Teenage suicides have become the second leading cause of death for young people, topped only by motor vehicle accidents, according to the Centers for Disease Control in Atlanta. About 5,000 suicides were reported in 1990 - a jump from 2,000 in 1986.
Who commits suicide among the young? Eighty percent of the victims are male, and two-thirds are white. But the "why" is much more elusive.According to a spokesman for Teens in Action Suicide Awareness campaign, 80 percent of the young people who threaten or attempt suicide and subsequently receive treatment have symptoms of clinical depression. The implication to be drawn is that most suicides result from depression.
But a recent study of completed suicides by two New York researchers found the cause of death frequently appeared to be incidental: a bad report card or a wrecked family car and the resulting fear of punishment. According to surviving family members, the victims had shown none of the signs of personality or behavior change that would indicate they were suffering from prolonged, unresolved depression.
This raises several questions:
- Are the "suicidally depressed" not the ones who usually commit suicide?
- Or did, and do, the families of suicides miss the danger signs?
Yes to both questions, says Dr. Abby Was-serman, a St. Louis child and adolescent psychiatrist at St. Luke's Hospital.
"People make suicidal gestures for many reasons. It doesn't only mean depression," she says.
On the other hand, it would be negligent for a parent to ignore signs of depression, because depression is sometimes an indicator - if not a cause - of a suicide attempt.
What is unnerving for conscientious parents is Wasserman's statement families often don't notice the mood alterations in their children.
A: Different reasons. They may deny it. They may be so busy they don't notice. Or they may notice but not make the connections. For instance, they may come in and tell me, "I knew her grades were going down, but I thought it was because she wasn't getting enough sleep." They didn't ask themselves the next question. Or the alteration may be so gradual it's imperceptible. Then maybe a teacher who hasn't seen the child in a year will run into her and say, "That's not the girl I used to know." And the teacher will sound the warning.
Q: What are the signs of trouble?
A: I'll just list them: withdrawal, violent or rebellious behavior, drug or alcohol abuse, loss of interest in hygiene, persistent boredom, difficulty concentrating, changes in eating and sleeping habits. They may sleep all the time or almost not at all. Likewise, they may lose their appetite or gorge.
Decline in schoolwork, frequent stomach and headaches, loss of interest in pleasure, inability to accept praise, feelings of worthlessness, giving away favorite possessions and giving verbal hints like "why should I worry about 10th grade? I'm not going to be around."
Q: If a child comes to see you, is it the parent who brings the child, or the child who brings the parent?
A: I've had it happen both ways.
Q: Could you give some specific case histories of attempted suicides among teens?
A: A girl who thinks she's pregnant but can't talk about it and wants to get into the hospital. That happens more often than you'd think. I guess there are parents who feel that if you talk about sex, you give permission. We do pregnancy screens as a matter of course on all adolescent girls who come in for evaluation.
(Another case was) a teenager with a new stepmother. The teenager overdosed. She had told her father she couldn't live with the stepmother, putting him in the position of having to choose.
This case is an example of suicide as a manipulative tactic. And the point here is that, even if the gesture or the threat is to control or manipulate, it should be taken seriously. Because if the threat is disregarded, the person's next step to get attention may be an actual attempt.
I also had one child with a learning disability who overdosed. The child had severe language disturbances. I showed the parents how to communicate on her level. And there are children who threaten suicide after the loss of a parent. In those cases I often find both the child and the remaining parent are depressed. A lot of times they're grieving at different rates, and just helping them mourn together, bringing them closer, does a lot to resolve the problem.
Q: It's interesting that three out of four of the cases you brought up have a communication lack as one element in the problem: a teenager who can't talk about her pregnancy, a child with a language disturbance, two grieving family members who can't express themselves to each other. . . . One study I read pinned suicide directly on the adolescent's awkwardness in communicating and lack of coping mechanisms.
A: A suicide attempt is a cry for help. When you talk to them about why they did what they did, often they will say they thought it was "the only way out." Language has failed.
Q: What does intervention consist of?
A: It's individualized. I work with their medical doctor. I may prescribe medication for depression. I talk to them about how they got that way and how to watch for it, giving them coping and self-monitoring skills. If the problem requires family therapy, I work with the whole family.
Q: What happened to the girl who couldn't live with her stepmother?
A: She's in the hospital now. The family has some alternative courses of action: They can divorce or separate. Or they can put the daughter in a supervised facility. Counseling has been tried.
Distributed by Scripps Howard News Service