Teen suicide: the next epidemic?
Three teen suicides on the tracks in Palo Alto were declared a "cluster" by Caltrain on Monday. And just as Caltrain was holding its press conference, a San Mateo high school was shut down and surrounded by Sheriff's deputies in response to a 17-year old attempting a Columbine-style pipe-bomb attack. Meanwhile, for each dramatic incident that grabs our attention, there are multiple other teenage mental health tragedies that don't make it into the news.
Caltrain's frank declaration of a local suicide cluster is an exemplar of responsible government action. But combined with the near-tragedy in San Mateo, it triggers all sorts of alarms for me as a professional forecaster. I strongly suspect that these twin tragedies are a weak signal indicator of an emerging crisis. Teen suicides are moving from cluster to epidemic.
Statistics alone don't tell the whole story. Here in the Bay Area, rates for teen suicides and self-inflicted injuries between 1996 and 2007 have been flat, according to data from the California Department of Public Health. But "low number events" (as statisticians call this sort of data) can mislead if the sample size is too small. The Bay Area alone may be too small a region to reveal underlying trends in quantitatively meaningful ways.
Data at the National level is far more troubling. A study reported in the Journal of the American Medical Association in September 2008 concluded that a decade-long decline in US teen suicides ended with a sharp increase in 2004 that continued into 2005, the last year National data was available. Though the time sequence was short, the statistical shift was so significant that the authors concluded it is very likely the leading edge of a trend. The authors dryly listed contributing factors like drugs and alcohol, the Internet, untreated depression and suicide among US troops, and recommended conducting studies to identify the causes underlying teen suicides.
With suicide very much in the news, it is a safe bet that every parent with teenagers in their home is asking the same question. A recent suicide brushed the edge of my life and that of a particularly thoughtful friend who also is raising a young adult. Comparing notes about this trend led me to rethink my assumptions about the factors contributing to teen suicide. In the hope of fostering similar conversations, here is a speculative list of factors contributing to this epidemic in the making:
The Internet. We are in the midst of a personal media revolution that dwarfs the earlier mass media revolution of TV for sheer scope and impact. New social media like Facebook, MySpace and Twitter are an obvious concern, but are just local phenomena in a much larger shift. The volume and immediacy of information accessible to youth is unprecedented. Though our children are facile information surfers, I fear this bright information cloud has a darker lining than we are willing to admit.
Drugs. The evidence is anecdotal at best, but adolescent drug use seems to have gone from "lots to virtually all teens," as my friend puts it. And the variety of drugs is unrecognizable to anyone who was a teen in the 70s or 80s. Instead of pot, ecstasy and unaffordable cocaine, teens are tempted with a veritable pharmacopeia of drugs, not to mention marijuana potent enough to leave a 60s stoner unconscious.
Alcohol. Aggressive enforcement has caused teen alcohol abuse to plummet, but this comes with unanticipated consequences. Teens who might otherwise drink now experiment with more easily obtained drugs. Pills are more portable than a six pack, and more cool than booze.
Hookup culture. The parents of now-aging Boomers were horrified by free love, premarital sex and one-night stands; imagine what they would think of hookups and "friends with benefits." Sixties serial monogamy seems positively Victorian compared to this amorphous new polyamory, and the notion of a "date" as archaic as Colonial-era bundling. Nothing precludes hookup relationships from delivering emotional support and affection, but the vague uncertainty of this still-morphing social norm has to be a source of teenage anxiety.
Attention-deficit hyperactivity disorder (ADHD. The authors of the JAMA study fingered higher rates of untreated teen depression caused by antidepressant warnings as a possible cause of teen suicides. I am equally worried about the large number of teens who are medicated for ADHD with stimulants like Ritalin or Dexedrine. Mix these with alcohol or illicit drugs and the emotional impact is unpredictable.
Performance expectations. I lived in Japan for a portion of the 1980s and still vividly recall the stories of inseki-jisatsu - performance-driven suicide - by high school students. Teen suicide in Japan is epidemic today, and performance pressures on US teens has grown to near-Japanese levels. Is it a coincidence that the three train suicides all occurred in Palo Alto, the hypercompetitive epicenter of Silicon Valley?
I am particularly alarmed by stories of teen Internet business successes driving students to conclude that they must match their 4.0 GPAs with entrepreneurial wins before they graduate. A high school senior who recently sought my advice deferred his entry to college for a year because he felt he would destroy his reputation if he didn't turn his breathtakingly ambitious Internet business plan into a successful startup in the next 12 months. Another anxious youth confessed to me that he felt like a failure because he was "nearly 25 and still hadn't established his brand yet." With social pressures like this who needs parents laying on guilt-trips?
The trauma of 9/11. We vastly underestimate the shock inflicted on American society --and youth in particular-- by 9/11 and its aftermath. Contrast the mood today with that on New Year's eve 1999. The Millenium's giddy optimism has been replaced by a climate of fear, distrust and grim determination.
Popular culture is awash in trauma themes in shows from "CSI" to "Generation Kill", and a new show, "Trauma", is being filmed in San Francisco as I write this. Dr. Ginger Rhodes, a San Francisco-based psychologist who specializes in working with trauma survivors, observes, "Knowing trauma the way I do, I am suspicious of how much attention has been paid to trauma in popular culture in the last eight years. My hunch is that kids are influenced by how adults are coping with serious stress issues." Like the rash of suicides among our returning veterans.
Other teen suicides. There isn't a teen since Romeo and Juliet who hasn't thought about suicide at one time or another, but thinking takes on a whole new level of risk when a teen knows of others who have actually taken their lives. Japan's experience suggests that suicide can be epidemic in the literal sense as the fact of one death can help inspire others.
I hope my forecaster's intuition is wrong and teen suicides do not become epidemic, but it is a risk that we must take seriously both individually and collectively as a society. Epidemics are most easily stopped before they start, and in this instance that means vigilance, and education to ensure that the youth in our lives understand suicide for the bleak and utterly devastating non-option that it is.
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