Suicide Awareness and Prevention — Maximizing Children’s Safety

by Effective School Solutions

Literary scholars can debate about the layers of meaning associated with the opening lines of T.S. Eliot’s poem The Waste Land that refers to April as the “cruelest month”. Mental health professionals are certain, however, that contrary to popular belief, April along with May and June are indeed the cruelest months in that suicide rates are consistently highest at this time of year.

There are a variety of biological, psychological, and social theories but little hard evidence about what contributes to this annual pattern. Individuals with mood disorders, especially bipolar disorder, tend to experience a worsening of symptoms at this time of year. Increased light is thought to cause an uptick in manic symptoms that in turn can elevate risk by increasing agitation and the energy to commit suicide while at the same time impairing judgment. Spring allergies and associated inflammation may also increase risk as inflammatory processes affect the brain and are related to depression and other mood changes.

As we are reminded in Mr. Eliot’s poem, the experience of contrast can impact human happiness as well. As April arrives and nature springs to life, depressed individuals can observe the stark contrast between external signs of rebirth and the inner experience of despair, loss, and emptiness. Similarly, there is often the expectation of more social activities as the weather warms and light increases, and this may exacerbate feelings of loneliness and disappointment for individuals with poor social connections.

Interestingly, the link between spring suicidality and school-aged children may be clearer. By spring students have a good idea about how their school year will end up grade-wise, seniors are hearing about college acceptances and rejections, and activities like proms, performances, and team sports can bring both joy and agonizing disappointment. It is important to attend to the surge in students’ mental health needs all year-round of course, but special vigilance is called for during the last few months of the school year.

Children’s Mental Health Symptoms and Suicidality — The Scope of the Problem

According to a study published in the Jama Network by Lebrun-Harris, L. A. et al., between 2016 and 2019 there was a significant increase in children’s mental health conditions, including a 27% increase in anxiety and a 24% increase in depression. In addition, from 2019 to 2020 the authors found a 21% uptick in behavior or conduct problems and an 18% decrease in the number of school-aged children getting at least 60 minutes of daily physical activity. The pandemic, of course, has only exacerbated these trends.

While children’s mental health needs have been increasing, the study also found that there was no significant improvement in the delivery of mental health treatment over the past 5 years: only 80% of children who needed mental health care received any services and there was a 19% increase in the proportion of uninsured children. To make matters worse, over the same period researchers documented a steady decline in parent or caregiver well-being based on self-reports about mental/emotional health and the ability to manage parenting stress.

As for suicide statistics, the Centers for Disease Control and Prevention (CDC) reports that overall suicide rates increased by 30% between 2000 and 2018. Children and young adults account for 14% of all suicides, and while the rate for youth and young adults is lower than for other age groups, suicide is the 3rd leading cause of death for individuals who are 10–24 years old and the 2nd leading cause of death for those who are 10–14 years old. In 2019, 9% of high school students reported attempting suicide in the prior 12 months compared with 6.3% in 2009.

Since the start of the pandemic, the CDC has reported a 31% increase in emergency rooms visits for suspected suicide attempts among people ages 12 to 25. Emergency room visits have increased by 51.6% for teenage girls and by 3% for teenage boys. Despite the spike in suicidal thinking and emergency room visits for attempts, however, youth suicide rates have stayed consistent since pre-pandemic times.

There are numerous factors that might account for the large disparity in suicide attempts between girls and boys. Girls are socialized to engage in more help-seeking behavior and tend to rely more on social connections with friends, teachers, and schools for their mental health. In addition, girls face enormous pressure to look and behave a certain way and are more likely targets of social media judgment and criticism.

Understanding and Monitoring Risk Factors

Even the most vigilant parents and school professionals face many challenges when trying to monitor a child’s safety. Younger children typically do not have the language skills or maturity to articulate their emotions and impulses. Teens, as part of their individuation process, can be quite secretive and actively hide things from parents and other caring adults. That said, there are common risk factors to watch for:

A history of depression or other psychiatric conditions
Prior suicide attempts
Verbalizations of suicidality and/or a preoccupation with death
Expressions of hopelessness, feeling trapped, of being a burden to others
Mental health or developmental conditions and behaviors that increase impulsiveness and decrease judgment, such as ADHD and substance abuse
A family history of suicide
Having a friend or even being aware of a celebrity who committed suicide
Sudden mood changes, including an unexpected shift to an upbeat mood
Behavior changes, such as social withdrawal
Changes in appearance or hygiene practices
Recent deaths or other losses
A sudden drop in grades or academic engagement
An event or situation that represents a significant blow to self-esteem or a sense of belonging, or that involves public humiliation
A history of trauma, including bullying and sexual/physical/emotional abuse
Giving away possessions
LGBTQ and other gender non-conforming youth are at higher risk because of stigma, prejudice, discrimination, threats of violence, and other traumatic experiences
Minority youth are at higher risk due to the burdens of structural racism, intergenerational trauma, and chronic healthcare disparities
Accomplished, perfectionistic students can be at higher risk due to unrealistic and rigid standards and the fear of failure. These youngsters often excel at putting up a front and not letting on that anything is wrong. As noted by Gina Meyer, the mother of Stanford University soccer star Katie Meyer who took her own life on March 1st, “There is anxiety and there is stress to be perfect, to be the best, to be number one.”

How to Help

Needless to say, the last two years have been exhausting for teachers, parents, and students. Many are hanging on by a thread to make it to June and what will hopefully be a well-deserved summer break. That said, educators cannot let their guard down and there are some guidelines to consider as districts partner with and support the families of their students.

First and foremost, it is critical to challenge the myth that talking about suicide will plant the idea in the head of a student who previously had not thought about it. This is just not true. District leadership and mental health staff must proactively educate staff and parents that adults must be direct in asking children about whether they are having thoughts of suicide, and that the words “suicide” or “killing yourself” must be used, not euphemisms like “hurting” or “harming.” These are not the same thing. If adults repeatedly raise the hard topics — isolation, depression, fear, anxiety, hopelessness, suicide — children and teens, despite their protestations, will be relieved and know they have allies.

Other suggestions include:

Regularly circulate information to parents, teachers, and other district staff about warning signs and about groups that are particularly at risk (e.g., students with ADHD, trauma histories, depression, or substance abuse problems; gender non-conforming students; minority students). Even very young children can be in deep emotional pain and may want to die even though they do not understand the permanence of death.
Require professional development opportunities for teachers, coaches, counselors, etc. to help them build confidence and skill in talking to students about difficult topics in developmentally appropriate ways.
Circulate and post information about the school’s mental health services as well as community resources, including suicide hotlines and emergency department numbers.
Encourage parents to get professional help for students who are showing any of the warning signs of suicide.
Encourage parents and teachers to discuss the many forms of peer pressure and how to keep it in perspective. Negative peer pressure can cause students to engage in a variety of self-defeating behaviors such as cutting class, cheating, stealing, smoking, bullying, or using alcohol and drugs. Harnessing positive peer pressure, on the other hand, can help students thrive academically, accept school leadership roles, and meaningfully participate in their communities.
Ensure that school and community counselors work with at-risk students to develop a safety plan that includes the names and contact information for individuals to reach out to if they are feeling suicidal.
Offer a training workshop for parents about how to monitor their children’s online activity so that they can be aware of sites being frequented and whether there is any indication of online bullying.
Encourage staff and parents to ask students directly about the impact of break-ups, changes in social groups, failures of any kind, etc.
Validate and do not dismiss the feelings and reactions of students even as you offer other potential alternatives.
Boost opportunities for students to be outdoors and to engage in physical activity during the school day.
Encourage parents to stay consistent with administering their children’s medications, and to lock up medications, alcohol, and any weapons present in the house.
Use physical education classes to inform students about the brave revelations of mental health struggles by sports stars like Simone Biles, Naomi Osaka, and Michael Phelps.
Develop a sense of community about keeping children safe, adopting the “It takes a village” approach. There is nothing more dangerous than a teacher/counselor/parent and student dyad in which they are the only two people aware of and monitoring fluctuations in risk.
Studies show that one suicide can raise the risk of other suicides among children and teenagers who knew or identified with the person in the community. Develop a protocol to actively respond to such deaths on a school-wide basis.
An over-emphasis on grades or winning can put undue pressure on students; foster a school culture that puts academic and other achievements into proper perspective.

Looking Ahead

Armed with the knowledge gleaned from this challenging school year and with pandemic-related and other funding sources, many districts are already deep into planning mode for the 2022–23 school year. Addressing staff shortages and morale issues are high on this list of to-dos because staff who are demoralized and depleted will have a more difficult time being vigilant protectors of their students.

It is also important to consider how to build Tier 1 capacity within the district’s Multi-Tiered Systems of Support (MTSS) framework. Building or expanding universal screening activities can be a critical component of suicide prevention. Districts can take this opportunity to re-examine what screening tools and methods are used, and the timing and frequency of such screenings. Early spring may be an ideal time to conduct a universal screening, maximizing the chance that April will bring showers and May flowers instead of devastating loss and sadness.

References & Resources:

Suicide Awareness and Prevention — Maximizing Children’s Safety

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