Between 2009 and 2017,
The number of high schoolers who contemplated suicide reportedly increased by 25 percent. Deaths by suicide among teens increased by 33 percent in that time period as well. Suicide is now the second leading cause of death among teens after accidents (traffic, poisoning, drownings, etc).
According to the authors of a new paper in JAMA Psychiatry…..
Recently, “To our knowledge, no other intervention for suicidal adolescents has been associated with reduced mortality.” That line stopped me cold. There’s nothing that’s been scientifically proven to save lives when it comes to suicidal teens, except what they discovered in this paper?
The results, which were first published in 2009, were modest. There were small, temporary reductions in suicidal thoughts among the teens in the treatment group, who were more likely to stick to their follow-up therapy. “It wasn’t a big effect, but just somewhat more likely,”
Cheryl King, who’s been studying youth suicide prevention for the past 30 years at the University of Michigan
King explained that the paper revisits a clinical trial she and colleagues conducted more than a decade ago. In the trial, half of 448 teens who were admitted to a psychiatric hospital for suicidality were asked to select up to four adults in their lives to receive continuing education and suicide prevention. Simply put: The adults were getting education and support, so they could better support the teen.
King took advantage of a sabbatical, and she and her colleagues tried to see how many of their participants — those who received the treatment, and those who did not — died 11 to 14 years later.
There were 13 deaths among the control group participants (most died of drug overdoses — it’s unclear if they were intentional or not). But among those who elected adults to help them, there were just two. The most conservative interpretation of the data suggests a 50 percent reduction in death among the treatment group.
“If you can come up with a treatment where you had 50 percent less mortality with a treatment, that is actually huge, if that were to replicate,” King says.
King developed the intervention after working with a lot of suicidal teens, and observing that they weren’t getting enough support when they transitioned out of the hospital. When they’re inpatients at the hospital, they get 24/7 care. “And suddenly,” when they are discharged, “they are supposed to go back to school and wait for their first weekly appointment,” King says. That transition is really hard, and can bring them back to a dark place. “I developed this out of wanting to build a supportive bridge from them.”
It’s key, King says, that the intervention targeted the adults around the teens — the ones providing support. She had the teens nominate up to four so it wasn’t just their parents charged with looking out for them. The teen were encouraged to nominate other family members, educators, or people in the community. They just had to be people that the teens knew cared about them.
The adults were educated in how to talk to suicidal teens and how to make sure they’re adhering to treatment. After an in-person training, the adults got support over the phone for a few months to help them work through the challenges of helping a teen in trouble.
King suspects what makes the intervention effective is that the kids were the ones to nominate the adults. Perhaps that makes them think about the connections they have with others — and opens a door to strengthening them.
King doesn’t know what the secret ingredient is. “Things can cascade” for teens, she says. Small choices about education, drug use, living situations, and romantic partners begin to accrue and set the course for our lives. And it’s hard to say how exactly this intervention could tip the scales.
“suicide is relatively rare,” as Kathryn Gordon, a clinical psychologist and researcher who recently left her academic job for a private practice, tells me in an email. In 2017, the Centers for Disease Control and Prevention reported there were 2,877 deaths by suicide among those ages 13 through 19 across the whole country.
“Often intervention research will instead focus on suicide attempts and suicidal desire — useful outcomes, but not the most crucial ones to establish that an intervention saves lives,” Gordon says. And it’s just hard to study something that is rare.
Making things harder: Studies aren’t typically funded long enough for mortality data to accrue in a statistically meaningful way.
In 2017, the National Institutes of Health spent $37 million on research grants for suicide prevention. That’s trivial when you compare it to the $6.6 billion it spent on cancer research. Out of 295 disease research areas the NIH funds, in 2018, suicide prevention ranked 206. Research on West Nile virus — which kills around 137 a year — is ranked higher.