Part Two of a Two Part Series

In 2018, the Centers for Disease Control and Prevention (CDC) published a mortality report which showed an unprecedented and unpredictable rise in suicide deaths among children and teenagers. The last blog focused on the “Why?” It is important to know the “why” in order to formulate possible solutions to the problems. Research has shown a couple of factors that are thought to have played a part in the increase in teenage suicide over the last ten years: income level, access to firearms, high expectations of personal perfection, perceived social isolation, social media, bullying, and cyberbullying.

Clinical psychologist, Lisa Damour, argues that teenagers’ attitude and behavior changes are attributed to “teenage angst”, and parents need to look for these signs and have honest conversations when changes in the child are recognized (Healy, 2019). Parents, teachers, peers, and physicians must look for individuals who start isolating, changing sleep patterns, and appear distressed or depressed. Sansea Jacobson (2018), a child psychiatrist, also advises them to pay attention to a withdrawal from previously enjoyed activities and socialization with friends.  She stresses that some teenagers, when depressed, will not outwardly appear sad. She also states that depression often manifests in younger individuals as somatic, physical complaints, such as headaches, stomach aches, and fatigue (Jacobson, 2018). Some also become angry and rebellious, and may experiment with drugs and alcohol (Jacobson, 2018). This behavior is often misinterpreted as “teenage angst”, when the individual is changing due to an underlying, potentially treatable depression.

There is a higher suicide incidence in counties that are considered impoverished, as per a recent study by Hoffmann et al. (2019). While the researchers note there must be more research into the role income plays in the increased risk of suicide, they also point out that there could be a connection between access to firearms and ammunition. A recent study showed that only 35% of physicians educated families on firearm injury prevention, due to the political nature of the conversation (Yanger, 2017). Lower income counties may not have the resources to adequately screen children and adolescents for risk of suicide. There is also less access to mental health facilities and programs. A community health-based approach is needed in lower income areas to make sure the most vulnerable have  resources available.

Pediatricians and school guidance counselors can perform formal screening, such as the Patient Health Questionnaire 9, which screens for risk of depression (Jacobson, 2018). Students in school can be educated about how to ask each other how they are feeling (Jacobson, 2018). While there is a stigma still attached to mental health, those who are closest to children and adolescents are the “gatekeepers to mental health treatment.” (Jacobson, 2018) Young people are capable of speaking openly about their feelings and emotions. Adults and professionals must be made to realize that “talking and asking about suicide does not increase the risk of suicide… it is silence that is dangerous.” (Jacobson, 2018) The more this topic is discussed, the more it will become much less taboo.

One of the main causes behind the increase in teenage suicide is cyberbullying and the increased use of social media. Luxton, June, and Fairall (2012) published an article about social media and suicide risk. After explaining the negatives of social media, the authors stressed that social media and the internet could be used in an advantageous way to turn the tables and prevent suicide. Facebook groups exist with suicide prevention themes, to provide a safe place and a support group to those who are lonely and isolated (Luxton, June, & Fairall, 2012); in addition, Youtube has published numerous suicide prevention videos (Luxton, June, & Fairall, 2012). The National Suicide Prevention Lifeline’s website has a feature where suicide survivors can tell their story in an animated clip using avatars and disguised voices (Luxton, June, & Fairall, 2012). Google displays suicide prevention advertisements whenever a search is made regarding suicide intent (Luxton, June, & Fairall, 2012). Social media sites continue to work on ways to report cyberbullying. Luxton, June, and Fairall (2012) state that this is where the most research is needed, as cyberbullying is linked to increased suicide risk.

ED visits for considered or attempted suicide doubled between 2007 and 2015 (Burstein et al., 2019). The emergency department is frequently the first place to see a young person who is experiencing active or passive suicidal ideation. Plemmons et al. (2018) found that children’s hospitals are frequently reporting shortages of mental health clinicians, and pediatricians are not adequately trained to manage mental health complaints. Researcher Burstein et al. (2019) states “A single suicide attempt is the strongest predictor of future completed suicide.” Emergency departments must be prepared to properly assess these patients and set them up with appropriate follow-up care to ensure the individual remains safe and gets the help they need (Burstein et al, 2019). Research needs to be focused on post-ED risk reduction strategies and interventions (Burstein et al, 2019). Children and adolescents who may present as troubled or attention seeking, may not be taken seriously by providers, peers, family, and friends. All statements and concerning behaviors must be addressed and taken seriously, since it is “better to overreact than underreact.” (Jacobson, 2018)

 

References

Burstein et al. (2019). ED visits double among US teens considering suicide. JAMA Pediatrics. doi:10.1001/jamapediatrics.2019.0464

Healy. (2019, June 18). Suicide rates for U.S. teens and young adults are the highest on record. The Los Angeles Times. Retrieved from https://www.latimes.com/science/la-sci-suicide-rates-rising-teens-young-adults-20190618-story.html

Hoffmann et al. (2019). Pediatric suicide rates and community-level poverty in the United States, 2007 – 2016. Retrieved from https://www.healio.com/pediatrics/developmental-behavioral-medicine/news/online/%7Bd281df98-1b62-4d52-b803-cb5b43a29334%7D/rate-of-pediatric-suicide-higher-in-areas-with-more-poverty

Jacobson. (2018). Q&A: Recognizing suicidal thoughts in pediatric patients. Retrieved from https://www.healio.com/pediatrics/developmental-behavioral-medicine/news/online/{f4dd215f-f270-4191-aaef-8e47fcb93bb3}/qa-recognizing-suicidal-thoughts-in-pediatric-patients.

Luxton, D. D., June, J. D., & Fairall, J. M. (2012). Social Media and Suicide: A Public Health Perspective. American Journal of Public Health, 102(S2). doi: 10.2105/ajph.2011.300608

Plemmons et al. (2018). Number of youth suicide-related hospital visits on the rise. Pediatrics. Retrieved from doi:10.1542/peds.2017-2426

Yanger et al. (2017). Firearm safety: A survey on practice patterns, knowledge and opinions of pediatric emergency medicine providers. Retrieved from https://www.healio.com/pediatrics/practice-management/news/online/%7Bff751c47-0f82-45e5-b396-6720d5debfa9%7D/few-ed-physicians-counsel-families-on-firearm-injury-prevention