Why To Exercise Today: It May Make Bullied Adolescents Feel Less Suicidal

How much better can exercise make you feel?

A new study suggests that the mood boost may be profound.

The nitty gritty of the study is that researchers at the University of Vermont report a 23 percent reduction in both suicidal thoughts and suicide attempts among bullied students who exercise four or more days a week. The analysis of national data from the Centers for Disease Control and Prevention showed that across the board, frequent exercise was associated with improved mood for adolescents, both bullied and not.

It’s important to note that the study shows an association only between exercise and improved mental health. Still, lead author Jeremy Sibold, an associate professor at the University of Vermont, and chairman of its Department of Rehabilitation and Movement Science, says this is an important first step. It…”shows a critical relationship between exercise and mental health in bullied adolescents,” he says. “These data do not prove that exercise will reduce sadness or suicidality, but certainly support more research in this area.”

(Nick Tonkin/Flickr)

(Nick Tonkin/Flickr)

The study, published online in the Journal of the American Academy of Child & Adolescent Psychiatry, concludes:

Physical activity is inversely related to sadness and suicidality in adolescents, highlighting the relationship between physical activity and mental health in children, and potentially implicating physical activity as a salient option in the response to bullying in schools.

An accompanying editorial, by Dr. Bradley D. Stein and Tamara Dubowitz of The Rand Corporation in Pittsburgh, says,

“…the evolving literature suggests that physical activity interventions appear to be potentially promising as preventive interventions for some children and adolescents at risk for developing mental health disorders and for augmenting more traditional interventions for children and adolescents being treated for depressive and anxiety disorders and attention deficit/hyperactivity disorder.

The “side effects” of such physical activity interventions are likely to be more positive for many children than those of many other therapeutic interventions and potentially less costly…”

I asked Sibold a few questions about the study. Here, via email, are his answers:

RZ: What’s the biggest surprise in the findings?

JS: We were not surprised really that exercise was associated with less sadness, etc., as exercise has been widely reported to have robust positive effects on a range of mental health markers.

However, our statistics were quite rigorous, and to see the positive associations extend to victims of bullying, including those who report suicidal behavior, was certainly a pleasant surprise and a first in the field we believe. It is also quite concerning that 25 percent of students overall report being bullied in the last year. This is a concern we cannot ignore in our schools. Continue reading

Is It Possible To Prevent Suicide? 2 Psychiatrists Map Out The Ways

By Gene Beresin and Steve Schlozman

Suicide is awful, more common than you’d think and, in many cases, highly preventable.

Perhaps most important, in virtually every culture and every ethnic group on the planet, suicide is highly stigmatized. It therefore makes sense for the international health community to designate a day when we stop to actively contemplate this potent cause of misery and death. That’s today: World Suicide Prevention Day, though the harsh facts surrounding suicide are so much bigger than a single day.

The statistics, from the International Association for Suicide Prevention, are staggering:

*There are an estimated 800,000 deaths every year throughout the world that are directly attributable to suicide.

*This number is probably under-reported, given the stigma associated with suicide, and the fact that deliberate, self-harming behavior is often misclassified as an accident. The teen that drives into a street lamp at 100 mph could very well be attempting suicide, and not be the victim of an automobile mishap.

*Suicide is the 15th leading cause of death on the planet.

*Suicide is more common among older people (70 years of age and up), but also occurs in middle-aged and younger individuals at alarming rates.

*Lower income nations endure more suicides, but suicide remains a major cause of death in developed nations as well.

*Suicide has been tied to numerous psychiatric illnesses (mostly mood disorders), to difficult economic or traumatic situations and environments, to substance use disorders (both with and without addiction), to the loss of loved ones, and to a lack of good follow-up care following suicide attempts.

*The number one predictor of death by suicide is a previous attempt.

2013 U.S. suicide rate by age group, via CDC

Why So Common?

In other words, we know a lot about suicide. So if we know so much, why does suicide remain so stubbornly common?

The answer to this question is actually much less concrete than we might think. Studies on post-suicide-attempt intervention are lacking and under-represented. Studies on pre-suicide-attempt intervention are also insufficient in generating a simple and generalizable prevention methodology. Moreover, the likelihood of creating a one-size-fits-all approach is minimal. This might be why we know less than we’d like to.

There are studies that show that email, phone and in-person communication following an attempt can make a positive difference, but these studies have relatively low numbers of participants and clearly need follow-up. We also have studies that show we can increase the understanding of suicide and its risk factors in high schools and colleges, but it isn’t clear whether this understanding leads to decreased suicide rates. We do know that treatment as usual — that is, telling someone to go to an appointment with a yet-to-be-met clinician following his or her discharge from an emergency room or hospital — falls short of other more personal interventions.

All of this points to a common flaw in the understanding of suicide.

Suicide isn’t a formal disease. We don’t treat suicide itself. We treat the causes of suicide.

Continue reading


Differing Views On Antidepressants During Pregnancy

The question of taking antidepressants during pregnancy is extremely intimate and complicated. Research studies evaluating the risks and benefits are mixed. There are documented harms, like an elevated risk of pre-term birth. But there are also the documented harms of untreated depression. In other words, it’s a deeply personal health decision that requires judgement based on a body of data that offers no easy answers.

The latest on this fraught debate comes from Andrew Solomon who wrote a long piece published in last Sunday’s New York Times Magazine, “The Secret Sadness,” with this basic message: “Pregnant women who are depressed often fear taking the medication they rely on. But not treating their depression can be just as dangerous.”

Solomon, whose own depression is well documented in his powerful book, “The Noonday Demon: An Atlas of Depression,” (The Times piece will be added as a new chapter in the book) begins the magazine article with an anecdote about Mary Guest, “a lively, accomplished 37-year-old woman” who “fell in love, became pregnant and married after a short courtship.”

Struggling with depression for much of her life, Mary took various antidepressant and anti-anxiety drugs, Solomon writes, but decided to discontinue the meds during pregnancy. But Mary’s mood and behavior “spiraled downward” so, “near the end of her fifth month of pregnancy, she finally, reluctantly, resumed taking an antidepressant,” he writes.

Then, at six-and-a-half months pregnant, and convinced that something was wrong with her fetus, Mary “went to the 16th floor of the building where her parents lived and jumped to her death.” Solomon quotes Mary’s mother saying: “We feel, rightly or wrongly, that if Mary had stayed on her medications, or even gone back on them sooner, it’s possible she would have survived.”

It’s an intense, moving story.

But Dr. Adam Urato, an assistant professor at Tufts University School of Medicine in Boston and a maternal-fetal medicine physician at Tufts Medical Center and MetroWest Medical Center in Framingham, says he’s got an important story to tell too: that antidepressants can also cause harm. Urato writes and lectures on this topic frequently, and says he feels that Solomon’s piece didn’t offer the complete picture. (Here’s Urato’s full rebuttal to Solomon’s article on the website Mad In America, published by journalist Robert Whitaker.

Solomon quotes Urato in the Times story (in fact, some of the quotes come from a post Urato wrote for CommonHealth). But Urato says his views weren’t fully reflected. Here, edited are a few of Urato’s points:

1. Anecdotes Have Limitations

No one wants a pregnant woman to kill herself. An article in which pregnant women stop their medications and kill themselves while others continue on their meds and have happy outcomes is sure to push readers in an obvious direction. However, such anecdotes are limited.

For example, the author could have told stories of women who stayed on their medications, weren’t counseled regarding the risks, and had severely impaired babies. Continue reading

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.


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

Falling Into The Postpartum Mood Disorder Abyss: A Personal Story

By Deb Wachenheim
Guest Contributor

Over the past two days, The New York Times published a series of articles about postpartum depression and other related mood disorders. The first article looked at the science and policy on this topic and highlights a few women’s stories.

Today’s article is about my sister, Cindy Wachenheim, who took her own life in March of 2013 after struggling for six months with postpartum mood disorders. I say mood disorders because it was not just depression (and the fact that there are other postpartum mood disorders in addition to postpartum depression was something about which I was previously completely unaware). She had extreme anxiety about, and obsession with, her baby’s health and she was depressed because she believed she caused him to have serious health problems. Also, according to what I have been told by experts, she may have been psychotic: she was so convinced that something was seriously wrong with her baby — despite doctors telling her otherwise — that she strapped him to her chest when she jumped out of her apartment window, believing, I can only assume, that this was what was best for him. Thank goodness, he survived and is thriving.

Beyond what is written in the article, I think it is important to give more detail and information on some resources and policy activities in Massachusetts, in the hope that this could possibly help others who are facing similar struggles. As is mentioned in the article, I reached out to Cindy’s son’s pediatrician after Cindy had gone to see her multiple times about her concerns.

Pediatricians are key to screening for postpartum mood disorders and making referrals for needed treatment. Most women see their OB a few weeks after giving birth and if everything seems okay at that point then they are sent on their way until the following year’s annual exam.

However, woman bring their infants to see the pediatrician many times over that first year. It is pediatricians who could notice if something seems to not be right with the mother. Continue reading

Study: Primary Care May Be Path To More Effective Suicide Prevention

The unanswerable question, “What If?” often dominates the talk when it comes to illness. What if the tumor had been caught earlier; what if the child’s ache taken more seriously? When it comes to suicide, the agonizing “What Ifs?” can run rampant.

Recently, following three suicide deaths by high school students in Newton, Mass. there has been much talk about what, if anything, might have been done to prevent these acts.

A new national study offers no easy answers — indeed, many people who die by suicide do so without any prior mental health diagnosis, researchers report. But this new research does suggest there may be opportunities — through primary care doctors, and other specialists, for instance — to more accurately identify people at risk for suicide, and perhaps intervene before it’s too late.

The new federally-funded study — based on a longitudinal review of more than 5,800 people who died by suicide from 2000 to 2010 — found that nearly all of these individuals (83 percent) saw a doctor or received some kind of health care in the year prior to their death, but half of those individuals did not have a mental health diagnosis. Moreover, researchers report: “Only 24% had a mental health diagnosis in the 4-week period prior to death.”

Also, strikingly, one in every five people who died by suicide “made a health care visit in the week before their death,” says the paper’s lead author Brian K. Ahmedani, Ph.D., assistant scientist in the Center for Health Policy and Health Services Research at Henry Ford Health System in Detroit, who speaks about the work in an accompanying video.

The study, published online in the Journal of General Internal Medicine, concludes that: “Greater efforts should be made to assess mental health and suicide risk. Most visits occur in primary care or medical specialty settings, and suicide prevention in these clinics would likely reach the largest number of individuals.”

Of course, that’s easier said than done. Anyone familiar with a typical primary care visit knows it can be, well, a bit rushed — not quite the perfect venue for dwelling on complicated emotional issues that may be difficult to articulate. Unless specific psychiatric symptoms are raised, they are often not part of routine care, says Massachusetts General Hospital psychiatrist Steven C. Schlozman, Continue reading

Newton Suicides: Is High-Achiever School Culture Breaking Our Kids?

Nearly 400 parents attended a community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Nearly 400 parents attended a community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Dr. Gonzalo Bacigalupe is the president of the American Family Therapy Academy and a professor in the Department of Counseling and School Psychology at the University of Massachusetts Boston. He’s also a Newton dad, and writes here about the need to address the toxic effects of high-stress school culture and its possible role in recent teen suicides.

In Newton there have been three suicides in less than four months among our high school kids. To us, it feels like an epidemic. In general, the response of the school system has been to provide grief counselors plus meetings to air the sadness and share what the school is doing or plans to do in the future. Experts talk about suicide and psychological problems; they tell us, parents, what we already know: support your kids and be mindful of their mood and behaviors. The message: this is either a mental health problem or a parental issue.

But the school system is not taking responsibility for the stress the kids feel day after day because of the tremendous pressure the Newton high school culture exerts to achieve academically, participate in multiple extracurricular activities, and/or play competitive sports — never just for fun, always to score the best.

Of course, some students put pressure on themselves, and some feel pressure from their parents and peers. But the school system must hold itself accountable for the pressure it puts on its students.

The official message accepts this situation as an individual or family problem, rather than part of a collective narrowness and craze about achievement.

“Who could ever imagine that we’d be back here again under similar circumstances?” asked Newton Public Schools Superintendent David Fleishman Tuesday night as he welcomed nearly 400 parents to another community forum on teen suicide.

In the fall of 2013, some of us did tell him that this could happen again if systemic measures were not taken. I personally wrote him a long letter and forwarded the message to the principal of Newton South High School. In response, I received a thank-you note in which promises were made about the school doing more to support our children.

So just what is the culture of Newton’s public high schools? Despite the communal expressions of grief, this past Monday, the day of the funeral of Roee Grutman, many of his classmates, friends and acquaintances (this is a small high school) did not participate in this important event because most of the school kept all academic activities unchanged, including, for example, mid-year exams.

Despite the message to teachers about allowing students to miss classes, some teachers conducted business as usual. Many students may not have felt free to stand their ground and attend the funeral. They were deprived of participating in a collective healing that cannot be replaced by a session with a school counselor or a mental health practitioner. I know this; I am a psychologist, a family therapist, a public health researcher and a specialist in trauma response. Continue reading

As Newton Grapples With Teen Suicides, A Quick Primer On Resilience

As Newton grapples with its third suicide by a teenager this school year, some of the discussion revolves around resilience. WBUR’s Martha Bebinger this week quoted Dr. Susan Swick, chief of child psychiatry at Newton Wellesley Hospital. She has been advising Newton schools and spoke to parents about how to build up their children’s resilience:

Nearly 400 parents attended Tuesday night's community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Nearly 400 parents attended Tuesday night’s community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

“This involves maintaining good social connections,” Swick said. “It’s about coping skills, it’s about self-care, it about getting good sleep, adequate exercise and nutrition. It’s about cultivating an ability to be flexible, to use humor, some creativity. There’s no one recipe for the things that you do, but it’s cultivating good behaviors that build resilience.”

And make sure, Swick added, that children have a network of adults who know them, talk to them and keep an eye on them.

For more on resilience and how to cultivate it, we turned to Drs. Gene Beresin and Steve Schlozman, child psychiatrists at Massachusetts General Hospital and its Clay Center for Young Healthy Minds.

By Dr. Gene Beresin and Dr. Steve Schlozman
Guest contributors

A 10 year-old deeply invested in hockey develops juvenile diabetes.

Three kids, 4, 7 and 15, are told by their parents that they are getting a divorce.

The parents of a 16-year-old find to their horror that their son has taken a fatal overdose.

An 85-year-old woman who is a survivor of Auschwitz finds that her grandson is being deployed to Afghanistan.

A 35 year-old single mom who left an abusive relationship with her husband finds out that her 15-year-old has been sexually assaulted at school.

A 16-year-old boy is suddenly dumped by his girlfriend of two years.

Sometimes life deals a bad hand. While some might object to the relative merits of these particular vignettes as lacking equally weighted misfortunes, our goal here is not to rank the relative intensity of lousy events. Our goal, instead, is to accentuate that life itself is fickle, that life ebbs and flows, and that the fortunes and misfortunes that come with being human are in fact part of the human condition.

They key question is not “why” this stuff happens, but how in the world do we manage ourselves when these things occur?

That’s why we have pop music as well as Dostoyevsky.

The fact is that we all have horrible things happen to us. Understandably, these horrible things can potentially overshadow the good. It’s not like the vignettes above are uncommon. They are also, maddeningly, mostly not anyone’s fault.

They just happen.

They key question, then, is not why this stuff happens, but how in the world do we manage ourselves when these things occur?

Do we crumble? Do we become depressed or hopeless? Or do we rally?

Perhaps most important – how do we rally?

These questions of course make us once again visit the concept of resilience. How do we understand this? Are we born resilient, or do we build our resilience as we might train for a marathon?

Although we have some answers to these questions, the jury is still out. We’ve only recently as a culture become nationally invested in understanding the phenomena of resilience. Continue reading

Third Teen Suicide In Newton: What Can You Say?

Newton South (Wikimedia Commons)

Newton South (Wikimedia Commons)

Tonight at the Newton South High School auditorium, school officials and mental health experts will try to offer some guidance on how to talk to children about suicide and how best to support kids and families reeling from the news of a third teen suicide in this community since the start of the school year.

Tonight’s gathering comes after reports that 17-year-old Roee Grutman, a popular Newton South junior, committed suicide earlier this month. (According to the state Executive Office of Public Safety & Security, Grutman’s death was a result of “asphyxia by hanging.”)

Grutman’s death follows two other suicides: Katherine Stack, a Newton South sophomore, took her own life in October, shortly after Karen Douglass, a Newton North senior, also committed suicide.

At a memorial service for Grutman last night, hundreds of classmates and family members gathered to remember the “bright, articulate, compassionate” young man, The Boston Globe reports:

“One after another, the speakers at Monday’s service told of a young man who lit up a room when he walked in, and despite his schedule busy with honors classes and sports, always had time for a friend.”

According to parents in the Newton South community, many children are still in shock (as are their parents and teachers) and struggling to comprehend the string of suicides in general, and in particular, the death of a boy who appeared to be so well-adjusted, socially connected and stable.

“I think the kids are beside themselves,” said Elizabeth Knoll, whose 17-year-old daughter, Anya Graubard, is also a Newton South junior and was friends with Roee. “My daughter was gray and pale and tightlipped for the last two days.” (Knoll says Anya gave her permission to be named here.)

Knoll said in Newton — where many kids have been classmates since the age of 4 — Grutman’s out-of-the-blue suicide is particularly excruciating. “No one among his family or friends…could see anything like this coming,” Knoll said. “It’s impossible to make any sense of it.” Continue reading

Memo: Death Of Second Newton Teen This Month

Update: 10/25/13:  Katherine Stack’s death was due to “asphyxia by hanging” according to Terrel Harris, a spokesman with the Executive Office of Public Safety & Security Commonwealth of Massachusetts. The state won’t comment further beyond the manner and means of her death, Harris said.

Update, 10/22/13: “The cause of death for Katherine Stack was determined to be suicide,” according to an email from Terrel Harris, a spokesman with the Executive Office of Public Safety & Security Commonwealth of Massachusetts.

It’s another horrible tragedy in Newton.

Newton South (Wikimedia Commons)

Newton South (Wikimedia Commons)

Authorities say the death of teenager Katherine Stack, a sophomore at Newton South High School, “is not suspicious and there is no foul play.” And while no one has uttered the word “suicide,” it’s no doubt on the minds of many students, parents and administrators today, following the death earlier this month of Newton North High School senior Karen Douglas. (Her death was described by her sister as a “suicide” on Reddit.)

Here’s a letter from Newton Superintendent of Schools David Fleishman to the community:

October 17, 2013

Dear Newton Community,

It is with great sadness that I am writing to inform you that Katherine Stack, a Newton South sophomore, died unexpectedly last night. Authorities have stated that the death is not suspicious and there is no foul play.

Our thoughts are with Katie’s family during this very difficult time. It is hard to imagine what they are going through right now.

The death of any young person is a terrible tragedy. This loss is compounded by the recent death of a Newton North student, Karen Douglas. Please know that we will have counselors available at our secondary schools, as we know that many of our students will have heard about this news through friends and social media. If you have any concerns about your child/children, please make contact with their guidance counselor and they will make sure to follow up. Processing two sudden deaths within a short time frame is very difficult to comprehend so we have provided some information below that you may find helpful.

Continue reading