The American Academy of Pediatrics recently updated guidelines advising pediatricians how to identify and help teenagers at risk for suicide. The group wants pediatricians to screen patients for suicidal thoughts and risk factors for suicide, such as bullying. Dr. Kim Cass, chair of pediatrics at University of Maryland Upper Chesapeake Health, said that at-risk teens regularly come to the emergency department, and she calls it a "serious epidemic for our youth."
Why were new guidelines needed for pediatricians regarding teen suicide?
The new guidelines were published in response to a recent rise in teenage depression, suicidal ideation and suicide attempts. Suicide is the second-leading cause of death in adolescents ages 15 to 19 and the third-leading cause of death in children ages 10 to 14, [according to the Centers for Disease Control and Prevention's Youth Risk Behavior Surveillance System survey]. In recent studies, one in 12 high school students say they have attempted suicide, and one in six say they have seriously considered suicide.
How do the new guidelines change the role of the pediatrician?
The new guidelines more clearly define the role of the pediatrician with recommended suicide risk-screening tools that should be used routinely at visits. Many adolescents will seek health care for seemingly unrelated issues as a means to seek help. If, during a visit, a physician asks, "Hey, teen years can be pretty tough, how are you hanging in there? How are things going?" it may open the door for that teen to feel comfortable bringing up uncomfortable issues. This, along with a written screening tool asking, for example, "Have you ever thought about suicide? Have you ever thought the world would be better without you in it?"will help identify those youths at risk. Once identified, then patients can be referred for therapy, follow-up or emergency care depending on the risk.
Why can pediatricians be key in helping to identify teens who are suicidal?
Most pediatricians have taken care of these adolescents for years; there is an existing relationship and trust between the adolescent and his or her physician. Identifying depression as a medical problem allows the adolescent to feel more comfortable discussing these issues.
How are these teens being diagnosed now, and are many falling under the radar?
Currently, most adolescents have to self-identify and -refer themselves in order to receive care and treatment. The problem with this system is that teens often lack self-awareness, and there is still a stigma associated with depression.
How are social media and the internet contributing to teen suicide and depression?
Social media is a double-edged sword. In the emergency department, we often have patients that are brought in because of what a patient has posted on social media about suicidal thoughts or attempts. From this standpoint, the teens that see this and tell an adult can truly be saving a life. The problem with social media is that youths never have a safe place. When we were young, we came home to our family. What happened at school did not follow us home. We had a safe environment to get away from bullying, name-calling, etc. With social media, kids never unplug. They aren't able to escape the trials of adolescence. Kids are also much braver online and often say and do things they would never do in person.
How do antidepressants contribute to suicidal thoughts?
This is really the million-dollar question. Do antidepressants increase suicidal thoughts, or are patients that are depressed and on these medications just [at] a natural higher risk of suicidal thoughts? There have been studies that have shown that there is a slight increase in suicidal thoughts and studies that have disproved this. What we do know is that there is a definite improvement in depression with treatment such as therapy and medication. This needs to be decided on a case-by-case basis, and adolescents that are on medication need to be closely monitored for any increase in suicidal thoughts.
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Pediatricians need to look for warning signs such as lack of interest in friends and activities, tiredness, and frequent visits for vague complaints, and also screen for suicidal ideation during visits.
Parents should be on the lookout for changes in behavior, changes in grades, lethargy, lack of desire and lack of enjoyment of activities their child previously liked. Parents need to monitor all aspects of social media and cellphones regularly. Be aware of who your child is hanging out with. During car rides and meals, make a no-cell rule — talk with your child. When they are unoccupied, it's amazing how much you may learn about what's going on in their lives. Above all, listen and don't judge. A teen that just broke up with their boyfriend or girlfriend feels the same as you would during a divorce; a serious problem with a teacher or a bad grade is similar to you having a serious problem at work. Everything is relative. The teen years are tough. Be your child's advocate and get help if needed.