Search for tag: "suicide"

Interviewer: You've noticed some signs that your child is engaging in self-harm which can be scary and confusing as a parent. So what do you do?

Dr. Thomas Conover is a psychiatrist board-certified in both child and adolescent psychiatry and general pediatrics at Huntsman Mental Health Institute.

Find out how to identify if your child is engaging in self-harm, how you should respond, and resources for help and treatment. What is Self-harm?

Dr. Conover: Self-harm is any deliberate attempt or act to injure oneself. So the term is pretty straightforward, but self-harm includes, from a psychiatrist's standpoint, both non-suicidal self-injury, which is any self-harm that's inflicted without any intent to die and also suicide attempts. Suicide attempts are a form of self-harm, and the difference between the two as we define them is whether the person who's inflicting injury on themselves means to die by doing it.

Interviewer: When I hear self-harm, I tend to think of cutting. Is that the only type of self-harm, or are there other types?

Dr. Conover: Making cuts and scratches on oneself is the most common type of self-harm. We sometimes see teens do other forms such as burning themselves deliberately or hitting themselves, striking themselves with a fist, or headbanging. Those are other forms that are fairly frequently seen. There are numerous other less common acts, but cutting or scratching on oneself is definitely the one that we see most frequently in emergency rooms or psychiatric specialty care. Why do Teens Engage in Self-harm

Interviewer: What leads to that type of behavior?

Dr. Conover: We don't know the exact reasons why any individual might engage in self-harm. You know, for each teen, it may be different. Some of the reasons may be a distraction or relief from some other thought or emotion.

Sometimes it may be kind of the cliché or proverbial cry for help, you know, trying to express some emotion or demonstrate distress that is too difficult for the teen to articulate in words. Those are two of the most common reasons teens engage in self-harm behavior. How Do Parents Discover Their Children Are Engaging in Self-harm?

Interviewer: Have you experienced the teen talking about self-harm before engaging in it with any of your patients? You said that self-harm is a form of communication and could indicate to a parent that I want to have a conversation about something with you, I don't know how to do it, so I'm doing it this way. But could it happen in terms of words before behaviors?

Dr. Conover: It certainly can. It may often be expressed to someone other than the parent, a friend or acquaintance, somebody that the teen is communicating with over texts or social media. And that's often a way that parents discover that their teen is either thinking about or engaging in that behavior.

One warning sign and one piece of good advice for any parent of a teen is to monitor the teen's social media use and texts with some frequency because sometimes that's who they may try to talk about.

Now, if a teen is coming to a parent or other trusted adult and expressing thoughts that they may harm themself, I would say, while that's a concerning situation, it's certainly a situation where at least the teen feels trusting enough and supported enough to bring that up verbally before doing it or even after doing it. And in some sense, in that situation, the teen and their caregiver are a step ahead of where they might be if the self-harm thoughts or behavior are completely concealed. Recognizing Self-Harm

Interviewer: Is it generally pretty easy in your experience for parents to recognize if their teen is engaging in self-harm?

Dr. Conover: I don't think it is, but I think the barriers to recognizing it are complex. One of the main barriers is that no parent wants to think that their child is experiencing distress that would lead them to deliberately harm themselves or attempt suicide. And so a certain degree of conscious or unconscious denial is a huge barrier to recognition. So I think to anybody who is listening to a podcast like this, to anybody who wants to know more about teens' mental health, I think having awareness is a way to bring that barrier down. As much as a parent doesn't want to think that their child might be experiencing that distress, some awareness and a level of openness to the possibility brings that barrier down.

Supervision and support is another thing that brings that barrier down. When a parent pays attention to their teenage child, when a parent knows what they are doing, who they're hanging out with, who they're communicating with, when a parent inquires actively and openly with their teen in a way that lets the teen know that they're caring and concerned, those are also things that bring down the barrier and make it more likely that the teen might talk to the parent about such behaviors. How to Talk to Teens About Self-harm Concerns

Interviewer: I would imagine if somebody is listening to our conversation right now and they found it via an internet search, they probably should trust their instincts. Would you say that's a safe thing to say?

Dr. Conover: If the parent has suspicion or concern, they should not dismiss that. The most direct first step is to initiate a conversation. Initiating a conversation about self-harm needn't be accusatory. It shouldn't be because that's a sure-fire way to have a teen shut down in conversation for a parent to approach them and say, "Are you cutting yourself? You should never do that," implies a judgment or seems like you're interrogating.

A better opening line might move from the general to the specific: "You know, some teens might even think about hurting themselves or even hurting themselves on purpose when they're feeling upset or distressed. Have you ever thought of doing something like that?" You know you can hear the difference when you're saying, "Hey, this is not something that you alone might have thought of or done. This is not something that I'm expressing any judgment about. I'm just saying it's something that people might do, And I'm wondering if that's something you've ever thought about."

Asking about thoughts is a little bit of a softer entry too. Because the teen doesn't necessarily have to confess, "Oh, yeah, I did cut myself once." Maybe they're not ready to say that, but they might be ready to say, "Well, yeah, you know, I've known some people who have done that, or I've heard that people do that, or I've even thought about it myself." And then the conversation can proceed from there. It doesn't have to be accusatory or judgmental, and it shouldn't be, but is it going to be a difficult and crucial conversation? Absolutely. There's no way to make that kind of an inquiry easy.

Interviewer: You bring that up with your teen, you ask them if they've ever thought about it, but there are obvious signs that something, you know, is going on. Is that the point that you say, "Well, I couldn't help but notice that on your arm there are scratches or on your legs, there's bruises?"

Dr. Conover: Yeah. Being gentle in inquiry is important, but we don't have to take it to the point of absurdity, right. You know, if what the parent is concerned about is something concrete like, "I found a text where you said to your friend that you were thinking of hurting yourself, or when we were at the beach last Saturday, and you were wearing your shorts, I noticed that you had some cuts on your leg." I think that it's fair for a parent to start with the concrete thing that the parent observed. That's reasonable. Again, not being accusatory or judgmental, right? Not, "What on earth are those that I saw on your leg during our trip to the beach?"

Interviewer: Yeah. "What are you doing to yourself?"

Dr. Conover: "Who does something like that?" Exactly, right? But just saying, "I noticed this, or I found this, or when I was looking at your texts from last week, I saw something that concerned me." I think that mustering some calm and then inquiring with the child is perfectly appropriate. And I think that does point to signs that a parent may look for. You know, it is my experience that most often it isn't the case that the teen will come to a parent and simply say, "I'm thinking about this, or I'm engaged in this behavior." It would be nice if they did. It's a good sign about the parent and child's communication if a child can openly state that.

However, I often see parents discovering signs that this might be happening. Signs that one might look for include finding items that someone might use to harm themselves in a place where you wouldn't expect to find that thing, like a kitchen knife in a bedroom, or old-fashioned razor blades, you know, that you might use to peel paint or do things like that hidden somewhere in a child's room, pieces of glass or metal. Certainly, if any of those items look like they've been used because they have, you know, blood or something that looks like that on them.

So finding items that a youth might use to harm themselves, that's one very common sign that parents might first come upon. A very common way is through monitoring social media or texts. I think it's very important to note that monitoring social media and texts should be given and what I advise parents to do before they let kids use those technologies is to set down a very clear contract and expectation that they will be monitoring their activity because that's necessary and it also avoids the conflict that would arise if a parent was monitoring those things without having set that expectation. When Should a Parent Seek the Help of a Professional About Self-harm Concerns

Interviewer: When a parent recognizes these signs, and they have addressed them with their teen, and they've started out the way that you've recommended, being very non-accusatory, talking about the physical things that you're seeing as opposed to passing judgment and you get that conversation going, you had mentioned that sometimes self-harm is a way of communicating that there's something else going on. I love keeping that in mind. I think as you're having this conversation is ultimately the point then to get to what the actual problem is that's causing the symptom of self-harm or is that the time you would want to involve a professional, or where would you go from that point?

Dr. Conover: An older view in mental health was that deliberate self-harm or suicidal thoughts or acts were always secondary to some other problem or a symptom of another disorder, and that you would need to treat the disorder in order to treat the self-harm behavior or the suicidality. To an extent, that is true, but a more current and up-to-date view is that while self-harm and suicidal acts can be associated with another problem like depression, or trauma, or abuse being two of the most common, they do constitute a problem in and of themselves. I don't think that a parent is best served to then become the behavioral health provider or a detective, right? You know, to say, "I'm going to get to the bottom of this. I'm going to get to the bottom of this and find out what's ailing you and what's causing this problem you're having." That's not something a parent wants to pursue on their own.

I think the first step of asking your child, "Hey, what's going on? I noticed this, or I noticed that. I'm concerned about you." That is definitely the parent's job. The parent's next job is then to help their teen by seeking some additional help and support. Self-harm thoughts, self-harm behavior, those are always a concern and virtually always merit some further support, whether that be through seeking some crisis services, or counseling, seeking some outpatient therapy, getting some additional support from a medical provider like a primary care doctor or other practitioner who maybe already knows the family and the child as a first step are what I would advise if that first conversation happens, really, no matter how that conversation goes, because a parent can do the right thing and ask the question, but the teen may still respond with denial. And I don't think that I would be giving good advice if I said, "Okay, ask these questions and ask them in a non-judgmental way." And you think they might be hurting themselves and you ask, and they say, "No, mom, I'm not doing that." You can't really close the book on the conversation with just that negative reply if you've seen signs or have a strong suspicion.

Interviewer: So the purpose of this conversation is to really have a mutual acknowledgment that this thing is happening. That's the place that a parent wants to get to with their child, expressing concern them so then that they can have a conversation about what we're going to do about it, which is ultimately going to lead to going to a professional to assist at that point.

Dr. Conover: That would be the way that I would advise that things would go. Not all teens who deliberately harm themselves make suicide attempts, but there is a strong correlation between the two. So engaging in self-harm without an intent to die is a strong risk factor and has a strong correlation with eventually making a suicide attempt. And so taking it very seriously when there are signs of such behavior or when there is an admission or confirmation of such behavior is really important because ultimately, you know, we're not concerned about the long-term health implications of having a few cuts or scars on your arm or your leg. What we're concerned about is bigger issues of health and wellbeing and ultimately safety and preventing any very serious injury or death. Resources for Parents Concerned about Self-Harm

Interviewer: Do you have resources that could go beyond this conversation that could help a parent that finds themselves in the situation where they have to have this conversation?

Dr. Conover: Resources that a parent might reach out to would include primary care providers. I think that primary care providers are a great first resource for families for a number of reasons. Primary care providers such as a pediatrician or a family practitioner generally have an ongoing relationship with the teen and the family. And so any discussion or decisions that are made will have a lot of context, and that there's a higher likelihood that the teen and family will feel trusting and agreeable to any advice or interventions that a primary care provider can give. Also, unfortunately, we don't have enough mental health providers as far as specialty mental health providers like psychiatric providers and therapists, and so it may be easier and more accessible to start with primary care. At any point where self-harm thoughts or behavior, including suicidal thoughts or suicide attempts are a concern, a parent can always access the crisis services that are available.

Here locally in Salt Lake City and in the entire state of Utah, the Utah crisis line is one such resource and the Huntsman Mental Health Institute crisis line, which are actually staffed by the same, very skilled, highly-trained crisis-intervening staff.

A parent might question, "Oh, is this big enough of a problem for me to call the crisis line?" As a practitioner, I would always give the advice, don't second guess yourself on whether you think this is a crisis. You are not going to call the Utah crisis line with a question about your child's self-harm or potential suicidal behavior and be told, "Hey, this isn't a problem. Why did you call us?"

updated: March 1, 2022
originally published: July 9, 2021

Suicide is one of those topics no one wants to talk about, but something that needs to be discussed. This is our topic today on The Scope.

Recently, a longtime family friend's daughter, who my kids have grown up with since they were really little, whom we have known since before our 12 year old was even born, acted on an impulse and took her own life. This podcast is dedicated to her. Her parents know I'm doing this podcast in her honor. During her services, her parents spoke about how important it is to bring awareness to the reality of suicide in teens, to talk about it, to talk to your kids about how they can come to you if they're having thoughts of self-harm, that there might not always be the warning signs that people tell you to look for.

With teens, their brains are not yet fully developed in terms of executive function skills. So they often can't see that while things may be bad right now, there is hope. And often, in time, things will improve. This is true so much this year with the pandemic. Our teens are not able to do normal teenager things like school functions, dances, hanging out with friends, having their first boyfriend or girlfriend. They have been cut off from interactions outside their families. Teens can only see what is happening here and now. And in their minds, it feels like things will never be the same again.

Unfortunately, they're probably right. Things will most likely never go back to the way that they had been. However, there is hope, hope that we are better able to understand COVID and hope that we will be able to bring an end to the pandemic. Hope that within the next year, people can start returning to what we consider normal life.

Knowing someone who has completed suicide will rock you to your core. Sometimes there are signs like sadness, wanting to sleep more, or stay away from others more than teens normally do, grades falling and your teen not really caring about school. Sometimes there is a history of mental illness or self-harm, and it gets the better of them. And sometimes, a teen will struggle in silence. They will appear happy and social on the outside, but be suffering within, until one day that wave of suffering overpowers them, and they act on their immediate feelings with fatal results.

The more I have spoken to teens and parents of teens, the more the subject of negative thoughts seems to come up. More and more teens are having these thoughts. More and more teens are doing self-harm, like cutting or attempting overdoses. I have about a patient a week lately, where I am having this conversation with them. It's real, it's serious. Teens need to know that we are there for them and that they can come to us, that they have options for help. No, we can't make everything go back to the way it was. No, we can't take their feelings away from them. But we can help them work through their feelings, give them options that are safe, and help them to understand that they aren't alone.

We see you, we hear you. You are beautiful and special, and you are loved.

Dr. Gellner: Suicide is not a topic anyone wants to talk about, but the reality is more and more of our children are exposed to suicide. Many think about it and attempt it. I'm Dr. Cindy Gellner and today we will discuss suicide prevention for your child.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Suicide is very rare in young children, but it is the third most common cause of death in children from ages 10 to 19. Children are the most likely to consider suicide if they suffer from depression, anxiety disorders, bipolar disorder, or alcohol, or substance abuse.

Stressful events can put kids over the edge. They're more likely to kill themselves on impulse than adults are. Many commit suicide within a few weeks of getting into trouble at school, or with the police, breaking up with a girlfriend or boyfriend, or fighting with friends. Other significant risk factors for suicide include previous suicide attempts, a history of disruptive behavior, and little communication with parents, especially with parents who are divorced, or recently remarried.

Girls attempt suicide more often than boys do. But boys are much more likely to actually succeed in their attempts. Girls are more likely to attempt by overdosing on drugs or cutting themselves. Boys most often attempt by using guns, hanging, or jumping.

Firearms are the most common and fastest growing method of suicide for males and females of all ages in the United States. Having a gun in the house increases the chances that a young person in the home will commit suicide.

An upset child or teen may impulsively use a firearm. Using a gun increases the chances that a suicide attempt will be fatal. Other methods are more likely to allow time for second thoughts and getting medical help. This is why gun safety in the home is of utmost importance. Have the weapons and the ammunitions stored in locked containers separate from each other.

Signs that your child may be considering suicide include an overwhelming sad or empty mood, loss of interest or pleasure in activities that they once enjoyed, withdrawing from family and friends, significant change in appetite or weight, significant trouble sleeping or oversleeping, very much irritable or restless, losing energy, feeling completely worthless, or having inappropriate feelings of guilt, letting the quality of his or her school work go down, for example, if they were an A student, they're now making Fs, risky behaviors such as abusing drugs or alcohol, or driving too fast, talking or even just joking about suicide, or writing notes or poems about death, and giving away prized processions, or throwing away important belongings.

If you are concerned about your child's behavior, ask open-ended questions. If your child knows they can talk to you about their point of view, they'll be more likely to talk to you about important things. Get your child treatment if he or she has signs of depression, or problems with drug or alcohol use. If your child is especially grouchy, worried, withdrawn, or upset more than you would expect based on their age or social situation, get an evaluation as soon as possible by a health care provider and a mental health provider.

Ask your child if he or she is thinking about suicide. You will not cause your child to think about suicide by talking about it. What you are doing is showing that you care when you ask. If he or she talks about death or mentions about suicide, do not get mad or pass judgment, just get professional help. Reassure your child that you love him or her. And remind your child that no matter how awful their problem seem, they can be worked out and you are there and willing to help them.

Again, removed or lock up any lethal weapons such as guns in your home. Be sure to also keep locked up narcotics and other pills and poisons. Both medications and therapy are useful to treat depression in children and adolescents. The only drug approved for use in children with major depressive disorder is Prozac. And many parents are concerned about giving their child antidepressants. Talk with your pediatrician or mental health professional about this. Untreated depression can be fatal.

If your child is depressed, starting on a new antidepressant, or taking a different dose, be aware of any changes in behavior. Never take your child off an antidepressant medication suddenly without talking to your child's pediatrician. With some medications, you must taper off slowly to avoid significant side effects.

A type of therapy called Cognitive Behavior Therapy is wonderful to help children learn about depression, teach them specific skills for managing their physical symptoms, negative thoughts, and problem behaviors. If you think your child is suicidal, get help immediately. Talk with your child's pediatrician or mental health specialist. And in an emergency, call the National Suicide Hotline at 1-800-SUICIDE.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: Could altitude play a part in depression? If so, could something as simple as a dietary supplement fix the problem? Up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking with Dr. Perry Renshaw, professor of psychiatry at the University of Utah. He's currently seeking crowdfunding for a project on Experiment.com to improve depression caused by living at high altitude, a particularly worrisome problem here in Utah.

Dr. Renshaw, you're researching the effects of altitude on depression. What led you to make that connection in the first place?

Dr. Renshaw: Well, you know the risk of being too long winded . . . I and my wife moved here as part of the USTAR program in 2008. In conjunction with that move, we started working at the VA Research Center on Mental Health. The assigned focus of that center which is called a MIRECC is on suicide. Never having done suicide research before, I was casting about for a topic. So this remarkable map of the United States which showed that across all the different states in our country, it was really the Rocky Mountain states that had a much higher rate of suicide than other places, which led to the idea that maybe that had something to do with the altitude in the Rocky Mountain states.

Interviewer: Do we know that this suicide is due to depression and not something else like suicidal pressures or other factors?

Dr. Renshaw: Well suicide is a complex phenomenon. People chose to end their life for a variety of reasons. However, in general, diagnosis like depression are pretty strongly linked to suicide. If we just look at rates of depression in Utah, there are two unfortunately. We seem to lead the nation in terms of the prevalence and severity of depression affecting both adolescence and adults.

Interviewer: So how are you addressing this problem in your research?

Dr. Renshaw: The most important goal that we have for our research is not so much to find the problems and understand them, but to rather to use that understanding to come up with better treatments. Really it's not going to be practical for every depressed Utahan to move to the coast or to some place at sea level. That would be a rather drastic intervention. The goal is really to see if there are simple things we could do that would just help people to feel better.

Interviewer: You're doing some investigations in rats. Why is that important?

Dr. Renshaw: Our motivation in looking at animals is to give us a way to test potential new treatments because we can do that much more quickly and effectively and safely, at least as a starting point in animals before beginning clinical trials. Well the test we use in animals is with rats. We ask rats to go swimming, which seems sort of like a silly thing but it's been a test that's widely used in trying to figure out what's going to be a good anti-depressant both in terms of changing animal behavior and in terms of people who have depression.

What we see is being the real benefit of having an animal model is that it gave us clues as to what's changing in the brain. What we find is that particularly for the female animals, they don't swim as much as you go up in altitude. We don't actually take them up to Park City. We have a hypobaric chamber. It can simulate any altitude we want. Particularly for the female animals in this experiment, the higher up you go, the more and more depressed they look. It's really a straight line showing that whatever else is happening in animals that makes them behave as if they're depressed to altitude is really a critical factor.

Taking the example of creatine which is the same substance, a natural product used by weight lifters and high school football players to build strength. Well if we use it on our animal model, the male rats couldn't care less. It has really no effect on their behavior using our simple test of a swimming test, which is widely used to study the effects of potential treatments for depression.

The female rats, though, are sort of off the charts thinking that this is really a powerful anti-depressant.

Interviewer: What is creatine and how is it connected to this effect that you are talking about?

Dr. Renshaw: So creatine can be converted into phosphocreatine, which is the highest energy compound that exists in the body. It exist predominantly in skeletal muscle and in brain. It's sort of a battery for anything that you need to have a very rapid supply of energy. So it becomes very important and it's been studied a lot in athletes in terms of their athletic performance. But it's only the 5 or 10 years that scientists have turned their attention to the brain.

In the area of depression, if you have low levels of phosphocreatine in the brain, you're very unlikely to respond to any kind of anti-depressant treatment. So having a high enough energy level in the brain if you will is something that really facilitates a good response to treatment.

In Utah, what we see is a lot of treatment resistant depression in children and adolescents. So we started the trial of creatine in adolescent young ladies who've not had a good response to treatment. This is an on-going trial funded by the National Institute on Mental Health. What we're doing is just adding creatine to a standard anti-depressant treatment, and so far the results are very encouraging, very positive.

Interviewer: What you're observing, is that if you add creatine to the regimen in addition to taking these anti-depressant drugs then you do see some improvements?

Dr. Renshaw: That's right. The first seven young ladies we studied, just to test the idea with our local population. Six of the seven were suicidal at times. None of them were working. None of them were in school. By the end of eight weeks of treatment, the group as a whole, and in fact every single individual have lost about half of their depression symptoms. Four of them had gone back to work or to school, and the outcome was really very positive.

Side effects to the creatine were really very modest because were using doses that have been well established to be safe for children particularly. When we look at football players, it's been estimated that approximately 60% percent of American high school football players take creatine as a nutritional supplement to build strength.

Interviewer: Right. So this is something you can just get at your local health food store, right?

Dr. Renshaw: Absolutely. Although in general, you don't want to start anything that's going to affect how you feel or how you behave or how you think without checking with your doctor.

Interviewer: It's kind of striking to me that there are all these kind of fancy drugs around but you may be coming back to sort of natural supplements to help people with this problem. I mean, that's kind of good news in a way.

Dr. Renshaw: I think so. If you look at what drives the use of any particular treatment in medicine, it's often having a company that is marketing a product that they really want to sell. Natural products tend to be inexpensive and you can't make a lot of money selling them, which means that there's not necessary be a lot of research using this compounds. Frankly, that's been a challenge for us raising funds to do treatment studies that are sort of Rocky Mountain or Utah specific.

We think it's really important because if you're depressed, feeling better is really going to make you happy, your family happier. You're probably going to be better off economically as your work performance goes up. There's a lot to be gained by treating depression effectively.

If we look at the increase rate of depression in the state of Utah at 25%. We think that this is probably due to the altitude. The economic consequences of that for the state are something like $200 million, direct and indirect losses. So addressing this problem has a lot to gain not just for those people who are depressed, but for the state economy as a whole.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Scientist Health Radio.