourage video viewers to contact them via a WhatsApp number. Then they, as “Momo,” ask people to complete challenges, some of which involve self-harm or suicide, such as how to take pills, according to international reports. Other examples include turning on the oven at night. "Momo" also tells viewers that she will “curse them” if they don’t do what she says, and encourages them not to tell anyone about the challenge. Some have decried Momo as a hoax, while others insist their children have been in contact with those behind the mysterious character. The shifting, bottomless nature of internet content, plus the tendency of Youtubers and others to quickly capitalize on scary memes makes it difficult to pin down the origin or measure the widespread impact of the trend. Youtube released a statement on Twitter Wednesday afternoon, saying the platform has "seen no recent evidence of videos promoting the Momo challenge on Youtube. Videos encouraging harmful and dangerous challenges are against our policies." Youtube urged anyone who has seen such videos on Youtube to flag the content immediately. The challenge was reportedly linked to several suicides worldwide, including two children who killed themselves just days apart from one another in September in Barbosa, Colombia, according to reports from the Daily Mail of England. The boy, 16, reportedly got the younger girl, 12, involved with the game before they both died. Police found messages associated with the game on the children's phones, reports say. Regardless of whether the challenge has truly played a role in child suicides or dangerous actions, the viral trend shouldn't be the only internet-related conversation parents have with their kids, others have argued. Parents should foster open conversations about internet usage and security, and set protective measures on computers and phones. “Our advice as always, is to supervise the games your kids play and be extremely mindful of the videos they are watching on YouTube,” said the Police Service of Northern Ireland in a post about the challenge Saturday. “Ensure that the devices they have access to are restricted to age suitable content.” Parents and others said they reported videos to Facebook, Youtube and other sites, and while some have been taken down, others are still live online and sometimes, the old ones reappear again. Other suicide messages have been found in popular children’s videos depicting Splatoon, a kid’s game in which squid-like characters squirt ink at each other. An unrelated character called Filthy Frank, created by former Youtuber George “Joji” Miller, appears midway through the video and appears to give kids advice about how to slit their wrists. It's unclear how the disturbing clip was included in a video meant for kids. “End it,” he says at the end of the 11-second segment, which then cuts back to the Splatoon video. Free Hess, a Florida-based pediatrician and mom who runs her own website PediMom.com, said she first encountered the video with a clip of the suicide instructions edited in about seven months ago from a concerned parent. Hess said that although the clip was removed from YouTube Kids — a version of YouTube available as an app billed as kid friendly — it had resurfaced on YouTube. There was also a second video that has been removed from Youtube. "There has to be a better way to assure this type of content is not being seen by our children," said Hess in a blog post published last Friday. "We cannot continue to risk this." In a statement this week, YouTube said any videos that don't belong in the app are removed, and the service has invested in additional parental controls to tailor the user experience more closely. "We work to ensure the videos in YouTube Kids are family friendly and take feedback very seriously," said YouTube. Last year, the YouTube Kids app was slammed by critics for allowing several videos to infiltrate the app that were not appropriate for kids. YouTube's parent company, Google, responded with an update allowing parents to curate the app with more kid-friendly channels such as Sesame Street. The suicide
rate in the U.S. has increased in recent
years, including among
minors. Suicidal
Thoughts in Children
Age and Suicidal Thoughts Suicide rates in America are the highest they've been in 50 years. According to the CDC, suicide rates were significantly higher in 2017 compared to 1999 among females ages 10 to 14 (1.7 and 0.5, respectively) and 15 to 24 (5.8 and 3.0) and males ages 10 to 14 (3.3 and 1.9, respectively) and 15 to 24 (22.7 and 16.8). In 2017, adolescents and young adults ages 15 to 24 had a suicide rate of 14.46. A 2018 study published in the journal JAMA Pediatrics found that the suicide rate among Black children under 13 years is double the rate for white children in the same age group. This accounts for both girls and boys. Typically, rates of suicide increase with age, peaking in late adolescence. Girls more often attempt suicide, but boys more frequently follow through to completion. Suicidal Thoughts and Depression According to one study, suicidal thoughts are linked to a worse course of depression, the symptoms of which include earlier onset, longer duration, and shorter intervals of remission. It's important to know that not all depressed children will have suicidal thoughts or show suicidal behavior. In fact, it's one of the least common symptoms of childhood depression. Also, not all children with suicidal thoughts and behavior are depressed. Perhaps most comforting to know, not all children who have suicidal thoughts will attempt suicide. However, it's a good predictor for future attempts, and these children always need to be evaluated by a professional. Warning Signs of Suicide Some important warning signs of suicidal behavior in children are:
Risk Factors for Suicide It's not always easy to detect the risk factors that may contribute to a child's risk of suicidal thoughts and behavior. However, recognizing them and getting help can be life-saving. If you think that your child or someone you care about has some of these factors, consider setting up an appointment with a mental health professional for a suicide-risk assessment. If the adolescent is high-risk, you may need to schedule these assessments on a regular basis.
How to Help Your Child Here are some strategies to help your child if you think they are having suicidal thoughts:
When to Get Immediate Help It's better to be safe than sorry when it comes to your child's well-being. If you think that your child is in crisis and that they have had a previous suicide attempt, is threatening to harm themselves, or you just have a "gut feeling," get your child help immediately. Don't wait. If needed, take your child to a pediatric emergency room. Do not leave them alone. Remove anything in the house they can possibly use to hurt themselves. If your child is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 or text SOS to 741741 for free support and assistance from a trained counselor 24/7.. If you or a loved one are in immediate danger, call 911. A Word From Verywell Having a child who is depressed or is
suicidal does not make you a bad parent or mean that you did
anything to cause their pain. The best thing you can do is
to get your child help and support them in their
recovery.
Seasonality
of Suicidal Behavior 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. 1. Introduction 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 [5], race [6], month of birth [7], socioeconomic factors [8], marital status [9], inter-personal relationships or life events [10,11], comorbid medical conditions, current or history of psychiatric illness [12], allergy [13], and most importantly, previous suicide attempts and violent methods of prior suicide attempt [2,14]. Physical environmental factors, e.g., sunshine, temperature [15], chemical (e.g., air pollutants) [16] and biological factors such as viruses [17], 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. 2. Methods 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 (1979–2011) 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. [32] 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 [35]. 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 [36]. 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 [38] 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. [42] 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. [25] 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. [15] 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 [26]. 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. [28] 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 [43]. 3.2. Geographic Location Chew and McCleary [4] 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. [44] 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 [24] 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. 3.3. Allergens Allergy has been previously linked to suicide [13]. 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) [19]. 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 [51] and aggressive behavior [52] all of which can be considered as endophenotypes for suicidal behavior [53]. 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. [54] 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 [54]. 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 [53]. 3.4. Viruses The human immunodeficiency virus (HIV) has been associated with suicide [55] 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 [17] did not include an evaluation of seasonality effect on suicide. More studies on the association of seasonal viruses and suicide are needed. 3.5. Pollutants Air pollutants have been correlated with rates of visits to the emergency room as well as inpatient admission rates of patients with mental illness [56]. Recently Kim et al. [16] 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 [57], 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 [58]. 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 [61] 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. [62] demonstrated a seasonal spring peak of suicide in a study of male patients with alcohol addiction. Rocchi et al. [45] also reported on the seasonality of suicide completion among patients with psychiatric illnesses. Recently, Postolache et al. [63] 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. [64] 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 [13]. Indeed, Timonen et al. [65] revealed an association between prior hospitalization for atopic disorders and seasonal variation of suicide. 5. Demographic Variables 5.1. Age Several studies have found associations between age and seasonal variation in suicide. Maes et al. [2] 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. [66] observed a suicide peak in fall among adolescents, particularly for those dying by shooting. Furthermore, McCleary et al. [67] 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. 5.2. Gender 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 inc asing prescription rate for antidepressants was associated with a decrease in national suicide rate but significantly decreased seasonality of suicide only in males [70]. 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 [70]. Seasonality of suicide attempts is also shown to be associated with gender [71]. 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 [74]. 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 [71]. Kreitman et al. also reported no considerable gender difference in seasonality of suicide attempts in the U.S. [75]. 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. [76] 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 [7]. 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. [79] 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. [80] 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 [4] 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. [81] 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 [40] 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. [35] 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 [82]. 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 suicide—thus, 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 [80]. 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. [39] 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 [48], Belgium [2,89], Greenland [37,90], Switzerland [1,81], UK [91], Australia, New Zealand [92], Asia [43], 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 [43]. 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 [94]. 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 [92]. Regarding non-violent methods, Hakko et al. [39] 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 [19]. 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 [95] 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 [96]. 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 [97]. 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 [3]. Ajdacic-Gross et al. [3] 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. [66] 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. [81] looked at 120 year trends of suicide seasonality in Switzerland and determined that there was a decline of overall seasonal variation during 1969–2000 compared to 1881–1920. 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. 7. Conclusions 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 [29]. 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 [26]. Unfortunately, many studies assessed seasonality over a relatively short period of time with data gathered in only one country or even smaller geographic unit [29]. 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 [98]. 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 [99], Hong Kong [100], Sweden [101], and Denmark [102] 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 [103], 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 Acknowledgments 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. References and Notes 1. 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Scand. 2012;125:127–146. [PubMed] 81. Ajdacic-Gross V., Bopp M., Sansossio R., Lauber C., Gostynski M., Eich D., Gutzwiller F., Rössler W. Diversity and change in suicide seasonality over 125 years. J. Epidemiol. Community Health. 2005;59:967–972. [PMC free article] [PubMed] 82. Kposowa A.J., McElvain J.P., Breault K.D. Immigration and suicide: The role of marital status, duration of residence, and social integration. Arch. Suicide Res. 2008;12:82–92. doi: 10.1080/13811110701801044. [PubMed] [Cross Ref] 83. Cheng Q., Chen F., Yip P.S. The Foxconn suicides and their media prominence: Is the Werther Effect applicable in China? BMC Public Health. 2011;11 [PMC free article] [PubMed] 84. Li X., Stanton B., Fang X., Xiong Q., Yu S., Lin D., Hong Y., Zhang L., Chen X., Wang B. Mental health symptoms among rural-to-urban migrants in China: A comparison with their urban and rural counterparts. World Health Popul. 2009;11:24–38. [PubMed] 85. Lin D., Li X., Wang B., Hong Y., Fang X., Qin X., Stanton B. Discrimination, perceived social inequity, and mental health among rural-to-urban migrants in China. Community Ment. Health J. 2011;47:171–180. doi: 10.1007/s10597-009-9278-4. [PMC free article] [PubMed] [Cross Ref] 86. Lester D. Seasonal variation in suicide and the methods used. Percept. Mot. Skills. 1999;89:160–165. [PubMed] 87. Kalediene R., Starkuviene S., Petrauskiene J. Seasonal patterns of suicides over the period of socio-economic transition in Lithuania. BMC Public Health. 2006;6 [PMC free article] [PubMed] 88. Hakko H., Räsänen P., Tiihonen J. Secular trends in the rates and seasonality of violent and nonviolent suicide occurrences in Finland during 1980–95. J. Affect. Disord. 1998;50:49–54. [PubMed] 89. Linkowski P., Martin F., De Maertelaer V. Effect of some climatic factors on violent and non-violent suicides in Belgium. J. Affect. Disord. 1992;25:161–166. [PubMed] 90. Björkstén K.S., Bjerregaard P., Kripke D.F. Suicides in the midnight sun—A study of seasonality in suicides in West Greenland. Psychiatry Res. 2005;133:205–213. [PubMed] 91. Salib E. Elderly suicide and weather conditions: Is there a link? Int. J. Geriatr. Psychiatry. 1997;12:937–941. doi: 10.1002/(SICI)1099-1166(199709)12:9<937::AID-GPS667>3.0.CO;2-O. [PubMed] [Cross Ref] 92. Yip P.S., Chao A., Ho T.P. A re-examination of seasonal variation in suicides in Australia and New Zealand. J. Affect. Disord. 1998;47:141–150. [PubMed] 93. Lester D., Frank M.L. Seasonal variation in suicide rates in the United States. J. Clin. Psychiatry. 1988;49 [PubMed] 94. Lester D., Frank M. Sex differences in the seasonal distribution of suicides. Br. J. Psychiatry. 1988;153:115–117. [PubMed] 95. Coccaro E.F. Central serotonin and impulsive aggression. Br. J. Psychiatry. 1989;8:52–62. [PubMed] 96. Maes M., Scharpe S., Verkerk R., D'Hondt P., Peeters D., Cosyns P., Thompson P., Meyer F.D., Wauters A., Neels H. Seasonal variation in plasma L-Tryptophan availability in healthy volunteers: Relationships to violent suicide occurrence. Arch. Gen. Psychiatry. 1995;52:937–946. [PubMed] 97. Lambert G.W., Reid C., Kaye D.M., Jennings G.L., Esler M.D. Effect of sunlight and season on serotonin turnover in the brain. Lancet. 2002;360:1840–1842. [PubMed] 98. Woo J.M., Gibbons R.D., Rogers C.A., Qin P., Kim J.B., Roberts D.W., Noh E.S., Mann J.J., Postolache T.T. Pollen counts and suicide rates. Association not replicated. Acta Psychiatr. Scand. 2012;125:168–175. doi: 10.1111/j.1600-0447.2011.01813.x. [PubMed] [Cross Ref] 99. Yip P., Chao A., Chiu C. Seasonal variation in suicides: Diminished or vanished. Br. J. Psychiatry. 2000;177:366–369. [PubMed] 100. Yip P.S.F., Yang K.C.T. A comparison of seasonal variation between suicide deaths and attempts in Hong Kong SAR. J. Affect. Disord. 2004;81:251–257. [PubMed] 101. Rihmer Z., Rutz W., Pihlgren H., Pestality P. Decreasing tendency of seasonality in suicide may indicate lowering rate of depressive suicides in the population. Psychiatry Res. 1998;81:233–240. [PubMed] 102. Yip P.S.F., Yang K.C.T., Qin P. Seasonality of suicides with and without psychiatric illness in Denmark. J. Affect. Disord. 2006;96:117–121. [PubMed] 103. Bridges F.S., Yip P.S.F., Yang K.C.T. Seasonal changes in suicide in the united states, 1971 to 2000. Percept. Mot. Skills. 2005;100:920–924. [PubMed] 104. Casey P., Gemmell I., Hiroeh U., Fulwood C. Seasonal and socio-demographic predictors of suicide in Ireland: A 22 year study. J. Affect. Disord. 2011 [PubMed] 105. Corcoran P., Reilly M., Salim A., Brennan A., Keeley H.S., Perry I.J. Temporal variation in Irish suicide rates. Suicide Life Threat. Behav. 2004;34:429–438. [PubMed] 106. Schreiber G., Dycian A., Kaplan Z., Bleich A. A unique monthly distribution of suicide and parasuicide through firearms among Israeli soldiers. Acta Psychiatr. Scand. 1993;87:110–113. [PubMed] Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC3315262/ Native American
Youth Suicide Goals: 1. Identify problems of those participating Native American youth from their perspective as it relates to drug, alcohol and substance abuse along with physical and sexual abuse. 2. Evaluate the depth and source of the problem. 3. Identify intervention services to combat these problems by overcoming the source of the problem and the perceived solution. 4. Implement methods to address appropriate counseling services in local areas and on a regional basis. 5. Attempt to identify the cause of the suicide attempts among the Native American youth in the area. 6. Locate and recruit participation in the development and correctional programs from positive role models from the local surrounding Native American community. 7. Develop participation in the programs by Native American youth utilizing a peer guidance and community support program. Flying With Eagles, Inc., is
registered in Pennsylvania as a not for profit corporation.
Flying With Eagles,Inc., is a public charity exempt from
federal income tax under Section 501(c)(3) of the Internal
Revenue Code. Young
Adults and Mental Health: A Guide for Parents Transitions are often a challenging time for many families. Whether it’s going to middle school, going into high school, going to college, or entering the workforce full-time, any major life change comes with mixed emotions. You may be excited one minute and scared or stressed the next. That’s completely normal, and normal for your kids, too. When young adults leave high school or college, the future can seem overwhelming. As a parent, your role in your kids’ lives change as they grow up, but maintaining an open line of communication can be beneficial for everyone. One of those benefits is on mental health. Talking with your kids about mental health can take many shapes and forms, but with a few questions in mind, and an open dialogue, you can help major transitions run a bit smoother. What Is “Normal?” Clinical psychologist Dr. Bobbi Wegner has parents who often come to her with concerns about their student’s transition into or out of college. She says that many kids go through adjustment issues, and it’s completely normal. But often young adults and their parents aren’t expecting these feelings to come up, so when they do, there is a heightened sense of worry. “Anxiety and depression is the common cold of mental health, but people don’t talk a lot about it,” Wegner says. “As a parent, a part of helping is normalizing anxiety, and feeling low or depression can be a ‘normal’ part of the experience.” “Normal” difficulties during transition times include increased anxiety, depression, and relationship issues. Young adults can have a hard time making new friends in the work place or at school and start to feel lonely or isolated. Increased workload and responsibilities can contribute to stress. Raising their awareness that those feelings are valid can go a long way. Be Prepared UCLA’s Executive Director of Counseling and Psychological Services Dr. Nicole Presley Green’s biggest advice to parents is to be proactive before there is a problem. Knowing what resources are available on campus, like student counseling centers, is a great step to being prepared. Similarly, making sure your young adult knows about their insurance information can help prepare them should they need to seek care at any point. Related: Guide to Young Adult Physical Health Care Being prepared also means maintaining an open line of communication between you and your young adult. That doesn’t mean you have to call them every few hours, but simply letting them know they can call you or reach out whenever they need to. Keep in mind that you’ve been with your kid for most of their life; you know what is normal for them. “It’s a really challenging time for parents. They don’t know how much to let them flourish and flounder, and how much to get involved,” Dr. Green says. “But they do know when their kid is really reaching a point where they need help.” Know the Red Flags As a parent, hearing that it’s “normal” might not help when you’re worried whether or not your kid is able to handle their new world. Fortunately, there are ways for you to help identify whether or not something more serious is going on. Dr. Wegner recommends keeping an eye out for any major changes in behavior in three categories she calls the “holy trilogy of health”:sleeping, eating, and energy. Any major shift in any of those areas (eating much more, eating much less, sleeping much more, sleeping much less, etc.) can be a red flag and a time for you to get curious and ask more about what is going on with your kid. Psychologist Dr. Michele Borba recommends keeping a few questions in mind when you’re talking and listening with your young adult. Ask yourself:
If you answer “yes” to these questions, it’s likely your teen is adjusting well, even if they say they’re stressed or sad. If they are showing no connections, or no interest in making new friends or getting involved, Dr. Borba says that is a “red flag” that there could be trouble ahead. Acknowledge, Empathize, and Be Intentional Ways to support your young adult are to acknowledge their feelings, empathize with them, and be intentional about the questions you ask. Often, when young adults reach out to parents in times of struggle, they’re looking for support or a shoulder to cry on. Dismissing their feelings or trying to fix their problems for them is a surefire way to end the conversation completely. For example, if your teen is feeling anxious or depressed, don’t dismiss those feelings by saying “That’s not something to be stressed about,” or “Everyone feels like that.” Similarly, trying to fix the problem also isn’t the answer. If your kid says they “don’t have any friends” don’t point out all the friends they had in high school, or their new coworker. It may be that they mean they don’t have the same strong friendships they used to have, which is something that can make them feel isolated or lonely. Instead, be intentional in your responses and turn the question or concern back to them. Dr. Wegner says this is a common tactic used by therapists to validate a patient’s concern, and empower them to find the answers themselves. You could try asking:
Simply by listening, and allowing your young adult to come to conclusions on their own, you’re empowering them to understand more about their feelings and address them. Let Your Kids Know It’s O.K. to Ask for Help Asking for help, especially for mental health, is often stigmatized in America. But it doesn’t have to be. For college students, most counseling centers are a free resource that anyone can use. For young adults not enrolled in college, most health insurance plans also offer mental health coverage. So visits to a therapist or psychiatrist are often covered in some form. And as far as that stigma, Dr. Wegner says there shouldn’t be shame in asking for help if you need it, even if the situation isn’t dire. “People think it’s something you should only do if you’re clinically depressed and that’s not true,” Wegner says. “You don’t have to make a commitment, and you don’t have to go forever. Sometimes just a few sessions and then moving on can be helpful.” Dr. Green does a lot of outreach on campus to try and decrease stigma associated with getting help. In some cases, that can be recommending parents encourage students to seek help in any way that seems accessible to them. For example, if therapy seems to scary, parents can suggest their students to talk with their RA as a first step. When to Get Professional Help First and foremost, trust your gut instinct. Dr. Green reminds parents that “they know their kid the best.” Any drastic difference in behavior or temperament from what is normal for your young adult can be a sign that something more serious is happening. If your young adult talks about self-harm, suicide, or suicidal thoughts, do not avoid it. Try to find out if they mean they want to hurt themselves right now and, if so, seek immediate help by calling 9-1-1. If your young adult is drinking in excess or using other drugs to the point it is interfering with their ability to function normally, that’s also a time to seek professional help. For a small subset of the population that has psychotic disorders, young adulthood is often when symptoms start showing up. If your young adult is behaving erratically, having hallucinations, staying awake for extended periods of time, or sleeping for extend periods of time, seek professional help. For more help, try any of these resources: National Suicide Prevention Life Line—call 1-800-273-8255 or visit suicidepreventionlifeline.org/ Crisis Text Line – Text “Connect” to 741741 or visit www.crisistextline.org Substance Abuse and Mental Health
Services Administration Treatment Locator – call
1-800-662-HELP (4357) or visit: findtreatment.samhsa.gov Mental health
problems rising among college students "At my high points I was working several jobs and internships — I could take on the world," said Ebeling, 24, who graduated from Ramapo College of New Jersey last December. "But then I would have extreme downs and want to do nothing," she told NBC News. "All I wanted to do was sleep. I screwed up in school and at work, I was crying and feeling suicidal." More than 75 percent of all mental health conditions begin before the age of 24, according to the National Alliance on Mental Illness, which is why college is such a critical time. Ebeling resisted getting therapy, but eventually got a diagnosis of bipolar II disorder from a psychiatrist associated with Ramapo's counseling office. "Then everything fell into place," said Ebeling, who is doing well on medication today. RELATED:Young Adults and Mental Health: A Guide for Parents College counselors are seeing a record number of students like Ebeling, who are dealing with a variety of mental health problems, from depression and anxiety, to more serious psychiatric disorders. "What has increased over the past five years is threat-to-self characteristics, including serious suicidal thoughts and self-injurious behaviors," said Ashley Stauffer, project manager for the Center for Collegiate Mental Health at Penn State University. According to its data, collected from 139 institutions, 26 percent of students who sought help said they had intentionally hurt themselves; 33.2 percent had considered suicide, numbers higher than the previous year. And according to the 2016 UCLA Higher Education Research Institute survey of freshmen, nearly 12 percent say they are "frequently" depressed. At Ramapo College, counselors are seeing everything from transition adjustment to more serious psychiatric disorders, according to Judith Green, director of the campus' Center for Health & Counseling Services. Being away from home for the first time, access to alcohol and drugs and the rigorous demands of academic life can all lead to anxiety and depression. Millennials, in particular, have been more vulnerable to the stressors of college life, Green told NBC News. "This generation has grown up with instant access via the internet to everything," she said. "This has led to challenges with frustration tolerance and delaying gratification." Millennials tend to hold on to negative emotions, which can lead to self-injury, she said. It's also the first generation that will not likely do as well financially as their parents. "Students are working so much more to contribute and pay for college," said Green. "Seniors don't have jobs lined up yet." 'I dragged myself to the counseling center' Like Ebeling, many students often experience mental illness breaks in college. She had been in grief counseling after the death of her father at age 8, and even had therapy — but refused medication — during her teen years. "I thought that it was weakness — 'why can't I just snap out of it?'" she said. "It became apparent it just wasn't that easy." She hit a deep low her senior year. "I was a crazy over-achiever," she said. "I got involved in all the clubs and extracurricular activities." But when her mood dropped, she said, "I couldn't do anything, but had all those responsibilities." "In one class I panicked so much, I freaked out," said Ebeling. "I dragged myself to the counseling center." The resources are available, according to Green, who first counseled Ebeling. Ramapo reaches out to freshman and their parents at orientation and reinforces the availability of mental health resources throughout the year. The college also maintains an online anonymous psychological screening tool so students can see if therapy might be helpful. RELATED:Meditation May Help Students Combat High Levels of Stress, Depression "Students are electronically savvy, so we meet them where they are," said Green. They also sponsor wellness fairs so students learn about nutrition, exercise and even financial well-being — "the whole gamut to keep themselves well," she said. As for Ebeling, she took her experience and devoted her senior capstone project to learn more about mental illness. "It was therapeutic." Kids going to college need to realize it's not a weakness," she said. "They shouldn't be afraid to get help." "I try to be open and talk about it with friends and family," said Ebeling. "Don't shy away from it. It needs to be addressed. Let go of the stigma." Ebeling had good communication with her mother regarding her mental health diagnosis, but said other students should consider sharing their medical information if they "feel they have a good support system. "I have friends who tried to discuss mental health issues with family members and completely got brushed off, which can be crushing and damaging," she said. "I think both students and parents need to keep an open mind, but at the end the of the day, those who are seeking help need to realize that they are doing this for themselves and no one else, and they need to put themselves first and foremost no matter what." Tips for Parents from the National Association of Mental Illness:
Source: www.aol.com/article/news/2017/06/28/mental-health-problems-rising-among-college-students/23007047/
One Important
Suicide Fact That Nobody Is Talking About We hear about gun violence in blips: The latest mass shooting or grisly homicide brings national attention and calls to action, and then the issue falls under the radar. It's easy to forget that two-thirds of gun deaths aren't high-profile homicides, but suicides—happening quietly, at a rate of one every 25 minutes. A new report by the Brady Center to Prevent Gun Violence, a gun safety advocacy group, delivers sobering stats based on data from the Centers for Disease Control and Prevention and academic journal articles—perhaps the most eye-opening being that keeping a firearm at home increases the risk of suicide by three times. A whopping 82 percent of teens who commit suicide with a gun are using a family member's firearm. Guns are a particularly effective means of suicide precisely because they are so lethal: Of those who attempt suicide by firearm, nine in 10 succeed. By contrast, only one in 50 overdose attempts result in death. The lethality is compounded by impulsivity: The majority of suicide attempts occur less than an hour after the decision is made to commit suicide. One common argument of the gun lobby
is that suicidal individuals will find a way to take their
lives—if they don't die by gun, they'll do it by some
other means. But the reality is that 90 percent of those who
fail in a suicide attempt do not end up dying by suicide.
With guns, though, not many get a second chance. FULL
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