A counterintuitive lesson learned this week comes as we celebrate Valentine’s Day on February 14th. We celebrate love! But too many of our students are feeling unloved. Across America, the suicide rate among youth aged 10 to 24 has climbed steadily over the past decade. It increased 56 percent from 2007 to 2017, passing the homicide death rate for this age group, according to a report issued in October 2019 by the CDC. In 2017, suicide claimed the lives of 6,700 individuals aged 10 to 24. The top three reasons for death in youth and adolescents now include accidents, suicide and homicides.
During my 50 years practicing medicine, I have collected suicide notes. That may be a strange quirk, but as a psychiatrist I am searching for causes, especially now with an alarming rise in youth suicide rates. In the 1970s, traditional letter-writing followed a general formula: opening/greeting, mood description, body, and closing. Current students who may write a note do not have the training to write a complete note. That is a commentary by itself for another column. Now the communication is more likely to be a tweet. My psychiatric analysis is aimed at gaining clues from the suicidal writer’s message, regardless of its form.
Another trend within a trend here in Upshur County is substance use, which has progressed in this drug epidemic now down to ages 10 to 14. We remain the absolute center of this perfect storm opioid epidemic. Across the USA, that age bracket of 10-14 mirrors the largest rate of increase in completed suicides. So sad.
Unrequited love remains a common topic in suicide notes, especially those written around the day our culture celebrates love—Valentine’s Day. And this suggests a possible explanation in the uptick in suicide by children. Menarche and the onset of puberty is happening earlier. Studies in the medical psychiatric literature show a higher rate of both depressive symptoms and antisocial behaviors in those who commit suicide. The psychological and physical autopsy shows the start of the adolescent storm with raging hormones to be a factor.
Ninety-five percent of individuals who die by suicide have a mental illness, typically a mood disorder. Based on common sense more than data, the Upshur County Schools Board of Education has countered the upward trend in mental illness and substance use disorders with more counseling, both by traditional education staff, as well as local health agencies, such as our school-based clinics by Community Care of West Virginia. We have contracts for services by Appalachian Health Center, United Summit Center, and other child and adolescent mental health agencies.
Hopelessness is often expressed in suicide notes. Once our identity in the Mountain State was synonymous with our family fortunes. Maybe that is true in a negative way today, now that 65 percent of our students live outside a traditional family unit consisting of a biological father and mother along with biological siblings. Also, tragically there is a higher risk of suicide in those students whose parents are in treatment for psychiatric illness.
Lesson learned through all this study of suicide notes, is that screening can save lives. We are on the front lines of having an opportunity to intervene and hopefully stop this trajectory. Our teachers are taking a Mental Health First Aid course that teaches how to help someone who is developing a mental health problem or experiencing a mental health crisis. (I took the class myself as a Board of Education member.) The training helps our dedicated staff identify, understand, and respond to signs of addictions and mental illnesses.
Most of the time, a suicide note is designed by the writer to be discovered. There is much ambivalence about giving up on life! Just by showing genuine interest, asking a person how he or she is doing—then listening—is often enough encouragement to prevent a suicide.