242017Aug

Preventing Teen Suicide: What the Evidence Shows

Rates of teen suicide continue to rise, federal health officials reported this month, with rates for girls higher than at any point in the last 40 years. A rational response would be to engage in evidence-based measures to try to reverse this course. Too often, we assume that there’s nothing we can do.

Sometimes, we even make things worse.

Suicide rates were even higher in the 1990s. But from 2007 to 2015 rates rose from 10.8 to 14.2 per 100,000 male teenagers and from 2.4 to 5.1 per 100,000 female teenagers. In 2011, for the first time in more than 20 years, more teenagers died from suicide than homicide.

But these trends have been known for years. Our response to them hasn’t adequately acknowledged their progression.

There are evidence-based ways to prevent suicide. The World Health Organization has a guide for how media professionals should talk about the subject. They should avoid sensationalizing it or normalizing it. They should be careful not to repeat accounts of suicide or to provide explicit descriptions as to how suicide might be attempted or completed. They should word headlines carefully, and avoid video or photos of suicides or the victims.

The Centers for Disease Control and Prevention has an evidence-based guide on how to prevent suicide as well. There are things the government can do, including strengthening economic supports, making sure families are more financially secure and have stable housing. The health care system needs to strengthen access to and delivery of mental health care, as well as improve our ability to identify and support teenagers at risk.

There are things we as a society can do as well. We need to make things safer for teenagers, which includes reducing their access to the means they might likely use in a suicide attempt. Also important but more difficult, we need to promote connectedness and limit isolation. The best thing we can do for teens at risk is to prevent them from cutting themselves off from others.

We have been failing to meet these goals too often when it comes to the media, guns and community.

The most public discussion around suicide this year centered on the Netflix series “13 Reasons Why,” adapted from the book of the same title. Supporters of the series argued that the show brought attention to teen suicide, and that it prompted more discussions of the issue — which would be a good thing. Many experts were concerned that the series glamorized suicide, though. They were especially concerned because the producers chose to show the suicide in a long three-minute scene, where the protagonist slit her wrists in a bathtub. In the book, she overdoses on sleeping pills, and it takes place “offscreen.”

Playing basketball in Brooklyn. One difficult but effective way to prevent teenage suicide is to promote connectedness and limit isolation. Credit Alex Wroblewski for The New York Times

Research shows that when the media focuses on the suicide of an entertainment or political celebrity, the copycat effect is much larger. This is even more true when the media focuses on the means by which the suicide occurred. Granted, there’s less of an effect when the suicide is fictional, but even then, it’s associated with more than a quadruple increase in a copycat effect.

Researchers recently published a study that examined the series’s apparent effect on internet searches about suicide. “13 Reasons Why” generated more than 600,000 news reports. In the 19 days after its release, searches about suicide were about 19 percent higher than expected. As hoped, some searches for things like “suicide hotline,” “suicide prevention” and “teen suicide” went up. But so did searches for “commit suicide,” “how to commit suicide” and “how to kill yourself.” The long-term effects of this are unclear, but are certainly concerning enough to monitor.

Our inability to address the issue of guns exacts a cost. There are about twice as many suicides annually using guns (more than 21,000 in 2014) as there are homicides using guns. Almost none of the guns used in suicides are assault weapons, and yet that seems to be the singular focus of many activists. In about 45 percent of suicides among those age 15 to 24, guns were used.

Those who might counter that people who want to kill themselves would find other ways if we limited their access to guns ignore evidence about suicide. Research shows that most suicides are impulsive. Studies of people who came close to dying from suicide attempts, but lived, show that about one-quarter went from deciding to kill themselves to making the attempt in less than five minutes. Almost three-quarters of them took less than an hour.

Having access to guns can make a big difference, because they are devastatingly efficient. Suicide attempts by gun succeed more than 85 percent of the time; attempts by overdose or poisoning succeed less than 2 percent of the time. Meta-analyses show that access to a firearm increases one’s odds of a successful suicide by more than a factor of three.

While we can debate the relative merits of making it easier or harder to own a gun, it’s clear that guns should be kept out of the hands of children.

Finally, we are allowing teenagers to become more withdrawn from others. The Monitoring the Future study has been looking at the behaviors, attitudes and values of American high school students for decades. I pulled data from their archives for 2007 through 2015, specifically looking at high school seniors. In 2007, only 25 percent of them reported going out on dates one or fewer times a month — three-quarters were more social than that. In 2015, the percentage of people reporting one date or fewer in a month had risen to 36 percent. In 2007, the percentage of people who reported going out for fun and recreation one or fewer times per week was 46 percent. By 2015, that had risen to 59 percent.

In an article in The Atlantic, and in a new book, Jean Twenge argues that smartphones and social media have disconnected teenagers from society. Others fear the internet in general also may be doing the same or increasing the potential for bullying without immediate repercussions. I’m not sure we can lay as much of the blame on technology as they do, but all of these data make a strong argument that teenagers are more isolated and at higher risk than before.

We need to talk about suicide in ways that help, not harm. We need to make sure young people have no access to guns. And we need to make sure they are connected enough to each other, to family, and to the health care system so that those at risk can be recognized and given the care they need. The rising toll shows we should not ignore this problem, or pretend that it’s just too hard.