Vol. 5, No. 2 • May 2001
Child and adolescent suicide
by Wesley Taylor and Jodi FlickSuicide in the young has tripled in the last 30 years. Of children 10 to 14, rates have increased 120% since 1990. Suicide is now the third leading cause of death for 12 to 18 year-olds. Thousands of adolescents take their own lives each year in the United States. Some believe depression is a major contributor to these horrifying numbers.
Depression
Although the teen years are full of strong and conflicting emotions, suicidal feelings are most often symptoms of depression. Depression in the clinical sense differs from the way we use the word "depression" in everyday speech. When we say, "I'm pretty depressed about it," we usually mean we are sad, upset, or disappointed. But clinically speaking, depression is a biological illness. Experiences of loss (such as parental divorce, termination of parental rights, separation from family, school failure, relationship problems, sexual issues, the death of a family member or friend, and moving to a new community) cause distress and grief in any normal child or adolescent. This is usually called "situational depression," which means that anyone in that situation would be expected to be upset, and that the person's depressed feelings will normally resolve on their own or with counseling.
In some people, though, experiences of loss and grief can trigger changes in brain chemistry that differ from a normal response to an upsetting event. There is a chemical in the brain called serotonin which helps regulate sleep, mood, impulsivity, and aggression. When levels of serotonin in the brain are low, people experience sleep problems, inability to feel pleasure, and difficulty concentrating. They are irritable, get tired quickly, think more slowly, and have trouble solving problems. Very low serotonin levels are associated with high suicide risk.
To the people around them, these symptoms often look like things the person could change if he tried, or are mistaken for "normal" teenage moodiness or boredom. But these symptoms cause problems for the child in school, in friendships, and in family relationships. Most people think that the problems in school or the troubles with family or friends are the cause of the depression, but it is usually the other way around—these problems are usually the result of depression.
Teenagers who cause trouble at home or school may actually be depressed and not know it. Parents often seriously underestimate depression in children and adolescents. Feelings of sadness are not necessary for someone to be depressed. In fact, many people with depression describe it as feeling "empty" or "numb." Depression in adolescents is more likely to look like irritability and disinterest in friends, activities, and school. Suicidal feelings are most often a symptom of unrecognized and untreated depression.
Depression IS Treatable
Depression IS treatable. A combination of medication and therapy has been shown to be the most effective treatment. How can you tell the difference between a normal teenage reaction and clinical depression?
If parents or teachers notice the following signs they should talk with the teenager about their concerns. If any of these signs persist for more than two weeks, consult a mental health professional and physician:
• Change in eating and sleeping habits
• Loss of energy or daily tiredness
• Inability to concentrate
• Feelings of guilt or worthlessness
• Change in grooming and hygiene habits
• Noticeable personality change; irritability
• Withdrawal from family and friends
• Loss of interest in previously enjoyable interests
• Unusual risk taking
• Decline in school performance
Alcohol or drug use make depression worse and increase the risk of suicide. Giving or throwing away important items or making statements such as, "you won't have to worry about me much longer" or, "I wish I were dead," can be warning signs that the person is having suicidal thoughts.
If a child or adolescent makes the statement that he is going to kill himself, take the statement seriously. Talk with the teenager about the statement and seek the advice of a professional.
Talking about suicide with a person does not increase the likelihood that it will occur. On the contrary, if this issue is discussed and adequate treatment arranged, suicide is less likely to occur. One study found that more than 85% of those who died by suicide were not on antidepressant medication at the time of their death—a clear indication that they were not receiving adequate treatment.
The important thing is to remind the teen that you care about him. If you believe the person is in imminent danger of harming himself, call 911 for help.
Do's and Don'ts
Here are some other suggestions for dealing with a depressed or potentially suicidal person:
• Don't try to "cheer up" the individual
• Don't criticize or shame the individual
• Don't tell the person you feel the same way he or she does
• Don't get angry
• Do be a good listener
• Do ask questions about the problems the person may discuss
• Do reassure the person of your care and concern
• Do seek professional advice and treatment immediately
Further Reading
Books about the topic of suicide in general are Kay Redfield Jamison's Night Falls Fast: Understanding Suicide (Vintage, 1999) and Why Suicide? Answers to 200 of the Most Frequently Asked Questions About Suicide, Attempted Suicide, and Assisted Suicide, by Eric Marcus' (Harper San Francisco, 1996). Remember, depression and suicidal feelings are treatable. Seek the help of a physician and a mental health professional in dealing with these issues.
Wesley Taylor is a clinical social worker in the specialized foster care unit at Durham County DSS (919/560-8091). Jodi Flick is a clinical instructor with the Jordan Institute for Families at the University of North Carolina School of Social Work in Chapel Hill.
Copyright � 2001 Jordan Institute for Families
