Teen suicides rising, then came the pandemic
By Lisa Brody
Diane Orley, now living in Birmingham, was woken up before dawn on August 26, 2013, by two police officers at her Bloomfield Township front door. Her first thought was that her son, George, 20, had been in a car accident. The day before he had packed up his car and was driving back to begin his sophomore year at the University of Michigan.
Instead, they informed her, her husband Randy, and her son Sam, then a high school student, that George had died in an apparent suicide, after he parked his vehicle along the side of I-94, exited the car, and walked into oncoming traffic. A semi tractor-trailer struck and killed him.
“He couldn't deal with life with bumps in the road,” Orley ruminated. “Looking back, he had had surgery that took him out of college; he had diabetes at age 13, which was really hard for him to deal with. I think he was a kid who couldn't deal. And then the whole fraternity experience really beat him up and wore him down. It's what frats do with the hazing process – it breaks you. That humiliation, he was so fragile and probably broken – that was probably the beginning of the end, that humiliation and torture.”
She said that while George “wasn't super open with us,” about his struggles with mental health, and “kept his life inside,” he had come to her privately a year before that horrible day in 2013, asking to speak to her, to tell her that he had tried to take his life six months before.
“It was like an out of body experience,” she recalled, catching her completely off guard while out of town for a family celebration. “Looking back, he had had a hip surgery that took him out of college. I did see so much mania when he was recovering from hip surgery – and then of course then comes the lows. He was self-medicating,” she said, smoking a lot of marijuana, especially in the house, which she found out of character for him.
“We found him a good doctor to help – we got him into a psychotherapist, and he was diagnosed as bipolar,” she said. “It was shocking, but at least we had a diagnosis. We knew the seriousness of it but we got him on the meds.”
Orley said the mental health system was very difficult, without a lot of resources – especially since one doctor was required to prescribe medication but another was needed for talk therapy, as there are few who offer both. “I really feel for anyone going through it,” she said.
For George, medication to treat his bipolar condition “changed his personality. It flattens you. He was 'flatter,' tired. They take a lot of medication and they don't like how it feels. It turns out he did stop taking his pills two weeks before” his suicide, but they didn't know. “We did spy on him. We used to go to Ann Arbor to visit him and sneak into the bathroom and count his pills. We did everything we could. They're shutting down at that age anyway. We had zero warning signs that day,” she said, noting she had spent a “normal” day with him.
“My mantra was, 'he is out of pain,' and that is the only thing that has made me feel the slightest bit better. But it did, and it continues to this day.”
Sadly, according to the Centers for Disease Control and Prevention, suicide is the leading cause of death among high school-aged youths 14-18 after unintentional injuries, based on their 2019 Youth Risk Behavior Survey. The report notes that “suicidal behavior presents a major challenge to public health in the United States and globally. Although fatal (ie, suicide) and nonfatal (eg, suicide attempts) suicidal behaviors are a public health concern across the life span, they are of particular concern for youths and young adults 10-24 years. During 2018, a total of 48,344 persons (all ages) died from suicide, and suicide was the 10th leading cause of death overall in the Unite States, accounting for approximately 1.7 percent of all deaths. Among high school aged youths (14-18 years), 2,039 suicides occurred that year. Suicide accounted for approximately 33.9 percent, or approximately one of every three injury-related deaths among this age group. Between 2007 and 2019, in Michigan, there were 1,576 suicides for those between the ages 15-24, according to the CDC.
“During 2009 to 2018, suicide rates among youths aged 14-18 years increased by 61.7 percent, from six to 9.7 per 100,000 population… Many more youths make suicide attempts and struggle with suicidal ideation,” the CDC tells us.
In 2018 alone, according to the report, approximately 95,000 teens visited emergency departments for self-harm injuries.
In 2019, according to the CDC study, almost 19 percent of students reported having seriously considered suicide, with the estimates highest among females, at 24 percent; white non-Hispanic students, 19 percent; students who reported having sex with persons of the same sex or with both sexes, 54 percent; and students who identify as lesbian, gay or bisexual, 47 percent.
Among all students, nine percent reported having attempted suicide, with females the highest estimated group, at nine percent; Black non-Hispanic students, 12 percent; students who reported having sex with persons of the same sex or both sexes, 30 percent; and students who identified as lesbian, gay or bisexual, 23 percent.
“The age group 14 to 24 years are particularly vulnerable,” noted professor Douglas Barnett, director of Wayne State University Psychology Training Clinic. “There are a lot of theories, notably that at that age biologically, socially and psychologically, they're seeing the world in new ways, their bodies are changing and the way they're interacting with the world, and the way the world is interacting with them, is changing. But they're still kids. All of the stresses add up. They can't always imagine improvements that in their world can change, that their parents can change – that it can all be temporary. However, the numbers are indicating they are more suicidal in the last several years. It's a very serious problem for all walks of life – not just the poor, inner city kid. It's the wealthy suburban kids too. It's an international problem from communities around the world.”
Barnett said there have always been suicides among teenagers, but often it was something people hid from others. Today, there is a greater awareness of mental illness and the need, and availability, of help. Couple that with the awareness that many psychiatric issues, such as bipolar, schizophrenia, psychosis and other mental health disorders do not develop until the late teens or early 20s, as the brain is still developing.
“Thirty years ago if a teen made a suicide attempt, they were brought to a hospital for several days or weeks. That was in the '80s or '90s, and they were getting thorough assessments of what they needed,” Barnett said. “Now, they are often released within 24 hours, with the hospital pretending nothing happened, or depending upon the parents to find the resources. One of the challenges of this age group is the need for parental support as well as the teen has to want to get help. You need both to have cooperation. Good therapists know how to work with that.”
“There is an increased awareness of suicide amongst Gen Z (ages six to 24) – there is less stigma about talking about mental health issues. I think that's a positive,” said Alison Miller, professor of health behavior and health education, University of Michigan School of Public Health, Department of Health Behavior and Health Education. “It's viewed as, 'everybody has stress at times, everybody needs help sometimes.' It's not seen as a sign of weakness. As we learn about the genetic markers of mental health like depression, there's less stigma and there's a greater ability to speak about it.”
An additional stress to teens and young adults in the last year is the COVID-19 pandemic, which has put their life on hold and placed them in isolation – a direct conflict to their biological development.
“With teens it's such an abnormal push with what they are supposed to be doing at this point in their lives. It is against their biology,” said Miller. “They're not able to reach their developmental milestones – which is autonomy. All teens are not doing as well now, even high achieving teens aren't doing well, because they can't meet their goals. They've been waiting so long, doing so much right and then there's this huge block in their way they cannot move.
“There's so much grief and isolation and trauma – and especially community level trauma which have experienced so much,” continued Miller. “It's impossible to get away from it, and a lot of those kids are taking on additional responsibility for their families – they're trying to attend school virtually while working.”
One possible reason there has been an increase in mental health issues and suicide rates from 2007 to 2018, and anecdotally during the pandemic, can relate to economic issues.
“Suicides were increasing in the '80s and early '90s, and they started down, and then started to go back up around 2007. We don't know why, but about 2007, 2008, 2009, was the Great Recession, and the suicide rate tripled among teenage girls, who were adding on lots of responsibilities and then were fielding criticism about growing up too fast,” stated Jonathan Singer, president, American Association of Suicidology and a suicide researcher. “Parents were laid off, they lost their jobs, then some lost their homes, some had to move so they lost their friendship groups. It could have translated to increased pressure and that the world is less safe.
“Then, in 2020, that same adolescent sees the world tanking again,” Singer said. “We know isolation, a sense of burden creates an increased suicide risk. It's possible for a cohort of kids, especially girls, who do not see a likelihood the world will be a stable place.”
Miller concurred. “Teens observe the economic pressure in their families, those economic uncertainties, whether food insecurities, eviction, job losses, parents who are frontline workers or essential workers,” she said. “They see that their future feels uncertain and the future of the world looks uncertain. It is hard for them to make plans.”
The Zoom fatigue that has become chronic among many, she said, is amplified among teens because not only are they on for hour after hour, “but they are hyper self-aware and their breaks are often on social media, which we know can be a powerful way to connect, but can also be dangerous. It can be toxic if it's stirring you up – if it's FOMO (fear of missing out). Teens are already preloading to test the boundaries, and anticipating that others have it better, with social media, it just can magnify that.”
“Pre-pandemic, I believe it (suicide) was a pandemic,” said Rebecca Vannest, professor of counseling, School of Education and Human Services, Oakland University, who spent 13 years as a public school counselor. “It was at a rampant level – even higher than many people realized. Almost every day it was something I was dealing with. You have to always take talk and a threat seriously regardless of the age, and I found a lot of minimizing by caregivers. Parents just don't know what to do.
“It's not that people don't notice at school, it's that how does the child get the mental health care that he/she/they need?” Vannest asked, noting that Michigan has the second worst student/school counselor ratio in the country. “I had between 350 and 950 students to oversee – I would just have kids stacked up. Essentially schools are mental health waiting rooms in school offices because schools are responsible for them.”
Jennifer Perrone, director of special education, and Margaret Schultz, director of instructional equities, Bloomfield Hills Schools, said anecdotally for the last several years their counselors, teachers and social workers have been relaying to them “an across the board uptick in mental health issues, and not just with student with IEPs (individualized education plans),” Schultz said. “It's as prevalent with students from our general population as those with previous issues.”
“In the last few years, we have seen a great increase in identification with anxiety, and anxiety and depression go hand-in-hand, and they are vying for services,” Perrone said.
The American School Counselor Association recommends no more than 250 students per school counselor. Michigan currently has no school counseling mandated for students in grades K-12, according to the association. However, in February of this year, state Rep. Felicia Brabec (D-Pittsfield) introduced House Bill 4156 to require schools in Michigan to employ one school guidance counselor for every 450 students enrolled. The bill is currently with the House Education Committee.
School counselors are charged with providing critical guidance and support with secondary education and preparation, including skilled trades, but also on their plate is working with students to address struggles with mental health, suicide, stress and bullying.
“Our students' mental health must be a higher priority,” Brabec said. “Students need resources available to them that can help lower the rates of depression, anxiety and suicide in our younger students and teens. Having more school counselors available is a great first step a school can take.”
A further complication for teens and their families, Vannest said, is that once a student has indicated they need help, and parents are in the picture, navigating the mental health system “is very challenging. Many private practices are booked for weeks and can't get an emergency in. So it is left for the emergency rooms to deal with – which are only equipped to handle suicide attempts, and not the treatment or prevention of suicide.”
Vannest recalls a student she had who she felt was “imminent, and I told the parents to go directly to the hospital from school – this is an emergency. The hospital evaluated her, and she didn't have something physically wrong for them to treat, and they sent her home.
“She went home, swallowed a bottle of pills, and said to her parents, 'Can I stay there now?'”
This sad Catch-22, Vannest said, illustrates that there are few options in between day treatment programs and in-patient programs for young adults.
“The in-patient benefit is medication stabilization because it's very hard to get in with a child psychiatrist or psychologist in Michigan, to have them treat them,” Vannest said. One with 24-hours of supervision at night will provide a medical evaluation and stabilization – “and that's it. No therapy. They're given a referral. They're either waiting or given too much care. Maybe they just need to talk to somebody for a few times a week for several weeks.”
She said the ideal situation is an in-between program, where they can be hospitalized in a day treatment with group therapy and medication stabilization, and go home at night to parents' care.
Dr. Jaclyn Issner, a psychologist specializing in promoting mental health in children and adolescents, said while she has had many patients “with fleeting thoughts” or rumination, “distorted thinking where you get stuck in a dark, tough place – 'I'm horrible, I'm terrible, no one likes me, there's no purpose to my life, feeling so alone in life,' but we talk about how feelings are fleeting and they change. We'll talk about riding the wave and riding out the storm. Thinking about reasons you do want to live.”
Since the pandemic began, she said, like other health care providers, her private practice is off the charts. “There's an increase in depression, anxiety, substance abuse. Part of it is the social isolation. For teens, they crave the social connection, which is developmentally appropriate – but now they're just at home.”
Another aspect for some teens is the loss of sports and other extracurricular activities, which for some, has been their identity.
“For an athlete, some who identifies themselves by their sport, it's a loss of part of their identity,” said Issner.
“We've heard from schools, from teams, from athletes, during the darkest of times when no sports were being played because this is a once in a generation event. It was just devastating for those when we had to cancel the entire season last spring. You have this four-year period of time – and for a lot of kids it's two years, because that's how much time they're on varsity – and they're building for this, and they suffered,” said Jeff Kimmerly, communications director, Michigan High School Athletics Association (MHSAA). While they have little concrete data, “I'm sure it took a mental toll on a lot of athletes. We hear about how much joy there is realizing now how important this is to their life – realizing how significant it is to them, and how grateful they are.”
Ironically, Kimmerly said, before the COVID-19 pandemic, as a continuation of the MHSAA's 20-year health issue initiative, which has examined heat, heart and concussion issues, it was planning a wide-ranging effort to look at student/athletes' mental health. It's still on the docket.
“Not playing sports or being involved in other extracurriculars, like theater, has added a tremendous amount of stress to those who relied on them for their identity,” said clinical psychologist Gretchen Marsh, who in addition to her private practice also works with Birmingham Public Schools on mental health awareness. “Now they are depressed, they are suicidal. We are seeing increased rates of suicide.”
Marsh explained that for many who are suicidal, “suicide is not wanting to die necessarily – it's wanting to relieve the symptoms of depression or anxiety, and they want to feel better. They feel there is no other way to relive their symptoms. They can't find any other way out of it.
“Pre-pandemic, we saw this huge increase in suicide ideation and suicides between 2007 and 2018,” Marsh said. “Before that time, we saw a lot of depression, but after 2007, we saw an increase in anxiety disorders, which overtook depressive disorders. Anxiety disorders affect how you feel, with headaches, stomach aches, muscle tensions, jitters, how we think and thoughts often become irrational, highly negative and repetitive. We get these negative thoughts and we spiral, and consequently, when we get anxious we isolate, we withdraw, we get irrational, and we avoid anything that makes us anxious. In the short-term – it works. But in the long-term, it leads to depression. With the pandemic, we were told to isolate for our physical health, but we weren't told how to cope and cultivate our mental health during a pandemic.
“For impressionable 12, 13, 18 year old girls who are on social media – they see beautiful faces, beautiful bodies, homes, perfect lives. We know teens suffer from low self-esteem and insecurity, which is all normal. But when we expose them to social media, they fall for it and that can cause terrible anxiety and depression, which can lead to increase substance abuse and depression,” Marsh continued.
For boys, she said, “they're turning into a huge gaming population. Video games are made to be addictive, and not made to benefit kids. They're alone in their rooms. They're isolated and becoming depressed. For both sexes, YouTube and TikTok show a lot of inappropriate sex that are harming the young minds to what sex is.”
Marsh said there is a direct correlation of the increase in the use of social media and cell phones and the increase in mental health problems, as well as to the increase in academic and social pressures. “There is a parallel line,” she said. “Couple that with helicopter parents – now lawnmower parents, who move everything out of their way, and we don't allow children to fail, so they don't know how to cope with anything. That has led to anxiety and depression, which can be overlapping. Anxiety often precedes depression – and that is what we have seen with the pandemic.”
Schultz and Perrone of Bloomfield Hills Schools echo the issues they are seeing from an increase in social media exposure.
“Research shows access to technology, social media, and screen time equates to an increase in mental health issues,” Schultz said. “For example, if kids are not included in something, (because of social media) they know right away, and it's really hard on them. When we were kids, we left school, left our friendship groups, we weren't aware if other kids got together outside of school and did something and we weren't a part of it. Now they know instantly.
“It's very draining on their mental health. They have to be on all the time.”
Perrone concurred. “There's no place for them to be safe,” she explained. “They always have to be on monitoring Instagram, Snapchat, TikTok – and couple that with the expectation in this district with being one with high achievement expectations. There's this 'mom anxiety competition.'”
“Our brains function with the amygdala, which is fight or flight,” Schultz said. “If they're always on that 'fight or flight' mode, you're brain can't properly make decisions, and at that age the frontal lobe is fully developed.”
However, Singer of the American Association of Suicidology disagrees.
“At least for kids, research suggests there is no increased risk of suicide with those who have social media accounts or play violent video games,” he said. “Social media is a tool that can be used to support people or to tear them down. They can go on there and find someone who can be a support. Those kids with existing suicide risks, who watch pro-suicide list serves or watch videos on how to kill themselves, there are increased risks.”
Barnett of Wayne State University agreed, noting that “social media is an important part of the picture, and a part of the mental health picture. If they're isolating, it can help in getting them engaged in health, or if they're at a negative state, we try to get them to use positive apps, to make healthy choices and use healthier social media choices. However, the idea of hurting yourself can be contagious. But you can't cut them off from social media or their peers because it can be a way of getting them help.”
For those with suicidal ideation who have not received help, or it is still in process, “access to firearms is one of the biggest predictions of suicide completion,” said Miller of University of Michigan. “If somebody has suicidal thoughts or suicidal ideation (thinking about suicide, wanting to take your own life, and planning your suicide), they're more likely to die by suicide if they have access to a firearm because it's more lethal – and because they're home. If a teen is sad and stuck at home and feeling impulsive, if there's a delay, even by 30 seconds, if a firearm is locked up, that can make an important difference, much more than with pills or any other means.”
“Kids who have access to firearms in the home are 32 times as likely to die from suicide as any other means,” said the American Association of Suicidology's Singer. “Six percent who make a suicide attempt use a firearm – but half of the people who die of suicide use a firearm.”
Cathy Barber of Harvard School of Public Health's Injury Research Center, said survey data shows, “Gun owners are not more suicidal, but case control studies do show that those with guns in the home have, if mental health issues are there, higher levels to try.
“Most people use pills,” she said, “and most people survive.”
More men “by far,” she said, use guns, and it is their leading method. “With guns, it's pretty instant, unlike with other methods.”
Barber explained that most suicidal people have some level of ambivalence, “because most people don't want to go through pain. But if you're in tremendous psychic pain, where the thought is, 'I have to exit,' that kind of feeling can be a temporary feeling. Things have been terrible and there's a trigger and they want to check out. If they're using a gun and they can get themselves to pull the trigger – they can't change their mind. With pills, they might have second thoughts, they can reach out to someone or the body fights back.”
She said one area of work they are advocating for and working with suicide prevention and mental health professionals is to work with gun shop owners, firearm instructors and gun rights advocates, “in different ways to incorporate suicide prevention in their safety messaging. With firearms instructors, we explain they are in a position to teach awareness – if there are people fighting mental health issues, depression, bipolar, drug abuse, alcoholism, a divorce, maybe to carefully store the firearm in such a way the person at risk does not have access.”
She said they position it as a safety issue.
“What is the best way to protect the person,” she said. “We're looking at gun owners as part of the solution. For teenagers, a lot of access can be controlled by parents, and the message is lock it up, but also make sure that they don't know where the key is. If your kid is going through a really bad time – maybe it's a good idea to even get the guns out of the home for a period of time.”
She said they acknowledge that in rural areas, it's not entirely unusual for the guns to be the kids' own hunting rifle.
Although we may be rounding the corner of the COVID-19 pandemic, leading us out of isolation and back to a society of being together, there is no way to know if the young adult suicide rate will stabilize or drop. For every teen who is traumatized by being alone, there are some students who have felt comfort in being alone.
“What we have seen quite a bit are the ones we may have wanted to have had our eyes on, students who may have suffered from struggles with anxiety, depression or struggled with socialization pieces, they are choosing to stay virtual,” said Bloomfield Hills' Schools Perrone as schools return to in-person education.
“It makes sense,” noted Bloomfield Hills' Schultz. “If they're anxious, they're fearful. They're not always rational.”
One long-lasting benefit to the pandemic, will likely be the continued use of telemedicine. Miller noted it had previously “not been ready for primetime. But some kids are more accepting of telemedicine, which has become a key method.”
She also said it will continue to take a village to help each other, hence the Hear Something, Say Something program.
“Most kids will say something to someone at some point – it may be veiled and not obvious, but there has to be an awareness of red flags,” she said. “There is a big difference from a dark mood or days of dark moods. It's less of a sad mood and more of an angry mood. If there's a changed mood, a lasting mood – pay attention, ask your child if they're okay, and do they want to talk to someone.”
It could save their life.
(The National Suicide Prevention Lifeline: We can all help prevent suicide. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.1-800-273-8255).