with your teen about suicide
Alarming Rise in
Death by Suicide Among 10-14 Year Old Youth
At the Trevor Project, the nations only accredited suicide prevention program for Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) youth under 25, we hear from youth every day about the struggles they are facing. According to the CDCs Youth Risk Behavior Surveillance System (YRBSS) report, we know that LGB young people in 9th to 12th grade attempt suicide at a rate more than four times that of their heterosexual peers. While reliable national statistics for LGB youth in the 10 14 year old range do not exist, we know from the daily crisis calls, chats, and texts we receive that they too are at risk for suicidal ideation, particularly during this critical time in their identity development.
Of note, the rate of death by motor vehicles has dropped significantly over the same period that the rate of death by suicide has increased, among 10 14 year olds. The success in combatting motor vehicle deaths is attributable to a comprehensive approach including infrastructure improvements, policy and system change, partnerships, education and awareness, along with a major investment of over $576 million by the National Highway and Traffic Safety Administration funded in grants to promote motor vehicle safety and the U.S. If similar comprehensive, multifaceted national suicide prevention efforts were implemented and brought to scale, as outlined in the National Strategy for Suicide Prevention, this country would have the potential to reverse the trend in suicide mortality.
At The Trevor Project we are very disturbed to know that suicide is rising among the youth of this nation. We receive calls from youth as young as 9 years old who are looking for support as they struggle with their sexual and gender identity, said Abbe Land, Executive Director and CEO of The Trevor Project. It is imperative that more resources need to go toward preventing suicide in this country. It is unconscionable that significant dollars are not allocated when we know that suicide can be prevented. We call upon our national, state and local leaders to take action immediately.
While incredibly informative about prevalence, the report does not include information on the causes of these trends. There are certainly many contributing factors to consider, but is it also very important to note what can be done to foster resilience and safety for LGBTQ and other youth. Families, schools, and communities must come together to reduce the risk for youth suicide by creating safe, connected environments that foster resiliency, non-violent problem solving skills, and coping skills. In particular, the public can take part in improving the lives of young people who report being LGBTQ by showing them that we all care about their mental health:
Connect youth to Trevors crisis services. We save young lives 24/7 through the Trevor Lifeline at 866-488-7386. TrevorChat.org is available 3-9 pm Eastern Time daily, and youth can text TrevorText to 202-304-1200 Thursday Friday 4-8pm Eastern Time. Young people can also find friends on our online safe supportive community TrevorSpace.org as well as resources at our Support Center.
Create classrooms of peers who are better equipped to help through acceptance and support with Lifeguard, Trevors free online suicide prevention and crisis intervention education program for middle and high school students.
Advocate for the adoption of comprehensive, inclusive suicide prevention policies in school districts around the country and encourage the use of our Model School Policy which can help school districts draft suicide prevention, intervention, and postvention policies based on their specific needs.
Help create a bright future for LGBTQ
and all youth by showing that you truly care and that they
can thrive, they matter, and they deserve support. More
resources are available at www.thetrevorproject.org. The
Trevor Project is a partner of the National Action Alliance
for Suicide Prevention, the public-private partnership
advancing the National Strategy for Suicide Prevention and
championing suicide prevention as a national priority.
As medical director of mental health and child development at UCSF Benioff Childrens Hospital Oakland, Steinbuchel counsels such patients as they experience sadness, anxiety and depression. Sometimes they talk about the hopelessness of poverty; others feel the crushing pressure of high expectations.
They watch as images of wealth and perfection float by on social media, wondering if they'll ever achieve greatness and feel less lonely. Their phone may become an unpredictable enemy, delivering surprise cyber-bullying attacks.
These experiences alone don't lead to
suicide, says Steinbuchel, but they might have a tragic
impact when combined with proven risks like social isolation
and mental illness.
After more than a decade of decline, the suicide rate in the United States climbed 24 percent to 13 out of 100,000 people between 1999 and 2014 with men far outpacing women, according to new data from the National Center for Health Statistics. Starting in 2006, that rate climbed even faster.
Its a broad-based increase in suicide, said Sally Curtin, a statistician with the Centers for Disease Control and Prevention and one of the reports main authors.
All age groups younger than 75 saw a rise in suicide since 1999, the report says.
While the numbers remain small, the suicide rate among girls age 10-14 tripled from 1999 to 2014 and experienced the largest percent increase. That finding surprised Curtin, who explained that deaths are just one element to consider when studying suicide.
For that group, the deaths are just the tip of the iceberg, Curtin said. There are so many more attempts and hospitalizations.
According to CDCs data, suicide attempts among 10- to 14-year-olds rose 135 percent between 2001 and 2014, said Deb Stone, a behavioral scientist with the Centers for Disease Control and Prevention.
When examining suicide rate by race, researchers found the steepest rise among American Indian and Alaskan Natives, according to a newly released supplemental brief.
Risk factors included mental health problems, substance abuse, availability of lethal means, and exposure to anothers suicide, or contagion effect, Stone said.
Despite rising rates, Stone said, We know that suicide is a preventable public health problem.
She stressed that schools, workplaces and healthcare settings all can play a role in suicide prevention. These strategies might include: Educating people about suicide risk factors, decreasing stigma and reducing the availability of lethal means to people who are at-risk.?
She also recommended that if someone
needs help, they should call the National Suicide Prevention
Lifeline at 1-800-273-8255 where around-the-clock counselors
"It had been decreasing almost steadily since 1986, and then what happened is there was a turnaround," says Sally Curtin, a statistician with the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.
The suicide rate has risen by a quarter, to 13 per 100,000 people in 2014 from 10.5 in 1999, according to an analysis by Curtin and her colleagues that was released Friday.
She says it's heartbreaking to work with these data. While other causes of death are on the decline, suicide just keeps climbing and it's doing so for every age group under 75.
"I've been losing sleep over this, quite honestly," says Curtin. "You can't just say it's confined to one age group or another for males and females. Truly at all ages people are at risk for this, and our youngest have some of the highest percent increases."
There is one age group that really stands out girls between the ages of 10 and 14. Though they make up a very small portion of the total suicides, the rate in that group jumped the most it experienced the largest percent increase, tripling over 15 years from 0.5 to 1.7 per 100,000 people.
And, Curtin points out, in any given year, there are a lot more suicide attempts than there are suicide deaths. "The deaths are but the tip of the iceberg," she says.
Until the suicide trend reversed upward, there had been a number of improvements in the past few decades.
In the late '80s, things were probably looking up partially due to new antidepressants that were more effective and had fewer side effects, says Dr. Maria Oquendo, a psychiatry professor at Columbia University Medical Center and president-elect of the American Psychiatric Association. "We saw this very encouraging decrease in suicide deaths," she says, and the parallel between antidepressant prescription and a decline in suicide was mirrored in other countries. "It was really very remarkable, and somehow that trend toward decreasing suicide rates abruptly stopped in 1999."
What changed? One possibility is economic stagnation, which left more people out of jobs and probably made it harder for people to access health care and treatment. There was also a switch from the use of cocaine and crack to use of heroin and prescription painkillers, which can be lethal in case of an overdose.
And there's also the matter of health insurance a lot of people weren't covered or didn't have access to treatment for depression, the most common risk factor for suicide. (Since 2014, however, the Affordable Care Act has led to a substantial increase in insurance coverage.)
"Now, the other thing that we were anticipating with some dread was the aftermath of the black box on antidepressants," says Oquendo, referring to a warning label that in 2004 the Food and Drug Administration required for commonly prescribed antidepressants.
The label says that in people under age 26, the medications can actually increase the risk of suicidal thoughts and actions. Research has suggested that the warning scared doctors away from prescribing antidepressants to people of all ages.
"And some of the increment in suicide deaths in the younger populations is potentially linked to an understandable reluctance by physicians who see these youngsters to prescribe antidepressants, even when they're aware that the individual is suffering from depression," says Oquendo. Research has shown that the benefits of prescribing antidepressants to mentally ill children tend to outweigh the risk of suicidal tendencies.
But why such a sharp rise among adolescents, particularly girls? "We don't know what's going on, to be quite honest," says Arielle Sheftall, who works at the Center for Suicide Prevention and Research at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio. "We have thoughts, that maybe it's this, maybe it's that. It's really hard to pinpoint one specific risk factor that really, truly is driving this trend."
She and her colleagues study the risk factors that might push a depressed child or teen to attempt suicide. One hypothesis about what's going on with girls is pretty surprising: earlier puberty.
"It's usually been referred to as the storm-and-stress period of life because there's just a lot of change happening all at one time," says Sheftall.
Boys tend to hit peak puberty around 13 years old, and girls around 11 years old, though some studies show that girls are starting their periods earlier.
"Research has shown that puberty, unfortunately, is associated with the onset of psychological disorders, specifically depression," says Sheftall.
And depression is a big risk factor for suicidal thoughts and actions. So, because of the shifting age of puberty onset, girls might be opening the door to anxiety, depression and other psychiatric disorders earlier on in life.
Sheftall and Oquendo say the hypothesis hasn't been carefully studied, but it's possible. Another potential factor is that girls attempting suicide could be using more lethal methods, resulting in more deaths.
"It's frustrating because you want to never ever see these trends increase," says Sheftall. "That's what we kind of have dedicated our lives and research to: What is causing these increases to occur?"
For now, there are still more questions than answers.
If someone shows the warning signs of
suicide: Do not leave the person alone, remove any firearms,
alcohol, drugs or sharp objects that could be used in a
suicide attempt, call the U.S. National Suicide Prevention
Lifeline at 1-800-273-TALK (8255), and take the person to an
emergency room or seek help from a medical or mental health
That grim fact was published on Thursday by the Centers for Disease Control and Prevention. They found that in 2014, the most recent year for which data is available, the suicide rate for children ages 10 to 14 had caught up to their death rate for traffic accidents.
The number is an extreme data point in an accumulating body of evidence that young adolescents are suffering from a range of health problems associated with the countrys rapidly changing culture. The pervasiveness of social networking means that entire schools can witness someones shame, instead of a gaggle of girls on a school bus. And with continual access to such networks, those pressures do not end when a child comes home in the afternoon.
Its clear to me that the question of suicidal thoughts and behavior in this age group has certainly come up far more frequently in the last decade than it had in the previous decade, said Dr. Marsha Levy-Warren, a clinical psychologist in New York who works with adolescents. Cultural norms have changed tremendously from 20 years ago.
Death is a rare event for adolescents. But the unprecedented rise in suicide among children at such young ages, however small the number, was troubling and federal researchers decided to track it. In all, 425 children ages 10 to 14 killed themselves in 2014. In contrast, 384 children of that age died in car accidents.
In 1999, the death rate for children ages 10 to 14 from traffic accidents about 4.5 deaths per 100,000 was quadruple the rate for suicide. But by 2014, the death rate from car crashes had been cut in half, part of a broader trend across the entire population. The suicide rate, however, had nearly doubled, with most of the increase happening since 2007. In 2014, the suicide death rate was 2.1 per 100,000.
Far more boys than girls killed themselves in 2014 275 boys to 150 girls in line with adults in the general population. American men kill themselves at far higher rates than women. But the increase for girls was much sharper a tripling, compared with a rise of about a third for boys.
The reasons for suicide are complex. No single factor causes it. But social media tends to exacerbate the challenges and insecurities girls are already wrestling with at that age, possibly heightening risks, adolescent health experts said. (The data published Thursday did not include methods, but an earlier report gave those details.)
Social media is girl town, said Rachel Simmons, the author of Odd Girl Out: The Hidden Culture of Aggression in Girls. They are all over it in ways that boys are not.
Statistically, girls dominate visual platforms like Facebook and Instagram where they receive instant validation from their peers, she said. It also is a way to quantify popularity, and take things that used to be private and intangible and make them public and tangible, Ms. Simmons added.
It used to be that you didnt know how many friends someone had, or what they were doing after school, she said. Social media assigns numbers to those things. For the most vulnerable girls, that can be very destabilizing.
What to Do If You Need Help
The National Institute of Mental Health recommends this site. It also warns that reporting on suicide can lead to so-called suicide contagion, in which exposure to the mention of suicide within a persons family, peer group or in the media can lead to an increase in suicides.
There are many groups that help people having suicidal thoughts. One, Crisis Text Line, inspired by teenagers attachment to texting but open to people of all ages, provides free assistance to anyone who texts help to 741741.
If you prefer to talk on the phone, N.I.H. recommends the National Suicide Prevention Lifeline: 1-800-273-TALK (8255).
The public aspect can be particularly painful, Dr. Levy-Warren said. Social media exponentially amplifies humiliation, and an unformed, vulnerable child who is humiliated is at much higher risk of suicide than she would otherwise have been.
If something gets said thats hurtful or humiliating, its not just the kid who said it who knows, its the entire school or class, she said. In the past, if you made a misstep, it was a limited number of people who would know about it.
Another profound change has been that girls are going through puberty at earlier ages. Today girls get their first period at age 12 and a half on average, compared with about 16 at the turn of the 20th century, according to The New Puberty , a 2014 book that describes the phenomenon. That means girls are becoming young women at an age when they are less equipped to deal with the issues that raises sex and gender identity, peer relationships, more independence from family. Girls experience depression at twice the rate of boys in adolescence, Ms. Simmons said, a pattern that continues into adulthood.
What is more, they live in a culture of fast answers and immediate change. That compounds the pressure.
For a young girl who starts to develop breasts, hips, body hair its a long haul before you land, Dr. Levy-Warren said. You dont really know how youre going to look for a number of years, and a lot of kids dont know how to wait anymore. Its just so painful.
She added, Theres this collision of emotional need, social circumstances and a sense of needing an immediate answer.
Depression is being diagnosed more often these days, and adolescents are taking more medication than ever before, but Dr. Levy-Warren cautioned that it was not clear whether that is because more people are actually depressed, or because it is simply being identified more than before.
Suicide is just the tip of a broader
iceberg of emotional trouble, experts warn. One recent study
of millions of injuries in American emergency departments
found that rates of self-harm, including cutting, had more
than tripled among 10- to 14-year-olds. This is
particularly concerning as this type of injury often heralds
the researchers wrote.
and Suicidal Behavior
Overcoming the Shame of a Suicide Attempt
Those With Multiple Tours of War Overseas Struggle at Home
Silence Is the Enemy for Doctors Who Have Depression
Suicide and suicidal behaviors usually occur in people with one or more of the following:
People who try to commit suicide are often trying to get away from a life situation that seems impossible to deal with. Many who make a suicide attempt are seeking relief from:
Suicidal behaviors may occur when there is a situation or event that the person finds overwhelming, such as:
Risk factors for suicide in teenagers include:
Most suicide attempts do not result in death. Many of these attempts are done in a way that makes rescue possible. These attempts are often a cry for help.
Some people attempt suicide in a way that is less likely to be fatal, such as poisoning or overdose. Males, especially elderly men, are more likely to choose violent methods, such as shooting themselves. As a result, suicide attempts by males are more likely to result in death.
Relatives of people who attempt or commit suicide often blame themselves or become very angry. They may see the suicide attempt as selfish. However, people who try to commit suicide often mistakenly believe that they are doing their friends and relatives a favor by taking themselves out of the world.
Often, but not always, a person may show certain symptoms or behaviors before a suicide attempt, including:
People who are at risk for suicidal behavior may not seek treatment for many reasons, including:
A person may need emergency treatment after a suicide attempt. They may need first aid, CPR, or more intensive treatments.
People who try to commit suicide may need to stay in a hospital for treatment and to reduce the risk of future attempts. Therapy is one of the most important parts of treatment.
Any mental health disorder that may have led to the suicide attempt should be evaluated and treated. This includes:
If you or someone you know is thinking about suicide, there are numbers that you can call from anywhere in the United States, 24 hours a day, 7 days a week: 1-800-SUICIDE or 1-800-999-9999.
As with any other type of emergency, call the local emergency number (such as 911) right away if someone you know has attempted suicide. Do not leave the person alone, even after you have called for help.
Always take suicide attempts and threats seriously. About one-third of people who try to commit suicide will try again within 1 year. About 10% of people who threaten or try to commit suicide will eventually kill themselves.
The person needs mental health care right away. Do not dismiss the person as just trying to get attention.
When to Contact a Medical Professional
Call a health care provider right away if you or someone you know is having thoughts of suicide.
Avoiding alcohol and drugs (other than prescribed medicines) can reduce the risk of suicide.
In homes with children or teenagers:
Many people who try to commit suicide talk about it before making the attempt. Sometimes, just talking to someone who cares and who does not judge them is enough to reduce the risk of suicide.
However, if you are a friend, family member, or just know someone who you think may attempt suicide, never try to manage the problem on your own. Seek help. Suicide prevention centers have telephone "hotline" services.
Never ignore a suicide threat or attempted suicide.
Cole JCM, Walter HJ, DeMaso DR. Suicide and attempted suicide. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics . 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 25.
Brendel RW, Lagomasino IT, Perlis RH, Stern TA. The suicidal patient. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry . 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 53.
American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder; third edition. Arlington (VA), American Psychiatric Association; 2010 Oct. 152 p.
Review Date: 2/11/2012
Reviewed By: Linda J. Vorvick, MD,
Medical Director and Director of Didactic Curriculum, MEDEX
Northwest Division of Physician Assistant Studies,
Department of Family Medicine, UW Medicine, School of
Medicine, University of Washington, and David B. Merrill,
MD, Assistant Clinical Professor of Psychiatry, Department
of Psychiatry, Columbia University Medical Center, New York,
NY. Also reviewed by David Zieve, MD, MHA, Medical Director,
A.D.A.M. Health Solutions, Ebix, Inc.