#Suicide is now the second-biggest killer of ten- to 18-year-olds

In the 1950s, when the term “#teenager” had been popularised, it brought to mind trouble. Spotty #youths who engaged in risky behaviour outside the house—getting drunk, pregnant or into car crashes—were “the number one fear of #American citizens”, wrote Bill Bryson in his memoir, “The Life and Times of the Thunderbolt Kid”. Today, the risks #American #teens face come from within. #Boys are now more likely to kill themselves than to be killed in a motor crash. #Girls are nearly 50% more likely to injure themselves in a #suicideattempt than to face an unplanned pregnancy. #Suicide is the second-biggest killer of ten- to 18-year-olds, after accidents.

The rise in #youth #suicide is part of a broader increase in #mentalhealth problems among the young. This preceded the #pandemic but was probably accelerated by it. In 2021 nearly half of #American #highschoolstudents said that they had experienced persistent feelings of sadness and #hopelessness in the past year, up from 26% in 2009; one in five seriously considered #suicide, up from 14%; and 9% attempted to end their life, up from 6% (see chart). Although the rates for 15- to 19-year-olds are not unprecedented (there was a similar peak in the early 1990s), the rates for ten- to 14-year-olds are higher than ever before.

The fact that it has become more acceptable for young people to discuss their feelings has surely contributed to some of the changes, such as the rise in self-reported sadness. Better screening may also play a role. But neither explains the most alarming data: #suiciderates. Attempts, injuries and deaths have all risen among young #Americans over the past decade. Last year, no age group saw a steeper rise than men aged 15 to 24, according to preliminary data from the #CentresforDiseaseControlandPrevention (cdc).

The causes are only starting to be understood. The usual suspects (#childhood poverty, parental #substanceabuse or parental depression) have not changed meaningfully; indeed, #childhood poverty has fallen. What has shifted is how #teens live their lives and relate to their environment, and each other. Greater #isolation and #loneliness are probably important.

Experts have a reasonable understanding of how to help prevent #suicide and better protect against such thoughts. Not all young people are equally at risk. Although #girls in #America are much more likely to contemplate ending their lives, or injure themselves in attempting to do so, #teen #boys are nearly three times as likely to die from #suicide. Young people who identify as #lesbian, #gay or #bisexual are three times as likely to feel suicidal. During the #covid-19 #pandemic #children who had faced serious adversity, such as abuse or neglect, were 25 times as likely to try to kill themselves as their peers with happier #childhoods.

Geography matters, too. As with grown-ups, #children who live in #rural settings are at heightened risk, in part because they have less access to care. #Youths from tribal communities suffer more than any other group. Alaska’s #youth #suiciderate—at 42 annual deaths per 100,000 young people, the highest of any state—is four times the national average.

#America is not alone. Australia, England and Mexico are among other countries to have seen big rises in #youth #suicide over the past decade. In England and Wales, more than one in six children between the ages of seven and 16 now has a probable #mentalhealthdisorder, up from one in nine in 2017, found a recent survey by the #NationalHealthService. Between 2012 and 2018 #teen #loneliness grew in 36 out of 37 countries studied, according to a paper in the Journal of #Adolescence.

Unfortunate exceptionalism

But #America stands out for its absolute rates of #youth #suicide. Although in England and Wales #suicide among 15- to 19-year-olds has grown faster, in 2021 6.4 per 100,000 young people there took their own lives, versus 11.2 young #Americans.

#America is also exceptional for its availability of #guns. Use of a #firearm is the most common method of #suicide for #boys, which helps explain why they are more likely to die from an attempt than #girls. Easy access to a lethal method is one of the biggest risk factors for someone in despair. In Switzerland, after 2003 #suiciderates among #men of military-service age dropped sharply after the country halved the size of its army, which often requires soldiers to take weapons home. During the #pandemic, sales of #firearms increased in #America. That exposed an extra 11m people, half of whom were #children, to a gun at home. #Suicides by #gun accounted for the entire rise in #American #suicides between 2019 and 2021, according to an analysis by researchers at Johns Hopkins University.

But guns are only part of the story. Speculation over other causes has ranged from earlier puberty to the effects of #socialmedia and even to climate-change despair. Some of the more compelling evidence points to a change in how young people relate to their surroundings. #Children who say they feel close to people at #school were much less likely to suffer from poor #mentalhealth, and 50% less likely to have attempted #suicide, than those who did not, found the cdc.

This protective layer may be fraying. “The types of #adolescent activities that would be indicative of that social connection, or of building a sense of meaning or place in your social circle, are fundamentally shifting,” says Katherine Keyes at Columbia University. #Teens spend far less time on traditional social activities, such as playing sport or going on dates, than in the past. In the late 1970s over half of 12th-graders met up with friends almost daily; by 2017 just over a quarter did. Dr Keyes’s study also found a correlation between reports of low levels of social activity and feelings of #depression.

One of the fiercest debates is whether #socialmedia alienates young people or offer a new avenue for connection. Just as a #school environment can help or harm a #child, the same is the case online. Feeling virtually connected to peers, family or other groups during #covid had a similar (if smaller) protective effect as feeling connected to people at #school, found the cdc. Young people from sexual #minorities are especially likely to say #socialmedia help them feel less alone and more supported. But it can also make things worse, as a recent inquest into the #suicide of Molly Russell, a British 14-year-old, found. Harmful #socialmedia content probably “contributed to her death in a more than minimal way”, it concluded.

Being locked up during the #pandemic increased feelings of #isolation and #loneliness for many youngsters. The evidence of the harm to development and #mentalhealth done by #school closures is increasingly compelling. #Covid appears to have hurt the #mentalhealth of younger people disproportionately, says Richard McKeon at the #SubstanceAbuse and #MentalHealthServices Administration. This was “superimposed on a longer-term upward trend in #youth #suicide,” he adds. For #teen #girls, average weekly emergency-department visits for suspected #suicideattempts were 50% higher in February 21st-March 20th 2021 compared with the same period in 2019.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleOrder your copy of James Donaldson's latest book,#CelebratingYourGiftofLife:From The Verge of Suicide to a Life of Purpose and Joy

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Keeping the #kids safe

Even if the causes are not fully understood, solutions are. “This is not rocket science,” says Jane Pearson from the #NationalInstituteofMentalHealth. “We know what helps #kids develop healthy trajectories that make it less likely they develop #mentaldisorders or #suicidalthoughts and #behaviors.” Most important are a focus on improving family communication and support, family and community attachments, as well as #children’s attachments to #school, so they feel safe and connected. The challenge is to get all parties working together on prevention.

#Schools can be at the heart of the problem—or the solution. Programmes that train kids in coping with emotions and social problem-solving have had impressive results. The Good Behaviour Game, first trialled in Baltimore in the 1980s, teaches first-graders how to work in teams and behave in class. Pupils who took part in the original programme benefited well into adulthood in reduced #substanceabuse and criminality, and improved #mentalhealth. Compared with the control group, they were half as likely to think about, or attempt, #suicide later in life.

#Doctors’ offices are important, too. Nine out of ten #children who died by #suicide had some contact with the health-care system in their final year of life. If #pediatric practices were better prepared and incentivised to provide #behavioralhealthservices, this could make a huge difference, reckons Richard Frank at the Brookings Institution, a think-tank.

Lastly, educating #schools and communities in preventing #suicide “contagion” is essential. Between 1% and 5% of #teen #suicides are part of “clusters,” more so than for #adults. The playbook for #schools is clear: deaths should be commemorated but not mawkishly; #suicide should be openly discussed but not normalised; and #students should be encouraged to seek help. Just as important can be the work with staff members, who can become “numb” or even “disengaged” following too much tragedy, says Sharon Hoover from the National Centre for #School #MentalHealth, who often gets called in once a #school has suffered multiple deaths.

And yet it is crucial not to overreact. “#Suicidalthoughts have always been common. They peak in #teens and diminish in prevalence with age,” says Christine Moutier from the #AmericanFoundationforSuicidePrevention. “The vast majority of young people having #suicidalthoughts are not imminently about to act on them, or even at risk of dying of #suicide,” she adds. Rather, it is a sign of distress and a reason to discuss their feelings. “It’s crucial that caregivers and providers across the board do not panic when they hear the word ‘#suicide’,” warns Dr McKeon. A #child brave enough to open up about such thoughts then rushed to hospital against their will is unlikely to trust an #adult again. That is the last thing they need. 
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