Professionals grapple with rise in teen suicide

Although it is important for adolescents to think for themselves, it is the responsibility of adults to understand the factors at work in children's lives, recognize when there are causes for concern and intervene and repair situations before they spiral out of control.

The incidence of teen suicide rose in four years from representing 6.7 percent of each 100,000 adolescent deaths in 2003 to 9.4 percent in 2007, according to the most recent figures released in September 2007 by the National Centers for Disease Control. Suicide is the third leading cause of death in people between the ages of 15 and 24 after motor vehicle accidents and homicides.

Caution must be used in reading statistics, however, and they must be viewed in perspective. Though the percentage of teen suicides is rising, the actual number of deaths is low compared to deaths from other reasons. Further, mental health professionals are finding that many adolescent suicides are committed by youths who have had some extent of mental disorder for about two years prior to the event, as was discovered in a 1984 to 1986 study of 170 children, which revealed that more than 90 percent of them had some form of mental disturbance.

Dr. Nancy Rappaport is the Director of School Programs at the Cambridge Health Alliance, an assistant professor of psychiatry at Harvard Medical School and primary author of a December 2005 article in The Journal of Pediatrics entitled "Lost in the Black Box: Juvenile Depression, Suicide and the FDA's Black Box." The article centers around the debate of whether antidepressant-type medications actually promote suicidal thoughts or actions in youth. In an interview last week, Dr. Rappaport stressed that there is still no data determining the correlation between increased teen suicides and the use of antidepressant therapy, in part because since the Federal Drug Agency began posting "black box warnings" on these medications in 2005 the number prescribed for pediatric patients has declined.

Her research shows that actual adolescent suicides tripled between the 1960s and late 1980s, but dropped 30 percent since the early 1990s when antidepressants were given to youth more frequently. It is too soon to tell whether reduced treatment due to the recent warnings may be contributing to a reversal of the reduction in suicides. Nevertheless, Rappaport and other mental health professionals strongly agree that adults need to familiarize themselves with behavioral warning signs and take safety precautions to protect youth from life-threatening actions.

"We want to look at every kid's risks because statistics are just backdrop information. You want to give kids a sense of future and a sense of hope. There is no comfort when a community loses a child. We all feel impacted by it. We need to convey to our children that we value them and we want them alive," she said.

Rappaport said firearms are the most common method of teen suicide followed by drug overdoses and hangings. She said parents must be careful to securely lock up unloaded guns in the home and store ammunition in a separate locked location. Because substance abuse is often behind lethal teen suicide attempts, it is

also vital to prevent children's

accessibility to alcohol and drugs such as sleeping pills and pain medications that rob youth of inhibitions and judgement.

Signals that can indicate if a child is depressed include lack of concentration; feelings of isolation; a change in school grades; loss of appetite; excessive sleeping; lack of interest in friends, family, activities; restlessness; and relentless irritability. Rappaport said if a child exhibits five of these symptoms for a two-week period she advises the child have a medical evaluation. If depression is left unchecked,

the typical progression of a suicidal act begins with the active mood, substance abuse or anxiety disorder. If a stress event occurs, for example the loss of a loved one, a relationship break-up, legal problems, difficulty in school or a humiliating instance, that may set off acute mood changes, feelings of hopelessness and anger and initiate suicidal ideation. The final step is chosing a method and completing the suicide.

Adults must intervene at the initial part of this process and find out what is happening to the child and how it can be treated. The young need help to know how to handle the event(s) they are experiencing, and crisis services should be available to evaluate their condition and act to improve it. If there are multiple suicides in a community it is extremely important to

communicate with children and show

them there are other, constructive ways to deal with problems, and that taking their lives is not a viable option.

In addition, health professionals need to examine family dynamics, such as whether there is a history of depression, substance abuse, bi-polar disorder, aggression or completed suicide as part of determining what may be affecting the troubled adolescent. At the same time, adults need to ensure there are available outlets for youth to capitalize on their strengths and assist in providing mentoring relationships with trusted adults such as a therapist, coach, teacher, family friend or pastor with whom they can talk confidentially.

Dr. Steven Schlozman, a psychiatrist at Massachusetts General Hospital, concurs with Rappaport. He knows from his experience treating adolescents that when there is an underlying tendency toward suicidal behavior and then an acute stress factor occurs "the stressor has to be viewed through the eyes of the kid, not our eyes," he said.

Schlozman also noted that many youth do risky things for a variety of reasons.

"There are more ways out there for people to behave riskily. There are all sorts of quickly disseminated information out there. Kids in general are vulnerable. Insecure kids are at increased danger," he said. "There is a sense of infallibility, which is actually a normal part of development that makes you ready to leave home. We allow kids to get behind the wheel of a car because we want them to be able to drive themselves to school. Ninety percent of kids [who attempt or commit teen suicide] have a psychological disorder, but that leaves 10 percent where you can't fit the criteria together for a psychological disorder. One person's stress is not another person's stress.

"What pushes them to the point of suicidal feelings is if they have an insult to their sense of self that is developmentally relevant. If that insult happens and teams up with any of the risk factors it facilitates towards suicidal ideation and attempts," Schlozman said.

He noted that rather than believing there is a particular message youths are trying to send when engaging in risky or lethal practices, Schlozman views suicide as an impulsive act and one that, in some instances, might not be committed if a child had a few more seconds to think about it other than the moment when feeling a deep despair. The best a community can do is respond with preventive tactics to slow down suicidal thoughts in adolescents, with attention to and understanding of what they are experiencing, treat substance abuse issues if they exist with at-risk teens, and treat their

underlying disorders. I

WHAT MATTERS MOST?

Each week throughout this series, we will ask a question of island teens to, hopefully, help the community better understand what matters most to them and the challenges they face.

To protect personal privacy and encourage responses, we will not print the names of respondents. The intent of queries is not to be intrusive, but to help shed light on what today's adolescents are facing and thinking. Yet, for the sake of determining legitimacy, we ask that responses be signed by the authors. Again, names will not be published.

• Youth question of the week: What matters most in your life as a teenager - Relationships? Privacy? Feeling accepted? Having your views respected? Please explain your answer as much as possible. Email your responses to: don@nantucketindependent. com. Mail to: Don Costanzo, Editor, The Nantucket Independent, 15 North Beach St., 02554. Or fax: 508-228-4858.