By Dana Asby, CEI Director of Innovation and Research Support and Christine Mason, CEI Executive Director
The Centers for Disease Control (CDC) reports that in 2016, 45,000 Americans lost their lives to suicide (CDC, 2018). Mental health professionals, policy makers, and the media are increasingly recognizing that suicide is a national public health issue that demands attention so that these preventable deaths can be abated. The rise in suicide rates among all Americans is alarming with half of the states seeing a 30% jump between 1999-2016 (CDC, 2018), the rate of suicide for teens, particularly girls and African American youth, is especially startling.
While we know that the multiple factors leading to teen suicide can be complex, we also understand best practices to prevent suicidal attempts and where we must focus funding and resources to support those efforts.
Potential Risk Factors for Teen Suicide
Suicide is currently the second leading cause of death among teenagers with accidents being the only cause of death more prevalent (CDC, 2018). Three out of every 100 teenagers in 2016 made a suicide attempt serious enough to require medical treatment. Twice that many made a less serious attempt (Posner, 2018). While the underlying cause of suicide is an accumulation of multiple factors, the fact that the rate of suicide in teens is higher during the school year than the summer points to a possible connection between increased academic and social pressures (Whalen, 2018).
Typical signs that are indicators of the potential for suicide include many of the factors related to depression: mood changes, sadness, apathy, irritability, anxiety, and sleeping disorders, including getting too much or too little sleep (Whitmore & Smith, 2018). Some factors are more specific to suicide. These include:
Previous suicide attempts
A family history of suicide, alcohol, or drug abuse
Substance abuse
Bullying, both in person and on the internet
Interpersonal violence (King, Arango, & Ewell Foster, 2018)
A history of childhood trauma (Osofsky & McAlister Groves, 2018),
Easy access to lethal methods, including guns
Exposure to the suicidal behaviors of others
Incarceration
Dr. Christine Moutier of the American Foundation for Suicide Prevention says, “It is really important to understand that suicide happens as a culmination of multiple risk factors, always multiple, that pile on top and sort of converge at a moment in time” (Fox, 2017). Economic recessions, such as the economic downturn of 2007-2009, have lasting negative effects on entire families, including teens. Some have speculated that current economic pressures may be a factor in teen suicides. With 50-75% of teens in need of mental health support receiving inadequate treatment or no treatment at all, access to care is one obvious risk factor that can be remedied (Lewis, 2017).
Suicide Rate Higher Among Teen Girls & Minority Youth
Within teenagers, there are disparities along gender and race lines for suicide rates. In an eight year period, the suicide rate for teenage girls doubled (Lewis, 2017). While there has not been enough definitive research to point to explanations, speculation points to higher rates among girls due to cyberbullying, especially related to sexting (Fox, 2017).
White teenagers experience the second highest rate of suicide with American Indian and Alaskan Natives having the highest rates of suicide for ages 10-19 at triple those of the national average (Suicide Prevention Resource Center, 2017). While African American teenagers typically experience 50% fewer suicides than whites during ages 13-17, this trend is reversed during childhood with African American children aged 5-12 committing suicide at twice the rate of white children (Bridge et. al., 2018).
There is very little research about the suicide of African American youth, but some potential explanations are that there is a lack of access to both health and community mental health resources as well as a higher level of stigma for seeking help. Negative attitudes towards mental health may stem from the fact that the majority of providers are white, so minorities do not see themselves represented in mental health care. Other potential causes for this higher rate include higher homicide rates among older African American adolescents and the high rate of incarceration among African American men, which make up only 12% of the U.S. adult population, but 33% of the prison population (Welch, 2018). Other factors contributing to anxiety and depression in African Americans, which may be leading causes of suicide, are the impact of discrimination and acculturative stress (Al-Mateen & Rogers, 2018).
Teen Suicide Prevention
The most tragic aspect of this public health epidemic is that it is preventable. Nine out of ten youth who commit suicide struggle with mental health and four out of five give warning signs (Posner, 2018). Teens know when they need help and they are crying out for it. As a society, we must examine how well we are listening and responding to them. In 2009, Grace Rubenstein, in an article on the Edutopia website, described the need for communities and schools to take steps to help prevent teen suicide. In that article, Rubenstein pointed out the value of school-based suicide screening programs, two of which are described at the end of this article.
Here are steps the nation must take to stop the increase of teen suicide:
Create Compassionate Communities: Both at home and at school, teens must have caring adults who will listen to them without judgement. It is important for schools to intentionally create these communities by cultivating compassion, respect, inclusiveness, and trust. Parents, too, must show their children that home is a safe space to discuss any and all problems they are experiencing.
Destigmatize Getting Mental Health Care: Another important step is educating teens themselves, doctors, teachers, parents, families, and community members to be mental health first responders, because asking questions helps. New York City currently offers free mental health first aid training to anyone interested. More cities should consider offering this essential service.
Create and Distribute Better Depression and Anxiety Screeners: When the U.S. Marines introduced a screening program to all support workers, “including legal assistants, financial aid counselors, clergy,” they saw a 3.5% reduction in suicide in three years. It is currently being introduced in other brances of the Armed Forces (Posner, 2018).
Increase School-Based Mental Health Programs: The American School Counseling Association recently released a comprehensive school counseling model regarding suicide prevention that it believes all school counselors should follow to prevent teen suicide (Ravos et. al., 2018). Many schools are also implementing universal and targeted suicide prevention programs and/or mindfulness-based programs to reduce the stress, anxiety, and depression that can result in suicide if left untreated.
Create Policies that Result in Sustainable Funding for Mental Health Care for Teens: The National Suicide Hotline Improvement Act of 2018 was passed to explore the creation of an easy-to-remember number for those contemplating suicide to call. Currently, Arizona, Iowa, and Illinois have legislative bills for funding school-based mental health aid and suicide prevention on the docket. The Youth Mental Health Services Act of 2019 was also recently introduced in the U.S. House of Representatives. It would use existing grant money to improve access to mental health services in schools (Douglass, 2019). We must continue to pass such legislation at the federal, state, and local level.
Screening and Crisis Management Programs
The SOS Signs of Suicide Prevention Program, designed by Mindwise, a Massachusetts-based company, includes a free mental-health screening questionnaire and guidelines for working with families. It has components for encouraging help-seeking for self or friends; ways to increase student knowledge and help students cope with depression; and ways to increase partnerships with community-based mental health agencies. The program seeks to empower youth through three steps, referred to with the acronym, “ACT”— i.e.Acknowledge that you or a friend may be depressed or suicidal. Respond with Care. Tell a trusted adult.
If you or anyone you know is experiencing suicidal thoughts or demonstrating warning signs of suicidal ideation, seek mental health care immediately. Call the National Suicide Prevention Lifeline at 1-800-273-8255.
References
Al-Mateen, C.S. & Rogers, K. (2018). Suicide among African American and other African-origin youth. Suicide among diverse youth, 31-49. Cham, Switzerland: Springer International Publishing AG.
Bridge, J.A. et. al. (2018). Age-Related racial disparity in suicide rates among US youths from 2001 through 2015. Journal of American Medicine Perdiatrics, 172 (7), 697-699. Center for Disease Control (CDC). (2018). Suicide rising across the US. CDC website.
Congress. (2018). H.R.2345 – National Suicide Hotline Improvement Act of 2018. Congress.gov website.
Douglass, J. (2019, February 27). Blumenauer-backed bill aims to fight increased youth depression, suicide rate. KATU News website.
Fox, M. (2017, August 3). Suicides in teen girls hit 40-year high. NBC News website.
Lewis, R. (2017, August 4). Suicide rate for teen girls hits 40-year high. TIME magazine website.
King, C.A., Arango, A., & Ewell Foster, C. (2018). Emerging trends in adolescent suicide prevention research. Current Opinion in Psychology, 22, 89-94.
Osofsky, J.D. & McAlister Groves, B. (2018). Violence and trauma in the lives of children.Santa Barbara, CA: ABC-CLIO, LLC.
Posner, K. (2018, February 7). Preventing suicide: Teen deaths are on the rise, but we know how to fight back. USA Today website.
Ravos, B., Bardo, M., Bennett, C., Conley, A., Sanders, J., Sightes, H., & Graham, J. (2018). Suicide prevention for students: A comprehensive school counseling perspective. School of Education Works.
Rubenstein, G. (2009, November 10). Suicide prevention can start in school. Edutopia website. Suicide Prevention Resource Center (SPRC). (N.d.). Racial and Ethnic Disparities. SPRC website.
Welch, A. (2018, May 22). Study reveals “striking” role of race in kids’ suicide risk. CBS News website.
Whalen, J. (2018, May 15). Youth suicidal behavior is on the rise, especially among girls. Wall Street Journal website.
Whitmore, L.M. & Smith, T.C. (2018). Isolating the association of sleep, depressive state, and other independent indicators for suicide ideation in United States teenagers. Archives of Suicide Research.
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