By the time Cheryl Sharp was 18 years old, she had attempted to end her own life on three separate occasions. Her first attempt occurred when she was just 13.
Despite having many friends and social outlets, she said her teen years were marked by a pervasive sense of loneliness. “I felt like I did not belong in the world, that I didn’t really have a place where I was of value,” Sharp said. “What happened in the first attempt was the same thing that happened in all others. I felt overwhelmed by my emotional states and simply did not have the positive coping resources I needed to move through life.”
In terms of intervention supports, she talked to a guidance counselor a time or two, but that was the extent of it. She recalled one attempt where her father didn’t even take her to receive medical attention.
“Instead of taking me to an emergency room,” she said, “he made me drink hot salt water and walked me around the neighborhood.”
Today, Sharp is a senior advisor for trauma-informed services at the National Council for Behavioral Health. She said programs lacking during her teen years, like Wellness Recovery Action Plans (WRAPS), could make a world of difference for teens experiencing suicide ideation today.
Cara Anna made her first suicide attempt as a high school senior. She doesn’t recall being depressed or really even having a particular catalyst for the attempt. While driving, she just said she was “sick of everything” and made an on-the-spot decision to try to kill herself.
“I’m going to put this traumatic music on the car stereo and I’m going to ram into something,” she recalled thinking. “At the last minute, I turned away, and I didn’t hit the guardrail as hard as I had thought.”
She was quickly dismissed from the emergency room and said she carried on with her life rather easily. Few people, she said, even suspected the incident was a suicide attempt.
“It was surprising how impulsive it was,” she said. “I guess that’s why there’s so many suicide prevention groups that are so concerned about teenagers.”
As an adult, Cara Anna went on to become a foreign correspondent for the Associated Press. After a suicide attempt three years ago, she decided to tackle the issue of suicide head-on as a journalist.
“I am going to see what other people, who talk openly about this, how do they do it, where the communities are and what kind of resources are out there,” she said. “In short, I’m going to be open.”
Who is most at risk for suicide?
According to the Centers for Disease Control and Prevention, in 2010, some 1,456 young people in the United States committed suicide. That same year, an additional 78,000 kids (young people 18 and younger) made non-fatal attempts to end their lives.
For the 10- to 24-year-olds, the CDC reports that suicide is the third-leading cause of death among the age group as a whole.
Dr. Alex Crosby, a medical epidemiologist for the CDC’s National Center for Injury Prevention and Control (NCIPC), said many more young people try to kill themselves than succeed: The ratio of youth suicides to youth suicide attempts is usually in the range of 1-to-100 or 1-to-200.
“The male rates tend to be about three to four times higher than females in term of death,” he said. Generally, Crosby said, girls are about two to three times more likely to attempt suicide than boys. But boys are more likely to succeed in killing themselves when they try.
Dr. Matthew B. Wintersteen, of the Thomas Jefferson University Medical College’s Department of Psychiatry and Human Behavior, said white males appear to have an increased risk over other groups, while older youth, 14- to 18- year olds, are more likely to commit suicide than younger children. However, he said, “suicide does not discriminate,” and stressed that any young person in any demographic in the U.S. could be at risk for suicide. Furthermore, since many attempts do not result in hospitalization, Wintersteen said there may be an undercount of the number of young people in the nation who actually try to commit suicide.
Citing results from last year’s CDC “Youth Risk Behavior Surveillance” report, Crosby said there may be an emerging youth population of concern: “Of the three major groups that are reported in that data most often — Hispanics, African-American Non-Hispanics and White Non-Hispanics — Hispanic females are the ones that reported the most suicidal behavior in the past 12 months.”
Why do young people want to kill themselves?
“We looked at youth who have made significant suicide attempts in the past, and even interviewed people who had lost loved ones to suicide,” Wintersteen said. “Some youth feel like they’re a burden on other people, they may feel like they’re trapped in a situation they can’t get out of.”
Other young people may experience feelings of failure, embarrassment or humiliation leading up to their suicide attempts, he explained. Very rarely, however, does he believe there is a single trigger event that goads a young person into attempting suicide. “Typically what you see is somebody who’s been struggling for awhile. They may not have talked to anybody about how bad they feel. I think, culturally, we’re sort of told to keep how we feel to ourselves, and we don’t share that with people.”
“It’s not just you wake up one day and you go ‘OK, today I’m going to kill myself,’” said survivor Cheryl Sharp. An overpowering sense of hopelessness and powerlessness, she said, generally “sets the stage” for suicide ideation to begin.
Often, suicidal youth may be afflicted by a general sense of “nihilism,” she added. “My life is bad, the world is bad; it’s never going to get any better.”
A variable for today’s youth that hasn’t been the case for other generations, Wintersteen said, is the Internet. “You can get on the Internet these days and get information about anything you want to get information about,” he said. “I think social media is another piece to it … kids can communicate with a thousand other kids in a matter of seconds quite easily, and I think that really changes the dynamic in terms of how people deal with problems and how problems emerge sometimes.”
Histories of clinical depression, bipolar disorder or substance abuse problems are considered major risk factors for suicide, Crosby said.
Children exposed to domestic violence, as well as those who have experienced abuse or neglect may also be more likely to think about suicide, as are youth who do not have strong bonds with friends or family.
“Access to lethal means can also be a risk factor,” he added. “The most common method [of suicide] is firearms. That’s closely followed by suffocation, of which most is due to hanging.”
How can suicide be prevented?
Crosby said the public’s biggest misconception about suicide among youth is that it cannot be prevented.
“I think there is still a big stigma about suicidal behavior, especially in light of how preventable it is,” he said. “Most of the research has shown that you can intervene, and actually prevent many suicides from occurring.”
One of the difficulties of addressing suicide in the United States, Crosby said, is that while much research has been conducted on risk factors, fewer studies have been focused on protective factors. Perhaps the most powerful deterrent to suicide among youth, he said, was a sense of “connectedness” with others.
“What connectedness refers to is how a person is integrated into several different things,” he said. “So that can be connectedness to their family, it can be connectedness to positive peers maybe in their high school or connectedness to an adult, a caring adult.”
Kids who feel they have a safe place to talk with a peer group they feel connected to could prove a “life saving variable,” agreed Wintersteen.
Similarly, he said young people who have been taught coping skills may be less likely to attempt suicide. “If they’ve struggled with something or had to deal with something that wasn’t easy to do, if they’re able to successfully get through that,” he said, “that usually bodes well for youth who are struggling again at some point in time.” See sidebar article HERE for detailed resources in working with youth.
Great strides have also been made, Wintersteen said, in programs targeting specific youth populations. “There’s a lot of different [prevention] programs, and they work for different groups,” he said. “Over the last five or 10 years or so, we’ve been doing better work in terms of identifying where are the gaps [in] working with Hispanic youth, or working with LGBT youth.”
A public agenda?
As a public policy response to suicide among young people, Crosby said he was supportive of legislation like the Garrett Lee Smith Memorial Act, a federal grant program providing prevention and early intervention funding in all 50 states and more than 40 tribal organizations across the country. The Act, signed into law by President Bush in 2004, was reauthorized in 2013.
Wintersteen said systemic responses to suicide prevention for youth have improved considerably during the last decade. Several states, he said, now have laws requiring teachers to get prevention training. The American Foundation for Suicide Prevention lists a compilation of state laws and statutes regarding suicide prevention training on its website. (See Resources HERE.)
“They have an opportunity to see those things and intervene by referring it to a guidance counselor, whatever the protocol may be from the school, whereas in the past, a kid who’s got their head down on a desk or seems like a disinterested student, [an educator may say] ‘I don’t know what to do about that.’”
A different pathway
It wasn’t until she was in her mid-20s, Sharp said, when she began seeing a therapist with a “strengths-based perspective,” that she began to feel a breakthrough.
By placing a greater emphasis on behavioral or mental health, Sharp said primary care providers could “shift the landscape” by asking younger patients about traumatic experiences and social engagement. “Had I had the opportunity to create a WRAPS [wellness recovery] plan 40 years ago, I think it would’ve changed my life significantly,” she said. “I wanted someone else to stop the pain. … What I’ve realized is, I can actually stop the pain. There were things that I could do, which included reaching out to someone.”
The best preventative measure Sharp said, is addressing “the voice of despair” — a young person’s feelings of extreme stress — before those thoughts spiral into suicide ideation.
“We need to do something before things are that bad,” she said. “We don’t want to be waiting until someone is talking about suicide.”
Cara Anna, now 40, started a website, TalkingAboutSuicide.com, to create a community dialogue and share resources. She has conducted more than 50 interviews with suicide experts and survivors. Earlier this year, she was asked by the President of the American Association of Suicidology to create a similar site for their organization.
One of the gravest missteps those who work with youth can make, Cara Anna said, is writing off suicide attempts as mere cries for help.
“I just think it’s amazing that suicidal thinking, which can be so fatal, which can affect so many millions of us,” she said, “can be dismissed as something like, ‘whatever, they just want attention.’”
Teenagers, she said, are often shaken by stress, a lack of social support or, in some cases, abuse. The taboo nature of suicide, she added, may prevent young people who are experiencing ideation from talking to others about their feelings.
She would like to see more survivors speak out about their experiences. Their frankness could be a reassuring, positive influence on young people who have gone through, or thought about, suicide themselves.
“That can be a source of relief; that can be a source of confidence,” she concluded. “That can be a source of, perhaps, opening up and reaching out to resources that they might not have been before.”
James Swift is a Youth Today staff writer.