Question of the Week

September 10, 2007


A report released this past week included some distressing statistics.

" Following a decline of more than 28 percent, the suicide rate for 10- to-24-year-olds increased by 8 percent, the largest single-year rise in 15 years, according to a report released today in the Centers for Disease Control and Prevention?s (CDC) Morbidity and Mortality Weekly Report (MMWR). ... 'This is the biggest annual increase that we've seen in 15 years. ... [I]t's a harsh reminder that suicide and suicide attempts are affecting too many youth and young adults. We need to make sure suicide prevention efforts are continuous and reaching children and young adults.' ... A previously published CDC survey of youth in grades 9 to 12 in public and private schools in the United States found that 17 percent reported 'seriously considering' suicide, 13 percent reported creating a plan and 8 percent reported trying to take their own life in the 12 months preceding the survey. 'This study demands that we strengthen our efforts to help parents, schools and health care providers prevent things that increase the risk of suicide,' said Dr. Arias. 'We need to build on the efforts dedicated to education, screening and treatment and bridge the gap between the knowledge we currently have and the action we must take.'"

With suicide rates up, and the percentages of those who have attempted or "seriously considered" suicide as high as they are, many are concerned and looking for ways to help these struggling teens and young adults.

Unfortunately, this report did not provide the answers so much as it brought to the front more questions and concerns.

"Many of the suicide numbers issued Thursday raised more questions than could be readily answered. ... Why did suicide rates rise so steeply among young girls? 'Unfortunately, we don't know that,' said Arias of the CDC. It could be a statistical fluke, because the actual numbers are relatively small. Or it could be that there are troubling changes in girls' stress levels or ability to cope, she said. ... It's also unclear whether the increase in teen suicides truly represents an emerging trend. 'Until the CDC publishes data for 2005 we won't really know,' Schaffer said. He suggested more research is needed to understand the connection between teens' growing misuse of prescription drugs and suicide. Changing patterns of alcohol use by teens also are important, insofar as two-thirds of suicides by older teens are linked to alcohol abuse. Dr. Louis Kraus, chief of child and adolescent psychiatry at Rush University Medical Center, said the key point for anxious parents is this: 'If your kid is troubled, get him to a child mental-health expert to be assessed, and make sure there's good follow-up' if medication is prescribed."
Chicago Tribune

With the misuse of prescription drugs on the rise, and the majority of teenage suicides taking place when judgment is in some way altered, there are those who are making the connection. Still others think that a lack of prescription medication is partially to blame.

"The FDA was prompted to issue warnings about anti-depressants by two dozen studies showing that young people were twice as likely to consider killing themselves or start taking steps to do so after taking the drugs. None of the subjects in the studies committed suicide, and the risks were relatively small (4 percent versus 2 percent), but the agency decided it had to act. In 2003 and 2004, the FDA issued public health advisories warning that anti-depressants appeared to increase suicidal thoughts and behavior among teens. Late in 2004, it ordered drugmakers to place a black box warning -- the agency's strongest signal of serious risk -- on the medications' labels. The move contributed to a steep decline in anti-depressant prescriptions for teens, as pediatricians and family doctors re-evaluated their risks and benefits. Firms tracking drug use report declines of 25 percent or more since 2003. On Wednesday, University of Illinois at Chicago psychiatry professor Robert Gibbons published a paper in the American Journal of Psychiatry that documented a close correlation between declining use of the anti-depressants known as SSRIs and rising suicide rates among young people up to age 19. It concludes that if the FDA's warnings had been correct, 'we would have expected to see decreases in the suicide rate during the period of declining SSRI prescription rates.' Instead, 'we saw an increase.' The FDA's black box warning has had a 'horrible and unintended effect' and should be withdrawn, Gibbons said Thursday. The benefits of anti-depressants far exceed the risks, he said."
Chicago Tribune

While some avoided these anti-depressant medications because they had concerns that they might increase the risk of suicide, still others did not realize that depression was part of their problem and/ or tried to deal with their problems by using alcohol and drugs... not realizing the negative overall effect that this would have.

"Teens with alcohol and drug problems are also more at risk for suicidal thinking and behavior. Alcohol and some drugs have depressive effects on the brain. Misuse of these substances can bring on serious depression. ... The problem can be made worse because many people who are depressed turn to alcohol or drugs as an escape. But they may not realize that the depressive effects alcohol and drugs have on the brain can actually intensify depression in the long run. In addition to their depressive effects, alcohol and drugs alter a person's judgment. They interfere with the ability to assess risk, make good choices, and think of solutions to problems. Many suicide attempts occur when a person is under the influence of alcohol or drugs."

Everyone has difficult times. For some, these times are worse than others. Many teens who are living with depression don't realize that it is a part of their struggle and actually making it more difficult for them to cope with daily life.

"Most teens interviewed after making a suicide attempt say that they did it because they were trying to escape from a situation that seemed impossible to deal with or to get relief from really bad thoughts or feelings. ... they didn't want to die as much as they wanted to escape from what was going on. And at that particular moment dying seemed like the only way out. ... We all feel overwhelmed by difficult emotions or situations sometimes. ... So why does one person try suicide when another person in the same tough situation does not? What makes some people more resilient (better able to deal with life's setbacks and difficulties) than others? What makes a person unable to see another way out of a bad situation besides ending his or her life? The answer to those questions lies in the fact that most people who commit suicide have depression."

A person can be so consumed by their depression that they don't realize how much it is affecting them.

"Sometimes people who feel suicidal may not even realize they are depressed. They are unaware that it is the depression -- not the situation -- that's influencing them to see things in a 'there's no way out,' 'it will never get better,' 'there's nothing I can do' kind of way. When depression lifts because a person gets the proper therapy or treatment, the distorted thinking is cleared. The person can find pleasure, energy, and hope again. But while someone is seriously depressed, suicidal thinking is a real concern."

Depression and suicidal thoughts touch lives in every school.

"What if This Is You?
If you have been thinking about suicide, get help right away. Depression is powerful. You can�t wait and hope that your mood might improve. When a person has been feeling down for a long time, it's hard to step back and be objective. Talk to someone you trust as soon as you can. If you can�t talk to a parent, talk to a coach, a relative, a school counselor, a religious leader, or a teacher. Call a suicide crisis line (such as 1-800-SUICIDE or 1-800-999-9999) or your local emergency number (911). These toll-free lines are staffed 24 hours a day, 7 days a week by trained professionals who can help you without ever knowing your name or seeing your face. All calls are confidential -- no one you know will find out that you've called. They are there to help you figure out how to work through tough situations."

Sometimes it takes an outside perspective to help someone understand what is really going on.

"What if It's Someone You Know?
It is always a good thing to start a conversation with someone you think may be considering suicide. It allows you to get help for the person, and just talking about it may help the person to feel less alone and more cared about and understood. Talking things through may also give the person an opportunity to consider other solutions to problems. Most of the time, people who are considering suicide are willing to talk if someone asks them out of concern and care. Because people who are depressed are not as able to see answers as well as others, it can help to have someone work with them in coming up with at least one other way out of a bad situation. Even if a friend or classmate swears you to secrecy, you must get help as soon as possible -- your friend's life could depend on it. Someone who is seriously thinking about suicide may have sunk so deeply into an emotional hole that the person could be unable to recognize that he or she needs help. Tell an adult you trust as soon as possible. If necessary, you can also call the toll-free number for a suicide crisis line or a local emergency number (911). You can find local suicide crisis or hotline numbers listed in your phone book or check out the ones listed in the resources tab. These are confidential resources and the people at any of these places are happy to talk to you to help you figure out what is best to do."

Questions of the Week:
What do teens and young adults need to know about suicide and depression? What can you do if you think that a friend or family member is depressed? What can you do if you think that a friend or family member is suicidal? What should you NOT do? How can you provide the most help and support while still making sure that the person is not going to harm himself, herself, or someone else? Where can you find additional assistance when your friend or family member needs more help than you are able to provide? If you are depressed or having suicidal thoughts, where can you find help and support through this difficult time?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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