Suicide and Teens
| > Web Bonus: Losing a Friend |
| > Web Bonus: Calling the Hotline |
| > Where to Seek Help |
| > How to Start the Conversation |
Triple Points addresses three perspectives on one topic: the parent, the teen and the professional. We also include tips on how to start a conversation about the topic with your teen, and where to seek help. This article is addressing the topic of suicide, the third leading cause of death among teens. Not all suicides are preventable, and not all cases of depression are treatable. Your Teen looks at the leading factors of depression and suicide in hopes that those who can be helped, will be helped.
Parent 1
by AnonymousThree years ago, my 16-year-old son tried to kill himself.
Our day began in the usual hectic way: making lunches, organizing backpacks, driving to school, heading off to work. Then I got a call from the school guidance counselor. “You need to come to school right away. Alex* is having a bad day.” Having no idea what she was talking about, I insisted that she explain. “Alex tried to kill himself this morning,” she said. “He tried to jump out a window, but he was saved by another student and a teacher.” I was in disbelief. I think in my haze, I actually asked her if she was calling the right Alex’s mom! Then I heard my son’s tearful voice on the phone.
Somehow, I managed the 20-minute drive to school. My thoughts raced: How did this happen? What warning signs did we miss? How will I ever let him out of my sight again? How will I keep him safe? What do we do next?
Alex was immediately admitted to an inpatient psychiatric unit. As we drove home from the facility, my husband and I fought back tears and wrestled with our guilt and worry. I vacillated between shock, disbelief, fear and sadness.
The next morning, the psychiatrist from the hospital called with a diagnosis of severe depression. “How did everyone miss this?” we asked ourselves, as we replayed his recent behavior in our minds. Alex had not displayed the more typical signs of depression, like a change in grades or notably sad moods. But we came to understand that there had been changes in his behavior that we had dismissed as normal adolescence. Alex had become increasingly irritable over the last few months. He had been falling asleep over his homework, had become lethargic, and was even somewhat paranoid about his friends. In hindsight, I realize that Alex’s speech had slowed down, that it was hard for him to express his thoughts, and that this was making his friends and family increasingly impatient when talking with him. I never considered that these were symptoms of depression.
As we went through this painful review of all the flags we had missed, we also began the process of healing. Alex was prescribed psychiatric medications that immediately helped improve his condition. My husband and I immersed ourselves in the study of depression, trying to absorb everything we could about his illness and how to deal with it. We learned that Alex had a genetic predisposition toward depression, because there was mental illness and substance abuse in both of our families. Still, the fact that there had been no overt warning signs haunted us.
How did we get through this period? As parents, we worried incessantly about nearly every decision. We were terrified that it could happen again. We were afraid of exposing Alex to any stress, especially school. At the same time, we tried to protect Alex from our own anxiety, because he felt so guilty about “putting us through this.”
It was especially hard for Alex, who felt like he was under a microscope at home. We insisted that he leave his bedroom door open and that he spend the majority of his time at home with his family. We monitored his contact with friends, since they had been such a source of stress.
It was hard not to pathologize every behavior and to learn to manage our concerns, especially as Alex re-entered his everyday life. Alex was fortunate to have a compassionate therapist, who helped him work through the complexities of high school life and develop better coping mechanisms.
Fortunately, our story turned out well. Three years later, Alex is a freshman in college, majoring in computer science. He is doing so well that he is now completely off of his medication. But in the back of our minds, we are always aware that depression can recur. Alex has learned to be patient with me when I ask about his mood, appetite, sleep and stress level, and I, in turn, have tried not to analyze his every move.
The most common question people ask when I talk about what happened to our family is “What caused it?” But for Alex, there was no specific triggering event. One of the most difficult challenges for a parent is distinguishing between normal adolescent behavior and symptoms of psychological illness. We expect teenagers to be moody, have unusual sleep patterns, or spend time alone in their rooms. But as our experience demonstrated all too plainly, it can be a very fine line between typical teenager and a cry for help.
We never thought it could happen in our family. We always told our kids that they could talk to us about anything, but when our son was deeply troubled, he could not bring himself to tell us. Alex kept his plan to himself, for fear of “upsetting us.”
One of the most important things I learned from this experience is to stay involved in your teenager’s life. Listen to what he’s saying and what he may not be saying. And don’t be afraid to ask the hard question—have you ever thought about suicide? It may be the most important question you ever ask. *Name is changed.
Parent 2
by AnonymousMy first child was born on a warm Baltimore day, March 28, 1989. Labor and delivery were a long and arduous ordeal. Our son Dan* was a real “firecracker” from the instant he arrived, screaming and crying with such gusto, that the seasoned delivery nurse declared he was going to be a “boy to be reckoned with.” My husband and I settled into parenting and made many of the familiar blunders that new parents make, enjoying our demanding but loveable son.
As Dan grew, we saw that he was a high-energy kid who could throw an impressive tantrum and had no time for sleep or food. He was intelligent, comfortable in social situations and very entertaining. In school, Dan earned decent grades, loved sports and made friends with relative ease. He still struggled with his temper and could be demanding or emotional, but we attributed these issues to his basic personality makeup.
Somewhere around the seventh grade, we noticed a subtle change in Dan. His interest in sports began to wane, his circle of friends began to decrease, and he was spending more time on the computer. We attributed these changes to adolescence and were not overly concerned.
By the ninth grade, the picture became more worrisome. Dan’s grades were plummeting. He lost all interest in sports and school and was beginning to stay up late, complaining of insomnia. His mood changed. Our once outgoing and energetic son became sullen, irritable and unapproachable. His friends drifted away and he began hanging out with kids who seemed to be struggling like him.
We suspected that he was using marijuana and alcohol. My husband and I, both mental health professionals, grew more concerned and finally scheduled a meeting with a counselor. Dan was not exactly a willing partner with the “counseling thing.” We met with several counselors before he found one he liked and trusted. Then he began to make some headway.
Dan’s progress was slow and painful, a journey in which he made some steps forward, only to stumble backwards. During his treatment, he cut himself, which was an extremely frightening ordeal. I’ll never forget the night he showed me his arms. I was shocked at the lines of cuts going down both arms, not deep, but noticeable and unnerving. He hid these marks for months. I’ve always thought of myself as calm, but nothing prepared me for the overwhelming feeling of panic I felt that night. My son and I talked and cried deep into the night. The next day I called my son’s therapist, who fit him in that day. Dan was not suicidal at this point, but I hid all sharp and dangerous items in our house. My husband and I lived with tremendous worry, but thankfully, we were on the same page and supported each other. Dan did continue to cut himself for several months, but gradually stopped as he learned healthier means of coping, through the support of his counselor, parents and friends.
At the beginning of 10th grade, Dan lost a friend to suicide. Dan and his friends knew about his friend’s suicidal thoughts, but made a group decision to keep it a secret. Dan was devastated by the suicide and shortly afterwards was hospitalized with his own suicidal thoughts. He was placed on medication and continued counseling. We also changed his environment by transferring him to a wonderful and nurturing boys boarding school (Grand River Academy) for the remainder of 10th grade and then 11th grade. Changing schools was one of the most important things that helped him move forward. He flourished in this environment and came home more mature, self-confident and happy.
Dan still has occasional struggles with depression, but at age 20, he is a very insightful and intelligent soul who realizes what he needs to do in order to keep himself on track. For Dan, this means getting enough sleep, eating well, structuring his time, exercising and staying involved with others. Dan may always be at high risk for depression, but he also knows what he needs to do to help himself stay healthy.
Dan’s tumultuous teenage years were difficult and exhausting for all of us. We often felt alone in our community. My husband and I were fortunate to have wonderful friends through our mental health professions who were well-equipped to understand our situation. As I have learned, none of us is immune. Depression and mental illness are a part of life for many of us – they are quite common, but they are often treatable. No family should have to handle these issues on their own. *Name is changed.
Teen
by Kirk W. ZajacWhat makes a person influential? Is it their actions, their friendship, their life? For me, Andrei Philip Lehman didn’t influence me through his life, but unfortunately, through his death.
Andrei, known as Andy, was a senior at Notre Dame Cathedral Latin when I was a sophomore. Andy was a genius, effortlessly completing the most advanced courses in high school. Described by his father as “a true renaissance man,” Andy was especially brilliant in mathematics, able to compute complex equations in his head. A winner of the National Merit Scholarship, Andy was granted early acceptance to many prestigious colleges.
But my classmates and I viewed Andy as slightly overweight, reserved and too smart to have social value. We saw him as a geek – an easy target – and wondered aloud why he still rode the school bus as a senior. We taunted him about his weight, calling him a “polar bear.” Because that moniker stuck, we never even knew his real name. For most of the year, I was the ringleader of this horrible circus.
September 19, 2006, began as a typical day. I took my seat with the rest of my business class and noticed that the usually punctual Mrs. McNulty was late. When she finally arrived, she was crying. As the students exchanged looks of wonder, morning announcements came over the loudspeaker. Principal Waler instructed us to pay close attention to an important announcement: Andy Lehman had passed away. Silence filled the room as I wondered to myself, “Who was Andy Lehman?” The name was familiar, but I couldn’t conjure up a face. Students pouring into the halls exchanged nervous looks; some crying, some, like me, staring blankly into the distance. A close friend of mine, Colleen Heffner, ran up to me. Mascara and eyeliner ran down her face as she cried and embraced me. She could only manage a few words: “It’s polar bear.”
During second period, Mr. Waler addressed the student body. With great pain and sadness, he explained that “Last night, at 8:38 PM, Andy Lehman chose to end his own life.” I don’t remember much after that, as a tingling feeling of guilty shame ran up my spine and through my arms and sweaty hands. I felt solely responsible and guilty for Andy’s death, the number one reason he had killed himself. Mr. Waler continued to speak as I sat frozen at my desk, unable to move or look anyone else in the eye. That moment will replay in my mind forever.
Three months after Andy’s death, I shuffled downstairs and stepped into the kitchen to eat breakfast. Glancing at the News-Herald, a headline caught my eye: “Dad Pushes for Depression Awareness.” The article began: “On Sept. 18, one of the area’s brightest teenagers took his own life without warning. Now, three months after that tragic event, his father is trying to piece together what went wrong and looking for ways to help prevent such tragedies from occurring again.”
As an agnostic, I don’t know if there is a God, but after reading that article, I did believe that there was a higher being guiding and controlling our destinies. In that instant, I knew that I needed to pay my respects to the man who lost his only son to suicide. Sadly, had I not seen that article, I might never have realized that I needed to make things right.
That night, I walked one street north from my house to Mr. Lehman’s house. I had no pre-written apology, no mental notes of what to say to a grieving father. I didn’t know what to expect, but I hoped that some piece of my guilt might be wiped away. Five minutes later, I sat in the Lehmans’ kitchen, and told the story that had been bottled up inside of me. Three hours later, I had learned so much about Andy. He and I had similarities; we had both seriously considered suicide and both suffered from depression. I learned that while many factors contributed to his suicide, our bullying, combined with his deep depression, undeniably led him to act.
I couldn’t absorb everything that night; it took days to sink in. Mr. Lehman had welcomed me into his home and appreciated my sharing a larger piece of the puzzle of his son’s life. There was no anger on his part — only love. Since that day, my mission has been preventing tragedies like Andy’s. I have the honor of working with Mr. Lehman and the Suicide Prevention Education Alliance, as a certified speaker and teacher of their core curriculum throughout the Cleveland area. I strive to fulfill this mission as well as I can, for Andy’s sake.
The biggest lesson I learned from Andy is that our words always matter and they can hurt more than physical pain. I knew nothing about Andy, and I had neither the common courtesy to care, nor the compassion to stop taunting him. I will live with that burden for the rest of my life. When Andy died, he became a part of me, ingrained in my soul forever. His legacy lives on through me, as I work to prevent teen suicide.
Professional
by Nora McNamara, MD and Denise Bedoya, MA, CCRPUniversity Hospitals Case Medical Center Division of Child and Adolescent Psychiatry
Adolescence is too frequently described in popular culture as a period of intense suffering and psychopathology. Think of some of the most popular coming-of-age films that Generation X parents loved as teens (The Breakfast Club, Heathers) and the films that our own teens love (Mean Girls, Thirteen, Little Miss Sunshine). Constant bombardment with movies, television shows, books and music that depict teens as angry and depressed can cause caring adults to misinterpret real symptoms of depression as just a passing phase.
When I teach medical students, I remind them that 80% of teens show no evidence of emotional or behavioral disturbances throughout the course of their development, so the 20% need to be taken seriously. Doctors need to look for the signs and treat them, instead of taking the “wait and see” approach of previous generations. In reality, 2% to 3% of teens meet the symptom criteria for depression and 18% of teens report at least one two-week period when they were clinically depressed.
How it Looks and Feels
What does depression look like in a teen? In many cases, depressed teens may appear profoundly sad, like adults with depression. They may be irritable, crabby or explosive. The psychological symptoms of depression in adolescents include feeling inadequate, guilty, empty or bored; not feeling excited by anything; feeling hopeless or helpless; and most alarmingly, feeling suicidal. Suicide is the third-leading cause of death among adolescents, behind accidents and homicides, making the identification and treatment of teenage depression a significant public health concern.
The brain illness that we call “major depression” also exhibits physical symptoms including:
- sleep problems (too much or too little)
- fatigue
- appetite changes (too much or too little)
- lack of energy
- decreased ability to concentrate
- headaches or stomachaches not accounted for by other illness
Teens with depression are also at higher risk than their peers for problems like substance use (especially alcohol and marijuana), school failure, unplanned pregnancy and legal intervention.
Medical Findings and Treatments
For too long, families have been ashamed or embarrassed to bring a teen with depression for professional treatment, erroneously thinking that such symptoms are a sign of weakness or poor parenting. Only recently has medical research begun to demonstrate that major depression is a medical illness like any other. Like asthma or high blood pressure, depression can be inherited and exacerbated by life stressors, but it is treatable.
The most important study to date demonstrating the benefits of treatments for teen depression was designed by the National Institutes of Mental Health, and titled the Treatment of Adolescent Depression Study (TADS). In the TADS protocol, teens with depression were randomly assigned to either (1) talk therapy, (2) treatment with fluoxetine medication (Prozac), (3) talk therapy combined with fluoxetine or (4) placebo treatment groups. The best outcomes — defined as the fastest and most complete recoveries — appeared in the talk therapy combined with fluoxetine group.
This landmark study has given thousands of doctors new tools for the safe and effective treatment of youths with depression, and it has helped save an untold number of lives through early identification, treatment and recovery. Across the country, researchers are working to improve talk therapies, medicines and methods of depression prevention in high-risk teens. Every day, thousands of teens benefit from these efforts, which is exactly why good research benefits all of us.
Start the Conversation
Beginning a discussion about teen depression and suicide can be difficult. Moreover, not every parent will approach the conversation in the same manner. Two different expert sources suggest different approaches.
Pat Lyden of Suicide Prevention Education Alliance of Northeast Ohio suggests that parents ask the question directly. “If your child seems hopeless or depressed, ask the suicide question, ‘Are you having thoughts of suicide?’ You will not be putting ideas in their head.
If the answer is ‘no,’ they may still need treatment for depressive illness or bipolar disorder.”
The Youth Suicide Prevention Program of Washington State offers some opening lines that may effectively engage your teen in a dialogue about depression and suicide.
- Comment on their behavior without judgment: “I’ve noticed that you have been looking sad for several days.”
- Invite your teen to talk about his/her feelings: “Tell me what’s going on.”
- Allow your child to do most of the talking.
- Avoid unkind words: “You get everything you want; what do you have to be depressed about.”
- Ask one question at a time and wait for the answer; be comfortable with silence.
- Offer reassurance. “I’m on your side…we’ll get through this together.”
- Inform your teen about resources in the community, i.e. the school nurse or counselor, a teacher, the family doctor or a church group leader.
- Develop a plan of action. What does your child agree to do? What are you committed to doing? When will the two of you talk again? Do you need to seek professional help?
- Communicate love and acceptance of your teen’s feelings and acknowledge the courage that it takes to talk about “hard things.” Share your willingness to talk again.- www.yspp.org
Where to Seek Help
If you suspect a teen you know is depressed, there are many ways you can help. The best point person to assess evaluation and treatment for a depressed adolescent is the primary physician, whether pediatrician or general practitioner. However, if you are concerned about safety— especially suicidal threats, suicidal talk or any other concerning behavior— call 911 or your local suicide prevention hotline, or go to the nearest emergency room. In Cuyahoga County, the Child Mobile Crisis Team is available 24 hours a day, 7 days a week, at (216) 623-6888. The national suicide prevention line is 1-800-273-TALK.
Cleveland’s Case University Hospitals Medical Center is proud to support such research through the Discovery and Wellness Center for Children, which can be reached at (216) 844-3922 or by visiting www.case.edu/med/psychiatry/dwcc/dwcc-home.htm.
Web Bonus: Losing a Friend, a Teen’s Perspective
by E.Y.It was a Saturday night in November, not just any ordinary Saturday night because it was my sorority’s semi-formal. The evening was going to be full of fun and dancing. When my friends and I arrived at the dance, my sorority sisters and their dates were dancing. I made my rounds to say hello and then I began dancing.
Throughout the night everyone danced, ate, and had a good time together. I spent time with several of my close friends, including Sally*, a very good friend of mine. Throughout the night we danced, ate, and just had a good time together. As the last song of the night began, she pulled down her sunglasses and began dancing. When I think back, I wish that I could remember the song that was playing while we were dancing. At the end of that song, I told her that I had to leave and that I would see her later in the night. I moved on to another party and was having a great time.
Every weekend, my college has a visible police presence so I didn’t think anything when I saw the emergency lights. I heard a rumor that someone had jumped from a building but I did not think it was true. Suddenly, a sorority member came running into the house calling everyone to the sorority suite immediately. I started to put the pieces of the puzzle together – the police at the dorm building, the rumor, and the urgent sorority meeting.
After I headed to the sorority suite, someone told me who had jumped. I fell to the ground and began crying. I ran to the suite to see if this was true. I saw the director of Greek affairs, a minister, and everyone crying. I immediately understood that everything was true.
I began to learn the horrible story. My good friend Sally, who I had just seen at the dance, got into an argument with her roommate. Her roommate left the room and Sally climbed out of her seventh story dorm room window and jumped. She was still alive after hitting the ground. She was rushed to the local hospital and life-flighted to a larger hospital. We heard the life flight helicopter fly over the dorm. We sat silently praying for the slim chance that Sally would survive.
We all stayed in the suite until very late. After a horrible night of sleep, I woke up and went to the sorority suite. I heard the news – Sally had died during the night.
Sunday was a day of mourning. Everyone in the sorority spent all day in the suite and different people from the campus community came to show their condolences. On Sunday and Monday, there were memorials, church services, and remembrances of my friend. Classes on Monday were full of sorrow and silence. In some classes professors discussed the tragedy while others just taught the day’s lesson. Either way everyone’s mind was on what had happened that past weekend. At noon on Monday, the chapel bell rang 21 times in Sally’s remembrance.
On the day of the funeral, the school provided a bus so that her college friends could attend. That day was snowy and very cold but the sun would come out every so often. I kept thinking that the sun was Sally looking down on everyone who loved her.
Sally’s suicide was one of the most difficult times in my life. I wonder if Sally knew how much I cared about her, how much all of her friends cared. Not a day goes by that I do not think of her. I wear a bracelet everyday that the sorority made in her honor.
If you ever are thinking that your life isn’t worth living, please take a look around and realize how many people do care about you and would miss you if anything were to happen.
*Name is changed.
Web Bonus: What happens when you call the Cuyahoga County Suicide Prevention Hotline?
Cuyahoga County (CC) operates one of the few suicide prevention hotlines that includes a Mobile Crisis Team (MCT). MCT provides assistance on the phone, as well as outreach into the community to meet directly with those in need. Funded by the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County (formerly Cuyahoga County Mental Health Board), the Mobile Crisis Team receives an average of 50 calls per day. The Crisis Team helps anyone situated within Cuyahoga County who is experiencing a mental health crisis, whether they reside in the county or not.
MCT provides three different services:
- Information & Referral to mental health resources in community
- Suicide Prevention Hotline & phone counseling
- Crisis Services in the community
MCT employs licensed social workers, counselors and psychiatrists who make initial phone assessments. Following the assessment, the intake professional can provide short-term direct services to help resolve the crisis, or arrange admission to either a community crisis stabilization program or inpatient psychiatric services. Once the crisis is resolved, MCT staff links the person to a mental health provider for follow-up services.
When the phone call “hints” of suicide, MCT immediately conducts a Suicide Risk Assessment with the individual. This interview helps to determine whether the individual is at risk of taking their life. In an acute emergency, the police are called. When danger is not imminent, an intake professional speaks with the person on the phone until they agree to a face-to-face meeting. MCT will provide crisis intervention services and then help connect the person to any appropriate on-going services that may be needed. All services offered by the Mobile Crisis Team are provided free of charge. The Mobile Crisis Team is part of Cuyahoga County’s public health system.
If you are in Cuyahoga County, Ohio, call our Mobile Crisis Team at 216-623-6888 for 24/7 services, information, and support for a psychiatric crisis.
The National Suicide Prevention Lifeline is 1-800-273-TALK (8255).
