Expert’s Corner: Facing the facts on youth suicide

Feldman to speak at Be Mentally Well: Preventing Suicide—A Focus on Youth

By Sandra Gray

UMass Medical School Communications

September 27, 2013

feldman-barrySuicide is the third-leading cause of death among young people and the second-leading cause of death among college students. But youth suicide can be prevented.

“There are many points for intervention before things escalate to suicidal behavior,” said Barry Feldman, PhD. “Suicide prevention starts with education and awareness. By identifying at-risk youth early on and providing proper support and appropriate interventions, we can help save lives.”

Dr. Feldman (at right), assistant professor of psychiatry and director of Psychiatry Services in Public Safety at UMass Medical School, has devoted his career to helping individuals and institutions prevent suicide.

On Wednesday, Oct. 2, he and other suicide prevention experts will present “Preventing Suicide—A Focus on Youth” at UMMS. Free and open to the public, the program is the latest installment in the Department of Psychiatry’s Be Mentally Well community education series.

Speakers from UMMS and the Massachusetts Department of Education will provide key information for preventing suicide among youth, including a parent’s perspective on the importance of parental involvement with and advocacy for a child who has been suicidal.

In this Expert’s Corner, Feldman introduces some of the topics they will cover, and talks about UMMS collaborations to help prevent youth suicide in Massachusetts.

Q: What is the relationship between bullying and suicide?

A: There are misconceptions. Bullying is not at epidemic proportions, and research finds that bullying does not cause suicide—although it is a risk factor. The vast majority of youth who are bullied do not go on to die by suicide. Those youth who do kill themselves often have a constellation of risk factors other than bullying going on in their lives. Bullying can exacerbate instability and hopelessness in kids who are struggling with other stressors, increasing risk.

Q: What are other risk factors for youth suicide?

A: Pre-existing conditions that make an individual more vulnerable include a history of mental health problems, sexual orientation, family conflict and previous trauma. Current stressors that can exacerbate pre-existing conditions, which can increase vulnerability, include current circumstances in a child’s life, such as problems at school; troubled relationships with peers; or divorce or a death in the family.

Q: What makes youth different from adults who are at risk for suicide?

A: I like to use a behavioral definition of suicide to help people gain more of an understanding about suicidal behavior. From this perspective, suicide can be viewed as an attempt to solve a problem of intense psychic pain using impaired problem-solving skills. Like adults, when a young person is struggling with intense emotional pain, they want the pain to stop. Young people are typically very impulsive, which can lead to poor decision making. According to the U. S. Centers for Disease Control, brain development is not complete until age 24, with impulsivity one of the cognitive deficits in the young brain. Stressors such as problems at school or relationship breakups can seem catastrophic because youth’s coping and problem-solving skills to deal with conflicts in their lives are not fully developed.

Q: What is the difference between risk factors and warning signs—and what are warning signs that a young person might be headed toward suicide?

A: Using a traffic signal as an analogy can be a good method to conceptualize risk factors, warning signs and protective factors for suicide. Risk factors are like the yellow traffic light, which indicates we should use caution, slow down and pay attention. Warning signs are like the red light—when you see them, you need to stop and do something. Parents need to recognize the warning signs and seek treatment for their child. And, parents and educators are best equipped to recognize the transition from risk factors to warning signs because they know their children and students well. The mnemonic FACTS stands for the warning signs to look for (see more details below).

Q: What should parents and educators do when a child is displaying warning signs?

A: Immediate intervention is warranted. The key is to focus on developing protective factors which are buffers against suicide —the green light in the traffic light analogy. One of the most significant protective factors for young people is a caring relationship with an adult, who can be someone in their school or community, if not their household. Other protective factors are family connectedness and reduced access to firearms. Enhancing self-esteem and the ability to cope with adversity are skills that can be taught and learned.

Q: What are Massachusetts public schools doing to help prevent youth suicide?

A: Schools now have increased responsibilities for identifying at-risk students for both self-harm and violence toward others. There are many school districts across the commonwealth that are implementing comprehensive suicide prevention programs. Teachers and other school staff are being trained to identify students at risk and help them get the help they need.

Q: Is UMass Medical School doing anything to help prevent youth suicide?

A: UMMS is collaborating with the Massachusetts Department of Elementary and Secondary Education and the Department of Public Health’s Suicide Prevention Program to train school personnel to develop comprehensive suicide prevention programs that include intervention, prevention and postvention using evidence-based curricula such as Lifelines.

As participants in the Massachusetts Coalition for Suicide Prevention, we helped create regional coalitions. I’m now the co-chair of the Suicide Prevention Coalition of Central Massachusetts, which is youth-focused, to fill a void in the area for linkages to resources, assistance and support.

FACTS: Warning signs for youth suicide

  • Feelings of hopelessness, helplessness, increased anxiety, excessive worrying, emptiness and worthlessness;
  • Actions to access means of suicide, like stockpiling pills or seeking out weapons;
  • Changes in usual behavior and mood—which parents and educators are most likely to recognize;
  • Threats including verbal statements, such as “I wish I was dead” or artwork and writing depicting violence and death; and
  • Situations that may be potential triggers to move from suicidal ideation to enactment. Even being overwhelmed by normal life transitions for which they are ill-prepared, such as going to college, can tip the scales.

(SOURCE: Society for the Prevention of Teen Suicide and Lifelines)

Related links on UMassMedNow:

Be Mentally Well—Brain Development in Teenagers: Where Things Go Wrong
Be Mentally Well: Understanding the complex world of bullying
Collaboration announced to help prevent military suicide
Newsmaker: Programs hope to cut military suicide rate