Teens who have attempted suicide are at high risk for a second attempt. But there are ways to help them.
by Peter Simek
It is common for children and adolescents to think about killing themselves. Around 15 to 18 percent of teenagers in high school admit to having had some thoughts about suicide. The growing problem facing parents, teachers, doctors, and other adults responsible for those children is preventing suicidal thoughts from escalating into an attempt on their lives.
This can be a difficult task. Suicide is the second leading cause of death in children, claiming more young lives each year than cancer, diabetes, asthma, or heart disease. According to a recent study by the American Academy of Pediatrics, the number of teenagers in the U.S. admitted to a hospital for attempted suicide or for suicidal thoughts has doubled in the last 10 years.
Meanwhile, the threat of suicide remains widely unrecognized. Many mental health practitioners lack clear strategies for dealing with suicidal teens, and around 30 percent of suicide attempts become repeat attempts.
At the University of Texas Southwestern Medical Center, Dr. Betsy Kennard is changing that.
The clinical psychologist and Professor of Psychiatry has seen these statistics reflected firsthand in the uptick in hospital visits related to teen suicide at Children’s Medical Center in Dallas, where she serves as Director of the Suicide Prevention and Resilience in Children (SPARC) program at Children’s Health. This intensive outpatient program for treating suicidal teens has shown positive results in reducing the rates of repeat suicide attempts. The program involves individualized cognitive behavioral therapy developed for suicide prevention that’s adaptive to group settings; an evidence-based treatment called dialectical behavior therapy, which emphasizes mindfulness, tolerance, emotion regulation, and interpersonal effectiveness; and a background of previously tested relapse-prevention work — all combined in most cases with a progressive medication program.
Her secret is treating suicide the way a doctor would treat any other illness: with science.
About 15% to 18% of teenagers in high school admit to having had some thoughts about suicide.
Depression often manifests in mood changes that persist over time. At-risk children often display thinking categorized by self-deprecation, self-loathing, worthlessness, feeling helpless, and feeling unloved. Kids get more irritable. There is a decline in school performance, perhaps a change of peer groups. Depression can also affect how children function.
“Depression is clearly an illness,” Kennard says — but it’s not always treated that way. Often it can go unnoticed or ignored, mistaken for a moody teenager phase; for many, the right resources aren’t available or affordable.
By the time children arrive in the emergency room, their struggle with depression has usually gone unchecked for too long, or treatments have been unsuccessful.
Their battles don’t end there. After a suicide attempt, children are often admitted to hospitals and taken out of their schools, away from family life, and away from friends — an ordeal that can increase many of the stress factors that cause depression. Kennard says as many as one-third of teenagers hospitalized may be readmitted after a second suicide attempt.
“One of the things that we find is that these children who are discharged from inpatient care are at very high risk for reattempt, especially within one month after hospitalization,” Kennard says.
She began to think of a better way to treat those patients, and to prevent them from ending up back in those hospital rooms.
In Kennard’s outpatient program, patients are treated with a science-based approach to clinical care.
“I think it is a mistake not to talk about depression and suicide.”
Kennard has worked at UT Southwestern with Dr. Graham Emslie, an eminent psychiatrist who pioneered groundbreaking research in the ’90s that proved the effectiveness of antidepressants in treating depression in children and adolescents. She collaborated with Emslie to develop a relapse prevention cognitive behavioral therapy that was found to reduce relapse rates in children who responded to medication therapy.
“We were able to demonstrate that not only could we reduce relapse rates in depressed children and adolescents, but we could have a longer period of time that they were well,” Kennard says. The results were published in two studies that appeared in The American Journal of Psychiatry and the Journal of the American Academy of Child & Adolescent Psychiatry, and led her to create a new program based on their findings.
That program includes “skills-based” therapy that teaches teens how to tolerate distress and strategies for emotional regulation. It seeks to identify the factors that led to a suicide attempt and then develop methods to help mitigate those particular risk factors. That includes addressing “unhelpful” thinking, encouraging problem-solving, and devising strategies for tolerating distress and improving mood.
Therapists also work with families to reduce conflict and increase family support and communication.
“I think it is a mistake not to talk about depression and suicide,” Kennard says. “A lot of parents will educate kids on the dangers of alcohol, premarital sex, substance abuse, and texting while driving. I think we may be less likely to talk about depression and suicide.”
Kennard has expanded her research with the help of a partnership between UT Southwestern and Metrocare, a Dallas County-administered public health agency, to pilot a skills group for suicidal teens in one Metrocare location. Kennard and Children’s Health recently received funding from the state to expand this program and put a suicide prevention program in every Metrocare clinic in Dallas that treats children and adolescents. She hopes to show that her program — and her results — can be replicated in a variety of clinical environments, and can be made available to children everywhere.