This is the second piece in a four-part series about teen mental health. In the first article, we discussed the increase in teen mental health complaints since state and local governments introduced various coronavirus mitigation strategies in March 2020. This piece covers the rising incidence of teen suicide attempts prior to March 2020. Future articles will investigate the problematic link between antidepressants and suicidal ideation and the financial incentives for medical facilities to max out their available space and staff without buffers for times of crisis.

Recently published research indicates that the mental health of children around the world deteriorated significantly after March 2020. A meta-analysis published Aug. 9 in JAMA Pediatrics found that “1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of pre-pandemic estimates.”

In the United States, 31 percent more children aged 12 through 17 went to the ER for mental health reasons in 2020 than in 2019. Suicide attempts sent nearly 51 percent more teen girls to the ER in 2020 than in 2019.

Unfortunately, these dramatic increases in depression and suicidal behavior come on top of years of increasing child and adolescent mental illness. According to Center for Disease Control (CDC) data, suicide was the number two cause of death in the 10 through 34 age bracket in 2018.

In 2018, 256 Pennsylvanians ages 10 to 24 died by suicide, a rate of 10.8 deaths per 100,000 people in that age group. Pennsylvania suicide rates among 10- to 24-year-olds increased 53.6 percent from 2007–2009 to 2016–2018. (The CDC uses three-year averages of suicide deaths per 100,000 people, coded as U03, X60–X84, and Y87.0 according to the International Classification of Diseases, Revision 10. More information is available online: https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-11-508.pdf).

Reading views from federal health experts on reasons underlying the increase is like viewing the thesaurus page for “mystified.” After the Sept. 11, 2020, release of the aforementioned CDC report, the official government line was that public health researchers don’t know why the numbers are up, but they’re looking into it.

WebMD reported, “A nearly 60 percent jump in suicides by young Americans since 2007 has experts alarmed and somewhat puzzled.” Sally Curtin of the CDC’s National Center for Health Statistics told WebMD, “The increase in youth suicide has been pervasive across the U.S. […] Hopefully, these data will inform prevention efforts” (https://www.webmd.com/depression/news/20200911/suicide-rate-keeps-rising-among-young-americans).

In its own report on burgeoning youth suicidality, the National Institutes of Health (NIH) admitted, “Experts don’t know why this rate has been rising. But NIH-funded researchers are working on better ways to find and help teens who are thinking of suicide” (https://newsinhealth.nih.gov/2019/09/teen-suicide).

Smartphones, media contagion to blame?

After the initial surge in popularity of the Netflix series 13 Reasons Why, one of the most watched shows in 2017, featuring a 17-year-old girl who commits suicide, Thomas Niederkrotenthaler, MD, PhD, MMSc, and colleagues suggested that “media contagion” could have played a role in the uptick in suicides in the 10-through-19 age bracket (https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2734859). Warning that their findings should be interpreted with caution, the scientists noted nonetheless that “the suicide increase in youth only and the signal of a potentially larger increase in young females [from April through June 2017] all appear to be consistent with a contagion by media and seem to reinforce the need for collaboration toward improving fictional portrayals of suicide.”

Additionally, increased smartphone and internet use appears linked to higher rates of loneliness and depression among young people. Writing in the Journal of Adolescence, Jean M. Twenge and colleagues note, “Beginning in the early 2010s, loneliness, depression, and self-harm increased sharply among U.S. adolescents, particularly among girls. Similar trends were reported in other English-speaking countries such as Canada and the UK. These trends were especially striking as loneliness and depression were unchanged or down for years or decades before these sharp increases beginning around 2012.” Twenge and colleagues observe, “The psychological well-being of adolescents around the world began to decline […] in conjunction with the rise of smartphone access and increased internet use, though causation cannot be proven and more years of data will provide a more complete picture” (https://www.sciencedirect.com/science/article/pii/S0140197121000853).

Local expert shares advice for parents

Regardless of the causes of suicidal ideation among young people, experts are unanimous in the importance of taking warnings signs seriously.

Lisa Cozzi, Lehigh County Crisis Intervention director, shares important advice for parents. Acknowledging that “Children’s behaviors, moods, and interests change as they grow up and mature,” Cozzi adds that parents should “pay attention to significant changes,” citing several specific “red flags”:

• changes in sleep or appetite;

• withdrawal from activities or interests they had previously enjoyed;

• an increase in psychosomatic complaints like headaches, stomachaches, or other physical ailments that cannot be medically explained;

• a preoccupation with death;

• expressing feelings of hopelessness, helplessness, and feeling like a burden;

• giving possessions away.

Getting into the details of some of the warning signs, Cozzi explains, “As children mature, their interests change and that is normal. When the old interests are not replaced with new interests it becomes an area of concern and a sign of withdrawal.”

And it’s all too easy for a child or teen to take a fatal step.

“Unfortunately,” Cozzi tells the Press, “there are many websites out there giving advice and ideas of how one can end their life. Some of the suggestions are creative and use things one would not commonly think of as dangerous or a method of suicide.”

‘Communication is key’

“Friends, teachers, coaches, parents, etc., may only see one of the signs and may not notice its significance until after the attempt or suicide. It is important for involved parties in a child’s life to talk to the parents and share their concerns even if they are not sure,” Cozzi says. “Any parent who sees any of the warning signs needs to talk to their child.” Acknowledging that “it can be just as scary to ask as it is to answer,” she urges parents who see warning signs to ask their child, “Are you thinking of killing yourself?” and to ask it more than once, because the first response might not be honest.

Affirmative responses should lead to follow-up questions, the removal of potentially lethal items from the home, and strict supervision. “Studies show,” Cozzi notes, “that removal or restriction of access to a preferred lethal method of suicide results in no action being taken or the use of a less lethal method.” In addition to making their home safer, parents should seek mental health resources for their child.

The National Suicide Prevention Lifeline is available by phone (1-800-273-8255), text messaging (text CONNECT to 741741), and online (https://suicidepreventionlifeline.org/). Pennsylvania’s crisis hotline is 1-800-273-TALK (1-800-273-8255). Lehigh County Crisis Intervention is available at 610-782-3127, and Northampton County Crisis Intervention can be reached at 610-252-9060.

Counseling for non-emergency situations is available regardless of religious affiliation through Catholic Charities of the Allentown Diocese on a sliding-fee basis; families can call 610-435-1541 or connect online (https://www.catholiccharitiesad.org/contact/).

There is hope, when parents, friends, teachers, or coaches see the warning signs and intervene in time. “The earlier any individual accesses treatment,” Cozzi says, “the better their chances are for recovery and remission.”