The reality of teen depression and suicide
By Carolyn Milazzo
In retrospect, she should have checked the bag.
Something just didn’t feel right when she and her 13-year-old daughter returned home from a last-minute trip to the local pharmacy for school supplies. And for a moment, the Shoreline mother thought about grabbing and checking the bag her daughter was holding.
But because they fought so much, she held back. And before long, the two retreated to their respective corners of the house: the mother to her computer, the daughter to her bedroom.
Several hours later, the mother stood in horror as she learned the contents of the bag: two bottles of sleeping pills, which her daughter ingested in an attempted suicide.
As the girl lay near unconsciousness, she told her mother she had taken more than three dozen pills because she believed she was a bad person and a terrible friend, and she wanted to die. The mother called Poison Control while her daughter vomited. The teen was then rushed to the Hospital of Saint Raphael, where she spent two weeks in Saint Raphael’s Children’s Psychiatric Emergency Services (CPES) unit.
Though a heart-wrenching experience, the mother credits the CPES staff with giving her daughter a new chance at life. Removed from the everyday stresses and strains that ultimately overwhelmed her, the girl focused on her feelings and what led to her suicide attempt.
Today, both she and her mother are in therapy, trying to rebuild their relationship and lives. But the mother admits it is a constant struggle, filled with good days and bad. Just when she thinks her daughter has turned a corner, she will say or do something to show she is still very depressed.
“At the time she tried suicide, our communication was broken down. We were sharing space, but we really weren’t sharing our lives,” says the mother, who spoke on condition of anonymity. “I think if you feel in your heart that there’s something not quite right with your child, you really have to pursue it. I didn’t pay enough attention to that advice. It’s a battle I chose not to fight. And I really regret it.”
Thinking back on the months leading up to the suicide attempt, the mother admits there were warning signs. The most blatant was the disparity between her daughter’s behavior at school and home. Though outgoing, sweet and animated on the phone with friends, the girl became withdrawn and angry as soon as she’d hang up.
Her mother dismissed the mood swings as typical teen behavior. Only after the suicide attempt did she learn her daughter had been planning it for months. “The biggest issue I would later learn was that she felt she was playing a role at school; that she felt she had to act like someone other than who she really was,” says the mother. “She was acting happy and well-adjusted, but that really wasn’t how she felt. And the pressure of keeping up this act became too great to handle.”
Thankfully, this teen now appears to be on the road to recovery. However, thousands of youths in the United States commit suicide each year. Thousands more silently battle depression out of fear, guilt or shame over the social stigma associated with mental illness, experts say.
Last year, 14 Connecticut teens committed suicide, compared to eight the previous year. Thirteen of the suicide victims were males and the majority were Caucasian. The fact that these increased deaths occurred amid increased public awareness about teen depression and suicide is particularly disturbing, say state and social services officials.
“It’s a startling increase,” says Faith Vos Winkel, an assistant child advocate for the State of Connecticut, who reviewed the suicides. “Many of the cases appeared to involve some type of bullying — a feeling of social isolation, and that’s something that needs to be explored. That might mean the state Department of Education looking at every Connecticut school’s bullying policy, to make sure the issue is being addressed.”
But Connecticut’s increase in teen suicide is also part of a devastating trend plaguing the nation. Suicide is the second leading cause of death among people 15 to 19 years old. Each year, about 5,000 American teens commit suicide and 500,000 more attempt it.
Firearms are the most common method. And research has shown that accessibility to guns in the home — particularly loaded ones — increase the risk.
Youths who commit suicide are also often over-achievers, impulsive, aggressive or loners, experts say. Longstanding emotional or social problems appear to increase a teen’s chance of attempting suicide. But typically an immediate crisis, especially if it involves embarrassment or humiliation, occurs before a suicide attempt.
“Teen-agers have limited insight. They don’t have the level of ability to think outside themselves, to put their problems in perspective or consider the long-term effects of their actions,” says Jennifer Fuoco, a licensed social worker and clinical coordinator for Saint Raphael’s child psychiatric unit. “And many parents don’t realize how much kids internalize problems — how they keep to themselves when they should be seeking help.”
Estimates on how many American adolescents suffer from depression vary from 3 to 10 percent. However, at any given time, between 2 to 10 percent of school-age children are thought to be depressed, and studies show that first-time depression is occurring in youths at earlier ages, says Daniel Koenigsberg, M.D., chairman of psychiatry at the Hospital of Saint Raphael.
Depression is more common in boys before the age of 10, but significantly more common in girls by age 16. Experts say a range of factors can contribute to depression in youths — everything from a family history of depression to the loss of a loved one or pressures over school performance, social interaction or sexual orientation.
Biological-based, or depression that recurs throughout a lifetime, often surfaces for the first time in adolescents.
Common symptoms of depression — irritability, anger, social withdrawal, and fatigue and low energy — are often dismissed by parents as typical teen behavior. Yet there is a definite distinction between normal teen moodiness and symptoms exhibited by depressed youths, says Koenigsberg, who’s board-certified in child, adolescent and adult psychiatry.
“If you look at the whole person, there should still be some semblance of functioning,” Koenigsberg says. “Are they doing well in school? Are they still going out with their friends? Do they have excessive psychosomatic concerns? Are they excessively irritable? These are things that should be explored.”
It’s also important to realize that teen depression is nothing new, he adds. In fact, many adults who suffer from depression say they first began showing symptoms as teens, but never said anything because no one knew to ask about it, Koenigsberg says.
One West Haven mother says she never realized her husband had suffered depression as a teen until their son began showing symptoms at age 13. The mother, who also had some depressed relatives, says she was eager to get her son into therapy, but dismayed by the lack of therapists who treat adolescents.
“You hear so much about teen depression that when you find out your child is depressed, you want to get help right away,” she says. “I had to call four or five therapists and was told they couldn’t see him for a month. In the meantime, you’re on pins and needles. Unless it’s an immediate crisis, getting an appointment is very difficult.”
Though depression has plagued teens for generations, the nation has been on heightened alert about its potential danger since the Columbine, Co., massacre on April 20, 1999, when two students went on a killing spree in their high school before committing suicide. Two months after the tragedy, U.S. Surgeon General David Satcher declared suicide a major public health threat. As part of his initiative, he urged school counselors, parents, youth group leaders, clergy and even hairdressers to be aware of the warning signs of depression and suicide.
Unlike many diseases, there is no medical test to pinpoint the cause of depression, or which youths are at risk of developing it. Some youths have a strong family history that makes them genetically vulnerable to depression, while others with no family history suffer depression in stressful environments, such as troubled families or poor performance in school.
An underactive thyroid, which controls many of the body’s metabolic functions, is to blame in roughly 3 to 5 percent of cases of depression, including teens. But Koenigsberg believes the vast majority of cases lie somewhere in the middle — some genetic predisposition to depression that manifests itself in the face of external pressures.
That appears to be the case with Kaitlin, a 15-year-old Connecticut teen who was hospitalized last June after threatening to commit suicide. Though her father, grandfather and aunt all suffered from depression, Kaitlin knew little about her family’s history until her own battle, which began when girls started putting her down in the middle of seventh grade.
By eighth grade, Kaitlin’s depression worsened, and she didn’t need others to put her down. She did it for them. She also became plagued by suicidal thoughts and secretly began cutting herself with kitchen knives — a daily routine that ultimately landed her in the hospital.
Though miserable on the inside, Kaitlin says she tried hard to conceal her depression from family and friends. She succeeded until friends finally told a teacher that she was discussing suicide.
Kaitlin says her hospitalization showed her how much she missed her family, and how her life was spinning out of control. On one of her last days in the hospital, she looked down at the scars lining her arms and thought, “I don’t want these here anymore. They’re embarrassing.”
That was the first time she ever felt shame over the scars, she says, and it caused her to become determined to beat her depression. Though her family and doctors credit antidepressant medication with her turnaround, she credits a higher power. “I really believe it was God,” she says. “I woke up that day feeling I could do anything.”
Though Kaitlin’s mother says deciding to hospitalize her daughter was the most difficult decision of her life, finding a hospital bed for her was nearly as trying. Once the decision was made, the family searched Connecticut for a facility to care for her. But all were filled to capacity. So like many youths, Kaitlin was forced to wait. Many depressed teens, in fact, spend days in hospital emergency rooms until beds become available.
Saint Raphael’s receives roughly 35 referral calls each week for beds and services. That’s more than 1,800 calls a year, each representing a child in need of psychiatric care. To help fill the critical need for hospital beds, Saint Raphael’s expanded its CPES unit in 2001 and again earlier this year. As part of the expansion, the hospital doubled the number of nurses on the unit, and assigned more social workers and physicians to treat mentally ill youths and counsel their families.
The unit provides round-the-clock psychiatric services for girls up to age 15 and boys up to 13. Saint Raphael’s is also the only hospital in the state treating children ages 2 to 5 — many of them suffering from post-traumatic stress triggered by abuse or neglect.
“We’ve really seen a major increase in adolescent admissions over the past three years,” says Susan Wingard, M.S.N., patient care manager of the CPES unit. “Many days, emergency rooms are looking for beds for kids, and Connecticut has a critical shortage. We’re seeing a lot of depression, a lot of post-traumatic stress in young children.”
Hospitals — and their emergency rooms — aren’t the only places feeling the crunch. More Connecticut youths than ever before are reaching out for help through crisis hotlines, says Mary Drexler, vice president of training and community outreach for the United Way of Connecticut.
Over the past year, there has been a marked increase in the number of Connecticut youths calling the United Way’s Infoline at 211 for suicide prevention. Not only are there more teens calling, but the age of the callers is younger than ever before. Many of the calls are youths expressing concern over relationships.
As a result, Drexler says the United Way is part of a committee of state and social services agencies formulating a statewide suicide prevention plan.
“There’s a lot being done in pockets in terms of suicide prevention, but no one state plan,” Drexler says. “We need to find out what’s going on, take a look at what we’re doing, and come up with a comprehensive plan. Perhaps one recommendation will be starting suicide prevention at the middle school level.”
Though the transition from child to adult has been filled with turmoil and rebellion for generations, experts say societal changes have contributed to the growing number of depressed teens.
Many of today’s depressed teens feel isolated because they grew up watching TV, on the computer or in structured sports and never learned how to express themselves or communicate with others, says Linda Zunda, director of the Elizabeth Ives School for Special Children in Hamden, which serves troubled teens.
Another factor, Zunda says, is the growing sense of not belonging or having a sense of purpose among today’s teens. Years ago, most children had chores or other responsibilities that helped the family function as a cohesive unit. For example, a 5-year-old child might be responsible for gathering eggs from the hen house so that working family members could have a hearty breakfast and meet their daily work expectations. As a result, the child perceived a sense of importance and in doing his or her part.
But today’s teens have far fewer opportunities to contribute to something greater than themselves in a meaningful way, she says. Families and neighborhoods are far more fractured than previous generations. Years ago, children belonged to intact families and extended families and lived in neighborhoods where everyone looked out for each other. Today, nearly 50 percent of children grow up in single-family households and many come home to empty houses. To compensate for the lack of family, many young people seek comfort in gangs and negative peer groups, doing anything to fit in, Zunda says.
Constant images of doom and gloom on TV and in newspapers and magazines also reinforce the feeling in some youths that the future is bleak and hopeless, Zunda says. Those images only worsened after the Sept. 11th terrorist attacks — a national tragedy that has left many adults depressed and anxious about the future.
To stem the tide, experts say it’s important for parents to recognize the symptoms of teen depression and take swift action, and to realize that depression is not a reflection of bad parenting. They also recommend providing an open forum for children to express their thoughts, feelings and concerns, saying such communication should begin well before the onset of adolescence.
“One way of minimizing this disaster is for parents to understand that growing from age 10 to 20 is a very complex and difficult time for their children and they have a right to have some time with this conflict,” says Rebecca Posner, a Middlesex County psychotherapist who specializes in child and adolescent depression. “When you’re a teen, you’re not an adult, but you’re not a child. It’s hard, but providing an open forum for children to express themselves in a non-judgmental way can go a long way in helping children through these years,” she says.
Kaitlin says she still suffers from depression. Though one of the most important things she and her family have learned is that there are no quick fixes for mental illness. She admits that some days are worse than others. But she is fighting hard to stay healthy — working daily to resist the harmful behavior that led to her hospitalization.
“I definitely didn’t want to go through any of this. But it’s made me a better person,” says Kaitlin, who one day hopes to be a therapist. “I’ve got to think it’s all going to work out in the end. I’m not going to give up. I’m going to stay strong, and one day it’s all going to pay off.”