Here are some numbers we can count on: the number of suicide deaths among people aged 15 to 24, over 36 in the United States.
As you can see in this graph, after a sharp decline in the late 1990s, the number of youth suicide deaths (measured as the number of deaths per 100,000 population) began to increase around 2008 before to reach a new peak in 2017, according to Centers for Disease Control and Prevention.
Suicide rates have recently increased in all age groups in America, in almost all states. But the suicide epidemic among young people is particularly painful even for the experts who study it.
There are many assumptions about what makes it float. They include the changing interactions between teens in digital spaces, the economic stress and fallout from the 2008 recession, growing social isolation, the contagion of suicide and the fact that teens can more easily search for online suicide methods.
Two other public health problems of our time are also at stake. Children of opioid users appear to be at greater risk of suicide. The same is true for young people who live in a house with a gun.
But the bottom line is that no one really knows why. This is not to say that more suicides can not be avoided, however.
The research on suicide prevention policies is not as sound and well funded as one would expect. Of the 295 research areas related to National Institutes of Health funds, suicide prevention ranked 206th in 2018. Research on West Nile virus, which kills about 137 people per year, is ranked higher.
But I spoke with several mental health researchers, all of whom said that we did not need to know the exact causes of adolescent suicide trends in order to help.
These solutions are not easy: some require political momentum that the country may not be able to bring together. But I found that parents, mental health clinicians and schools could help in many practical ways. It is important to note that there are also political solutions that could potentially contribute.
But first, I find it useful to review the scope of what is happening.
Suicide deaths are only the tip of the iceberg
Suicide is a difficult subject to write.
And it's not just because of the pain and sadness that accompanies such losses. This is because if we are not careful when writing about it, we can potentially make the problem worse. (Indeed, you may have seen a recent example: there are some not quite conclusive research that Netflix shows 13 reasons why child suicide in presumably glamorizing and normalizing it).
This is why it is important to state clearly: Although suicide rates are rising, it does not mean that suicide is normal or common. (Learning that suicide is "normal" can make a person more comfortable doing it himself.) It's still rare. In 2017, 6,241 deaths by suicide were recorded among 15 to 24 year olds. Most were men, but a growing number of young women are also dying this way.
Overall, about 16% of teens, according to CDC reports, are considering suicide in a given year. "It's an epidemic," says Mitch Prinstein, director of clinical psychology at Chapel Hill, University of North Carolina. And the dead are just the tip of a sore iceberg. Below, there is a rising tide of pain among young people.
For example, the number of adolescents diagnosed with clinical depression increased by 37% between 2005 and 2014. Suicide attempts – which are not always life threatening – are also increasing. Here is a disturbing example of this. A recent article in the Journal of Pediatrics It is estimated that in 2018, nearly 60,000 girls aged 10 to 18 years old tried to poison themselves. In 2008, this figure was closer to 30,000. Very few of these poisonings were fatal, but they represent a huge amount of emotional trauma.
"We see in schools many more children with mental health issues, including anxiety, trauma, depression, eating disorders, emotional problems, etc." James Mazza, a suicide researcher at the University of Washington. "Only a few of them will result in a suicide death. … Our schools need to focus more on mental wellness or provide children and youth with the skills to cope with the deregulation of the emotions they will experience during adolescence. "
So, how to act?
I will be clear: the following solutions are not an exhaustive list. Instead, they were the most mentioned in my conversations and the largest, and seem to have the most robust research to support their effectiveness.
Restricting access to weapons and drugs can clearly prevent suicide
The simplest, most direct and broadest policy tool for reducing the number of deaths by suicide is also the one that is most rarely used: simply reducing access to lethal means. If people can not access tools like guns and drugs to hurt themselves, there will be fewer deaths.
In the United States, that means gun control.
We hear a lot in the news about how firearms cause mass murder or mass murder. But guns are involved in more suicides than homicides each year. "Young people living in a home with access to a gun are much more likely to die by suicide," says Jonathan Singer, president of the American Association of Suicidology and professor of sociology at Loyola University in Chicago.
There is good evidence that stricter firearms control would save lives when it comes to suicides.
After New Zealand passed tough gun control laws in 1992, "a 2006 study found that the number of firearm suicides has dropped significantly, especially among youth." Rates fell in the 15-24 age group, from four per 100,000 in the late 1980s to about one in 100,000 in the early 2000s. (And overall, research shows that when the number of firearm suicide decreases, these deaths are not offset by suicides by other lethal means.)
"As a population-level intervention, reducing access to guns is one of the best solutions," Singer says. "Does the country want to do that? No."
Another simpler option is what is known as "fatal counseling" for families with a child who is likely to commit suicide. This advice, which usually takes place in a hospital after a psychiatric emergency, involves talking to parents about the extent to which their children have access to firearms or poison, and then suggesting ways to make their homes safer.
Still, many children (perhaps more than half, according to one study) are coming out of the hospital without their family receiving such advice. And many are sent back to homes containing lethal drugs and guns.
Reducing access to murderous means does not simply mean limiting access to firearms. It could also mean limiting access to lethal drugs.
Dealing with the opioid epidemic could mean reducing access to pills for overdose. The simple act of taking opioid medications at home – prescribed to a family member – is associated with an increased risk of overdose.
But it's not just about potentially dangerous prescription drugs. Research has indicated that it would also be helpful to change the way some over-the-counter medications are packaged. In the UK, when a popular over-the-counter painkiller has been repackaged in blister (where pills must be extracted one by one), instead of bottles (which allow for easy pouring of multiple pills at a time), less overdose of this drug.
According to Mr. Singer, these measures would save lives, but do not necessarily make people feel like "lives worth living".
But for that, there are also potential interventions.
Asking a teenager if he feels suicidal can help
Schools are perhaps the most obvious place to implement policies to save the lives of young people.
For teens, "one-third of their day is spent in the classroom," says Samuel Brinton, head of advocacy and government affairs for the Trevor project. Teachers "are most likely to see the warning signs and be able to intervene appropriately," he says.
According to Brinton, ideally, schools would have three levels of prevention programs: programs to help prevent suicide in all students, programs to identify children in difficulty and to intervene, as well as strategies to cope with consequences of suicide or tragedy. in a school to help children cope and to ensure that a suicide contagion does not begin.
Is there an ideal off-the-shelf program to address all these areas? Unfortunately no. "There is no program," says Jane Pearson, Chair of the Suicide Research Consortium at the National Institute of Mental Health. "The field is trying to understand how to assemble these elements and determine what schools can do effectively."
Having said that, it can be helpful to ask children if they feel good and to subject them to suicide.
"There is a long-standing myth that simply asking a child if he or she is suicidal might give him or her an idea and increase risk," says Prinstein. "And we now know that it's completely wrong."
Screening teenagers involves asking them direct questions such as: Have you felt sad more days than not in the last two weeks? Have you ever wished to be dead? Have you thought of ending your days in the last two weeks?
Adolescents who answered "yes" may be referred for additional counseling services (in particular, dialectical behavior therapy seems to be helpful in helping people manage their suicidal thoughts). A study evaluating screenings in a group of more than 1,000 Grade 9 students in Connecticut revealed that such screening, coupled with mental health education, can reduce the number of suicide attempts in the United States. next three months.
"It's just a study," says Singer. "One of the challenges in talking about" Well, what's the evidence, what's the data "is that we're just starting out. It takes time for programs to be developed, for school districts to be prepared to do something that is not evidence-based, and then to take research that demonstrates that it works or that it does not work. . "
Gatekeeper Training Can Help Teachers Identify Students in Need
So many people who committed suicide have had no contact with mental health services. Schools can be a way to fill some of the gaps.
But it's a challenge. One of the obstacles is that schools are run locally. Each district should implement programs individually. And unfortunately, not all school districts have the money or resources to do it. In addition, not all parents may be comfortable with the idea that their schools are asking suicide questions to their children. Some states have laws mandating suicide prevention training for schools and staff, but not all do.
Which is a shame because of another promising potential intervention: the training of access controllers. It is at this location that teachers and school staff are trained to research and recognize students who may be at risk and to try to steer them further.
There is, in fact, good national data on the training of gatekeepers, thanks to a federal bill called the Garrett Lee Smith State / Tribal Youth Suicide Prevention and Early Intervention Grant Program.
It is named after a son of an American senator who died in suicide in 2003. The program provides schools with a grant that allows them to implement many types of suicide prevention programs.
Overall, the program seems to have helped, regardless of school expenses. "Studies have shown that the rates of suicide attempts and suicide deaths among the countries benefiting from these subsidies are lower than those of the twinned countries that did not receive funding," says a recent summary article by the government. American Psychological Association.
But in particular, data from Garrett Lee Smith grants show that counties that use access controller training see a one – year reduction in the number of suicide attempts and deaths by suicide. "Unfortunately, a recent review of the evidence on suicide prevention in Current opinion in psychology explains, the impacts "have not been maintained; Suicide rates and suicide attempts did not differ … two years after the training. "
This means that additional and ongoing training may be needed, or just that it's hard to stay alert for such a long time. Again, research here does not say a perfect answer. But it's at least optimistic.
Again, there are other options for intervention. And no single intervention should be used in isolation. Schools should also know that, according to research, the mere fact of founding a homosexual alliance – a club that encourages the inclusion of LGBTQ youth in schools and, in general, safe spaces for anyone – can reduce the risk of suicide among the two teenagers who identify as LGBTQ (higher suicide risk than their heterosexual counterparts) and those who do not. This shows that inclusive and supportive environments matter.
Parents and adults in communities may also be empowered to act
Policies should not only target young people. They could also target their parents and other adults in the communities to form safety nets.
"All parents should talk about suicide to their child," says Prinstein.
Kathryn Gordon, a clinical psychologist and researcher who recently left her academic work for a private practice, says parents can learn to "listen without judgment". Simple listening, she says, can be a first step.
As a parent, she says, it's easy to want to step in and start solving the problem immediately. "But children often see this as disdain or discomfort[ing]She says, "If you are open and listen, often children and adolescents can start to solve their problems on their own or ask for help."
One of the most promising studies – which could possibly also inform policy – on suicide prevention, which has been published recently, has shown that adults can actually help save lives, although the results are not may not be immediately visible.
The study involved adolescents who had been brought to the hospital after a suicide attempt. These teenagers were asked to name up to four caring adults, who then learned to talk to suicidal teens and make sure they adhered to the treatment. After in-person training, adults got help over the phone for a few months to help them overcome the difficulties of helping a troubled teenager.
More than ten years after the intervention, the researchers interviewed their participants by consulting the death registries. It turned out that teens who benefited from interventions more than a decade ago were less likely to have died. "To our knowledge, no other intervention with suicidal adolescents has been associated with a reduction in mortality," wrote the study's authors. The results were modest and need to be replicated.
Cheryl King, a suicide prevention researcher at the University of Michigan who created the intervention, suspects the effectiveness of the intervention, that is, it is the children who have nominated adults. This may inspire them to think about their relationship with others – and open the door to strengthen them.
The intervention also encourages adults – who are not all parents of the child – to be more proactive. "The truth is that it's not easy for adults to go there, talk to them, and try to help suicidal teens," says King. "We were always reassured by the fact that their role was simply to be a caring person and that they were not responsible for the choices made by the teenagers." Perhaps more programs could target parents and adults community to better protect young people.
Overall, I think the lesson is simple. We can remind teens that there are people in their lives who care about them. They feel like receiving this care at home, at school or, ideally, wherever they go. And that can help.