57. Teen SUICIDE peaks in October - What You can do to reduce risk

Did you know that teen suicide attempts PEAK in October?  In this episode, we share why October is so stressful for US teens, what YOU can do in your office to identify and help teens with suicidal thoughts.  FInally, we share THREE THINGS we wish everyone knew to reduce suicide risk in teens! 

00:00 Introduction and World Mental Health Day

01:07 The October Suicide Peak

02:20 Factors Contributing to October's Suicide Risk

04:39 Identifying At-Risk Groups

05:44 Strategies for Clinicians to Help

09:46 The Importance of Sleep

11:02 Building Positive Coping Skills

13:51 Nutritional Considerations

14:38 Conclusion and Final Thoughts

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Transcript

Dr. Elise Fallucco: 0:21

Welcome back to Child Mental Health for Pediatric clinicians, the podcast formerly known as Psyched for peds. I'm your host, Dr. Elise Fallucco, child psychiatrist, and mom. I'm recording this podcast in anticipation of October 10th, which is World Mental Health Day, and this is a great opportunity to increase awareness and discussion around mental health issues in children and teens. And the hope is by having these conversations and sharing this information, we can not only decrease stigma, but hopefully increase early recognition of kids and teens who are struggling and get them the help they need so that they can feel better. In today's episode, we're gonna be talking about an incredibly important public health issue in children and adolescents, suicide risk. Since we love to be practical on the podcast, I'm gonna share questions you can ask that can help identify which teens are at risk for suicide. And finally. I'm gonna share three things that I wish everybody knew that can help reduce risk for suicide in teens. Let's get started. Now, many of you already know that suicide is the third leading cause of death among us teens, but what you may not know is that October, this month is when we see the peak number of suicide attempts in the United States. Last year on the podcast, we talked about a beautiful study published in JAMA that showed major peaks in emergency department visits and in hospitalizations for suicide attempts among kids 10 years and older during the month of October. So you may be wondering, why October? Why would this be the peak months for suicide attempts? Well, the interesting answer comes from the fact that suicidality seems to show a significant trend in kids in adolescents that fluctuates based upon the school calendar. So those of us in clinical practice. Know that the summers tend to be relatively quiet for most of our kids, especially when we're thinking about suicide attempts but there are a couple times during the school year when kids are particularly at risk. October being the worst. And let's dig in just a little bit. Given the school calendar, why would October be the month of the perfect storm for suicide risk? Couple of thoughts. One has to do with academic pressure. So we all know that as school starts in August or September that the first couple weeks and even the first month or so, there's a lot of review period, and there's a lot of going over old material, and we might even call this a honeymoon but as we steep closer and closer to the month of October, kids are getting exposure to a lot more new academic material and are even beginning. To prepare for midterm exams by this second or third month of school, it's still possible for kids to be able to bring their grades up or to catch up or make up for any missed work or. Less than stellar performance in the first couple months as opposed to later in the semester when kids are preparing for finals and it feels like their grade at that point may already be a foregone conclusion. Okay, so one potential reason for increase in suicide attempts could be related to academic pressure. For those kids who are playing sports, October is often the time when our fall sports season is coming to a close and the teams are getting involved in playoffs or in district and regional championships, which of course are exciting, but also carry a great deal of pressure around that. So in other words, we're seeing a little bit of the perfect storm, where we've got a major increase in academic pressure at the same time as some extracurricular or sports related pressure. October also tends to be a period of increased social stress, where a lot of high schools have homecoming games and homecoming dances. Back when I worked in the St. Louis Children's Hospital, we would dread being on call in the emergency room during the weekends after some of our local high school homecomings because we very often saw a number of suicide attempts related to the stress of these events. There are plenty of other potential variables that could explain why October is a month, particularly elevated risk for suicide attempts You could it be a decrease in sunlight? Could it have to do with the fact that it's flu season and that all of the cytokines that are going around in people's bodies and the inflammation associated with various infections is contributing to low mood? Quite possibly, although this has not been systematically studied. Shifting gears from thinking about why is October a particularly high risk month? Now, let's talk about who should we be worried about, so who is particularly at risk? Honestly, anytime you think about suicidal thoughts and suicide attempts, there are very, very clear gender findings where girls are at much, much higher risk of having suicidal thoughts and attempting suicide than are boys. That being said, when boys attempt to end their life, they often use very lethal means, and so sadly, that's often more likely to result in a death by suicide. Children who are racial or ethnic minorities or who experience significant discrimination are also at increased risk for suicide. And likewise, the L-G-B-T-Q youth population is at increased risk for suicide, which is felt to be largely related to the stress from discrimination and often lack of support related to their sexual identity. Okay, so we've talked about why October is scary, which kids are particularly at risk for suicide during this time. But what we really need to know is what can we do about it? The first thing as clinicians that we can do is to normalize this. Any patient who you see in your office this month, or frankly this season, let them know that this tends to be a particularly stressful time of year. That it's normal to feel a lot of pressure and stress, and after you normalize it, it's a perfect opportunity to open the door and ask them, how are you doing with this? How are you? How have you been feeling? And most importantly, how are you managing stress? Because stress in in itself is not an awful thing. Stress is something we're experiencing all the time, and it really comes down to do we have the right support and resources to help us manage it? So after we normalize that, this is a stressful time, this opens the door to ask how have you been feeling and what helps you manage stress? Sometimes I like to use the analogy of a battery, especially because many of us are connected to smartphones that are constantly finding their battery trained, and so I'll talk to people and. I discuss the analogy of, you know, our energy is very similar to our cell phone battery. There are things that we do and there are people we're around in activities that can charge us up and give us lots of energy. And likewise, there are also things that drain our psychological battery. So what about you? Can you tell me about a couple of things that really energize you? And likewise, what would you say is the main thing or the couple main things that are stressing you out and bringing you down? and even just acknowledging that there is stress in life and that there's a lot going on can be therapeutic And by asking you're helping them think about what they can do to connect to some of the energizers in their life. Just these simple questions and having a very brief conversation during an office visit can be incredibly helpful because so few of us have time to stop and reflect, Of course, you know, I'm gonna talk about using screening tools for mental health and getting out your PHQ nine, or any sort of suicide risk screening tool that you use, and possibly the scared which helps to screen for anxiety, but in addition. To those patient report questionnaires. Just having this conversation can be incredibly helpful in the context of a brief office visit. Obviously the huge battery chargers for those teens who are struggling and who are particularly at risk, you know, could involve getting connected with cognitive behavioral therapy. And as a side note, one of the most common complaints that I hear from the. My pediatric colleagues is that it is really hard to get families connected to therapy either because of lack of access OR because families don't necessarily buy in. That they have this idea that this involves a major time commitment and they're not convinced that they have flexibility in their schedule to do that. And there seems to be a lot of uncertainty about how beneficial therapy can be, and so when you're having these conversations, particularly this time of year, this can be a great way to refresh the way that we talk about therapy to our patients. And one of my colleagues, Dr. Peggy Reco, the very esteemed pediatric psychologist, has a very brief description of the benefits of therapy that I've used that's really helpful for families. And what I typically say is. Having a therapist is a lot like having a specialized coach, someone who gets to know you personally and gives you particularly skills and exercises that'll help you address the stressors in your life. And these are skills you can learn now and they'll be helpful for the rest of your life. And I think when you phrase therapy that way, that's a much more compelling. Reason to motivate families. okay, so we've talked about battery drainers, battery chargers, and that as a final bonus I wanna share three protective factors for adolescent mental health. Number one, in our national data from the. Youth risk behavior surveillance study, which the CDC puts out every two years. Our most recent data shows that one of the most protective factors for adolescent mental health. And suicidality is drum roll, please sleep. Oh my goodness. Getting at least eight hours a night of sleep on a regular basis is perhaps the strongest protective factor and the thing that's most likely to help your child's overall mood and to reduce. Suicide risk. I know what you're thinking. If only that were so easy, if only teens weren't incredibly busy with school and academic pressure and all of these extracurricular activities. But knowing this, and especially having really recent national level data from us high school students. We can share this with parents and encourage them to really try to prioritize sleep, to have discussions with their teens about when they're going to bed, when screens and lights are turning off, and of course, making sure that there are no screens or technology in the bedroom that could interfere with sleep. One of the other highly important factors that can reduce a child's risk for suicide having a set of positive coping skills. The common thing that we see in many of the kids and teens who end up in the emergency room after suicide attempts is not even so much that they're experiencing. Excessive amounts of stress, but rather that when they feel completely overwhelmed by the stress, they don't have a large toolbox of things that they can do, people they can talk to, strategies that they can use to diffuse some of the stress and to help them feel better. And so in the absence of these positive coping skills, this is where we turn to pills or to other means. And just another brief pitch for therapy. Therapy is a fantastic place. To do some great brief time limited work with your teen to help them develop coping skills, but for those families who maybe don't have the time or the resources or whatever else that is needed to get them the privilege of engaging in evidence-based therapy. There are things you as a clinician can do in the office to help, just like the battery conversation. I would recommend asking them, wouldn't you feel overwhelmed or very stressed out? What helps you feel better and get them to name or list a few things. And also expect that some of these things may not be really healthy adaptive coping skills. You have to be imagining this conversation with a teenager in your office. Okay. So when you're not feeling well, what do you do to help you feel better? Well. I mean, I open Instagram or lock it or whichever social media thing, and I scroll or I look at this. Okay, I'm gonna try not to be judgmental. Let me ask you, does it work? How do you feel after you spend time there? Are you laughing at cat videos or do you find you're spiraling down into feeling worse? And just ask questions to encourage teenagers to self-reflect about how well are these coping strategies working? And this may be a good time to also bring a parent in or a family member to be part of this conversation so they can collectively brainstorm like. What helps you feel the happiest? Is it spending time with your friends? Is it journaling? Is it playing video games? What, what are the things that you find helpful and how can we come up with a much broader vocabulary or a larger toolkit, if you wanna use it that way, of strategies that are positive and adaptive to help you cope with stress. Okay, so we've talked about three things you can do to reduce risk. Number one is sleep. Number two is build your toolbox of positive coping skills, and then the third has to do with nutrition. Let's try to make sure that we're. Eating the rainbow, or at least that there's some color other than brown and beige on most of our plates. The bar can be really low in my house at times and in particular, consider checking a vitamin D level as that can affect mood and vitamin D. Insufficiency or deficiency is rather common in our teenagers. So you may need to supplement with vitamin D. And a very easy thing that you can tell families without even having to do any blood work is to consider taking fish oil capsules or fish oil gummies that have been shown in smaller studies of teens to help with mood instability. And the Omega-3 fatty acids are. Wonderful for your brain as a bonus. Okay? So thank you for your attention and for this public service announcement about World Mental Health Day. I hope that you took something helpful that you can share with your patients or with the children and teens in your life, and look forward to talking to you on the next episode of Child Mental Health for pediatric clinicians see you next time.