mental health

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When Teens Talk Of Suicide: What You Need To Know

By Gene Beresin, MD and Steve Schlozman, MD
Guest Contributors

Here’s the kind of call we get all too frequently:

“Doctor, my son said he just doesn’t care about living anymore. He’s been really upset for a while, and when his girlfriend broke things off, he just shut down.”

Needless to say, situations like this are terribly frightening for parents. Kids break up with girlfriends and boyfriends all the time; how, parents wonder, could it be so bad that life might not be worth living? How could anything be so awful?

For clinicians like us who work with kids, these moments are at once common and anxiety-provoking. We know that teenagers suffer all sorts of challenges as they navigate the murky waters of growing up. We also know that rarely do these kids take their own lives. Nevertheless, some of them do, and parents and providers alike must share the burden of the inexact science of determining where the greatest risks lie.

Suicide has been in the news lately with a flurry of new research and reports and, of course, the high profile death earlier this summer of Robin Williams.

But suicidal behavior among teenagers and kids in their early 20s is different and unique.

So let’s look at a couple of fictional — yet highly representative — scenarios.

depressed

Charlie, a 16-year-old high school junior was not acting like himself. In fact, those were his parents’ very words. Previously a great student and popular kid, Charlie gradually started behaving like a different person. He became more irritable, more isolated and seemed to stop caring about or even completing his homework. Then one morning, just before before school, he told his mother that he wished he were dead.

Myths: Common But Distorted 

There are countless other examples. Sometimes kids say something. Sometimes they post a frightening array of hopeless lyrics on Facebook. And most of the time — and this is important — kids don’t do anything to hurt themselves. Morbid lyrics and even suicidal sentiments are surprisingly common in adolescence. Still, this does not mean for a second that we take these warning signs lightly. In fact, there is a common myth that asking about suicide perpetuates suicide. There is not a shred of evidence in support of this concern, and in the studies that have been done, the opposite appears to be true. Kids are glad to be asked.

We have to ask. It’s really that simple. But, we ask with some very basic facts in mind. Suicidal thinking, and even serious contemplation of suicide, is, as we mentioned, very common among high school students. In the Center for Disease Control Youth Risk Behavior Surveillance Survey distributed every two years to about 14,000 high school kids in grades 9-12, students are queried about a range of high-risk behaviors, including suicide.

The Underlying Mood Disorder

In 2013, 17% of teens reported seriously considering suicide, and 8% made actual attempts. Each year in the United States, about 15 in 100,000 kids will die by suicide, making suicide the third leading cause of death in this age group. Additionally, we have no idea how many deaths by accidents (the leading cause of death) were, in fact, the product of latent or active suicide.

The greatest risk factors for a teenager to die by suicide include the presence of some mood disorder (most commonly depression), coupled with the use of drugs, or other substances, and previous attempts.

Although research suggests that girls attempt suicide more often, boys more often die from suicide. Add these risk factors together, and it turns out that Caucasian boys are at highest risk.

Some of this is also driven by a still immature brain. Impulsive behavior is notoriously common in teens, and in many cases, it looks as if the act of suicide was the result of a rash and sudden decision. Continue reading

Study: Bullying By Siblings May Double Risk Of Depression, Self-Harm

(Wikimedia Commons)

(Wikimedia Commons)

By Nicole Tay
CommonHealth intern

When I was growing up, I used to complain about the loneliness of being an only child. “I want an older brother like Mandy!” I would plead to my parents. I just wanted an older, cooler playmate; I never considered the potential downside.

Now, at 22, I’ve heard my share of horror stories; the sibling bullies who called my friends “butt face” or “stupid” or “brat;” the burnt Barbie dolls; the bag of caterpillars dumped on my poor friend’s head.

Is sibling bullying just a harmless rite of passage — or can it actually entail developmental repercussions?

A new study published today by the American Academy of Pediatrics targets that very question. After surveying more than 6,900 young people in the UK, researchers found that victims of frequent sibling bullying were twice as predisposed to depression, anxiety, and self-harm in young adulthood as non-bullied controls. This British-based study comes on the heels of similar findings in an American study last year. From the paper:

Of the 786 children who reported that they had been bullied by a sibling several times a week (55.3% female), depression was reported by 12.3% at age 18 years, self-harm occurred in 14.1%, and anxiety was reported by 16.0%.

And from the abstract: Continue reading

Even In Mass., Hundreds Of Young Central American Refugees Seek Care

"Flor" (Richard Knox for WBUR)

“Flor” (Richard Knox for WBUR)

By Richard Knox

CHELSEA, Mass. — The young Honduran woman appeared at the Chelsea HealthCare Center last February, fearing she was pregnant.

“Flor” — a pseudonym to protect family members back in Honduras — had paid a “coyote” $8,000 to escort her and her 3-year-old daughter to the U.S.-Mexican border. But when they got to the border town of Nuevo Laredo, the coyote sold her to a gang that held her in a tiny room with seven other women.

They raped her, then told her to pay $17,000 or they’d sell her daughter’s organs and force her into sex slavery.

Up in Massachusetts, her mother and father scrambled to borrow the money and wire it to Nuevo Laredo. Her kidnappers released Flor and the little girl; she doesn’t know what happened to the other women.

Flor and her daughter are among hundreds of Central American immigrants who’ve made their way to the blue-collar town of Chelsea, Mass., over the past year.

They represent a quiet influx that began months before the phenomenon hit the headlines and protests began flaring in communities from Cape Cod to California.

They come to Chelsea because many of them have family there. Sixty-two percent of the town’s 35,000 residents are Latino, and many are from Honduras, El Salvador and Guatemala.

As we sit in a conference room at the Chelsea health center, the sun backlights the thick dark hair that frames Flor’s broad face as she tells me how and why she made the 2,300-mile trek from the Honduran capital of Tegucigalpa.

“The decision I made, why I came here, was to give a better future to my daughter,” Flor says in Spanish, silent tears trickling down her cheeks. “In Honduras, it is very difficult. The gangs, they’re killing a lot of people. You have to give money month-to-month or they go to your house and they kill you.” Continue reading

P.S. To Jill Abramson: Grads, You Must Learn The Word ‘Fungible’

Jill Abramson, former executive editor of The New York Times, speaks at the commencement ceremony at Wake Forest University on Monday. (Neil Redmond/AP)

Jill Abramson, former executive editor of The New York Times, speaks at the commencement ceremony at Wake Forest University on Monday. (Neil Redmond/AP)

On Monday, ousted New York Times editor Jill Abramson began her post-firing public life by speaking at the Wake Forest University commencement, and shared her father’s buck-up maxim for when you’re dumped or disappointed: “Show what you’re made of.” Here, I add one other bit of advice: Learn the word “fungible.”

Dear soon-to-be-college grads:

I regret to inform you that at the last minute, we at the University of Hard Knocks have added one additional graduation requirement: You must learn the meaning of the word ‘fungible.’

But not to worry. We’ll help you out with the dictionary definition:

fun·gi·ble [fuhn-juh-buhl]: adjective.
(especially of goods) being of such nature or kind as to be freely exchangeable or replaceable, in whole or in part, for another of like nature or kind.

And here’s the deeper meaning: When you enter the working world, you will almost certainly be fungible. That is, no matter how hard you work, you will remain, at base, replaceable. Disposable.

This is not a cynical-making thing. It’s just a hard fact that it’s important to know as you plan your life and make decisions along the way. You might love your work as much as Jill Abramson loved hers, to the point that you wear your love not just on your sleeve but in a tattoo on your shoulder. But your work may not — cannot — love you back the same way.

The fact of her presence before a gigantic crowd said — indeed, shouted — ‘I am not ashamed. I soldier on.’

I use “work” here as a collective noun, and your working-world fate will likely rest in collective hands, just as Jill Abramson’s firing stemmed from rejection not only by the publisher but by the “masthead” — the newspaper equivalent of nobility. You’ll never know all the structural constraints and financial challenges and personal machinations that could converge into a pink slip for you. You just need to know, deep down, that it’s possible.

What to do with that knowledge?

First, you need to watch for the signs. Is your industry in trouble? Is your company hemorrhaging cash or known as a brutal shucker of staff? Have you noticed that you have no higher-level manager who seems invested in you, who has your back?

Second, live your life accordingly. There are some people for whom you are not fungible. Your parents. Your partner, if you’re lucky. Most of all, your children, if and when you have them. “The currency of love is time,” they say. Work can suck you in and make you forget that. But there are unpaid tasks that only you can perform. Continue reading

Know Your Mental Health Coverage Rights? Probably Not, Study Finds

Former Congressman Patrick Kennedy testifies at a Massachusetts hearing on mental health parity. (Courtesy of Scott Bryson)

Former Congressman Patrick Kennedy testifies at a Massachusetts hearing on mental health parity in 2013. (Courtesy of Scott Bryson)

No one could ever blame for you failing to grasp all the Byzantine ins and outs of your health insurance plan. But here’s a simple concept that everyone should know, and that most of us don’t: Under federal and state law, your health insurer must treat mental health on a par with physical health, covering care for mental illness and addiction no less than they cover physical care.

How do I know that most of us don’t know this? From a survey of more than 1,000 adults just released by the American Psychological Association (which, yes, may have a vested interest in spreading the word that therapy should often be covered.) It found that only 4 percent knew about the 2008 law that guarantees mental health coverage “parity” with physical health, no higher than in 2010. From the press release:

“More access to mental health care is the rallying cry, but the simple fact is many people may already have coverage and not know it or not understand how to use it,” said Katherine C. Nordal PhD, APA’s executive director for professional practice. “The mental health parity law, together with the Affordable Care Act, has expanded mental health treatment opportunities to many Americans in need who may otherwise have gone untreated. But laws don’t have the intended effect when people don’t know that they exist. Continue reading

Navigating The Senior Prom: Tips To Help Parents Cope

From left: Zack Beresin, Sophie Manning and Glennon Beresin (Zack's twin sister) before their senior prom (Courtesy of Gene Beresin)

From left: Zack Beresin, Sophie Manning and Glennon Beresin (Zack’s twin sister) before their senior prom (Courtesy of Gene Beresin)

By Drs. Steve Schlozman and Eugene Beresin
Guest contributors

The recent fatal stabbing of a 16-year-old girl in Connecticut have understandably cast a dark shadow over prom night.

Attacks like the one in Connecticut are rare, but these events receive massive attention and can thus obscure the more common tribulations characteristic of the spring dance.

In no way do we want to make light of the seriousness of recent events, but we also do not want to miss the opportunity to explore the more common hand-wringing of this yearly ritual.

So, consider the following scenario:

It’s late afternoon on the day of the prom. Your son ambles downstairs in his tuxedo, silently seeking approval. Your younger daughter giggles: “What’s that thing he’s wearing?” she asks.

“That’s a tuxedo,” you say.

“I know what that is, Daddy, but what’s that big black belt?”

“It’s a cummerbund,” you reply.

But you are wrong, according to your daughter’s analysis. “It’s morantic,” she says. “I think he looks morantic.”

That’s how she says romantic. It usually cracks up your son when she says this, but not today.

“No,” you respond. “You look very distinguished.”

He’s still not pleased. He’s 18, after all, and not ready to be distinguished.

And as his date arrives, you have this sinking recollection: they are preparing themselves for a night that can’t possibly live up to expectations.

Then you start to worry about the sharp turn that can separate the glamour of the dance itself from the potential debauchery of the post-prom festivities. No dress-up clothes then, no contrived formalities…just hanging out with friends and staying up all night, with possible cut-loose celebrations (read: sex) or unfettered over-indulgence (read: drugs).

For all those parents out there who are planning to launch their own kids into this great Western tradition, we would like to opine from our vantage points as child and adolescent psychiatrists, and as former prom attendees, and, for at least one of us, as someone who has seen four kids attend proms. Here are a few tips:

1. Don’t use the “S” word

When your daughter emerges in her prom dress, don’t fuss. Tell her that she looks great, or that she looks beautiful, but don’t say sexy. Continue reading

Mom’s Memo To Schools: Please, Make These Random Half-Days Stop

May I share with you the delights of my children’s April school schedule? They get out at 12:40 because of parent-teacher conferences on these days sprinkled through the month: Tues., April 1; Weds., April 9; Tues., April 29. Oh, yes, and just when you thought it was safe, one more on May 7. (Plus they’re off April 18-25 for spring vacation.)

That’s in addition to our new regular Friday early dismissals at 1:40. When we got word of that, one mother I know said to the superintendent, “You must really hate parents.”

I don’t think the administration hates us, but I do think that perhaps we haven’t spoken up loudly enough about the logistical stress these half-days create. And they’re common around the state, from year-round early-release Tuesdays in Newton to April half-Wednesdays in Westwood.

They’re an old tradition. Many of us remember the joys of occasional half days from our own school years. You know, back when our mothers were mostly housewives. Now, virtually all mothers work, and I venture to say that virtually all working parents wish that all our public schools provided universal, affordable after-school care.

(Photo: Rachel Zimmerman)

(Photo: Rachel Zimmerman)

Or at the very least, reliable after-school care on random half-days. At our school, a team of mothers has created a “half-day matinee,” gathering all the children who need looking after for a movie that runs until the normal 2:30 dismissal time. But their altruistic efforts are in danger of being overwhelmed by demand: More than 200 children have been coming to the movies this month, straining even their heroic volunteer powers.

“First-world problems,” you may say, and I’d agree but go a step further: This is specifically a first-world middle-class problem. Continue reading

Newton Deploys Relaxation Experts To Help De-Stress Community

Screen shot 2014-04-07 at 1.45.34 PM

As of today, the high-achieving suburb of Newton begins a new effort to combat stress in teens: helping their parents relax.

The town is hosting four seminars for parents to help them “relax and reboot” and learn some strategies to better take care of themselves and their stressed-out teenage kids.

In case you live in Newton and are thinking of attending, sorry. They’re already full. But the town is offering several related programs, including An Open Conversation on April 30 for parents to talk about “how we define success in a high achieving community and how that impacts the stress on our teens.”

National statistics suggest that teenage stress is at an all-time high, with kids apparently adopting adult-levels of stress, according to the latest American Psychological Association report on stress in America.

In Newton, the issue is particularly poignant because three Newton high school students took their own lives during the current school year.

But even before the suicides, Newton had decided to take a somewhat novel approach. It applied for and received a “mental health and well-being” grant — $30,000 over three years — to, in effect, allow students, parents and teachers to take a massive exhale and figure out ways, large and small, to take the edge off growing up.

One solution was to contract with the Benson Henry Institute of Mind-Body Medicine, based at Massachusetts General Hospital, and offer the stress-reduction sessions.

The town was already aware of its stress-related problems: Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

Mental Health Parity: If Not Now, When?

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, “ranging from depression to anxiety to sleep disturbance,” and in the midst of being evaluated for post-traumatic stress disorder.

If true, it’s a familiar story of a stressed-out soldier with mental health issues and easy access to guns: we’ve been here before.

Of course, we don’t know exactly what kind of care or treatment this shooter was receiving — and the VA system is generally better than others. Still, it’s worth reviewing the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

(ndanger/flickr)

The latest policy brief published in the journal Health Affairs, documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of “physical” medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still aren’t fully implemented today, despite widespread support, including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

…”Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders.

The supply and availability of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patients–more than twice the percentage who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with receiving mental health or substance use treatment. Eliminating the stigma and increasing the availability of high-quality providers are two keys to increasing access to care.

…Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, Continue reading