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Imagine Me Gone

The mental health of children, adolescents and emerging adults

A new novel by Adam Haslett, “Imagine Me Gone,” paints “a powerful portrait of mental illness” against a backdrop of family history and dysfunction, according to an April 29 review in The Boston Globe. And that painting is a timely one.

Why? Because sandwiched between Mental Health Awareness Month (May) and Suicide Prevention Month (September) sits the peak period for self-destruction. Indeed, despite popular myths about seasonality of suicides, rates actually spike in late spring and early summer rather than during the holidays or in the depths of winter.

Thus, there is an urgency to prevention – especially with new statistics from the Centers for Disease Control and Prevention (CDC) revealing that suicides in the United States are at a near 30-year high. Embedded in those numbers is an alarming rise in deaths among girls ages 10 to 14, from 0.5 to 1.7 per 100,000 between 1999 and 2014.

Overall, for girls and boys, young men and young women, the epidemic of suicide cannot be overstated. In fact, according to the CDC, suicide is the third leading cause of death for those between the ages of 10 and 24, resulting in more than 4,600 lives lost each year. In addition, the Suicide Prevention Resource Center ranks suicide as a leading cause of death among college students.

Serious mental health issues often reveal themselves during adolescence and emerging adulthood. To wit, the National Alliance on Mental Illness says such conditions are common among teens and young adults, affecting 1 in 5, with half exhibiting signs by age 14 and three quarters by the age of 24.

Commenting on the CDC report in his Medscape article “While Rome Burns: Addressing Rising Suicide Rates,” Jeffrey A. Lieberman, M.D., says, “We know that 90% of individuals who take their life by suicide have pre-existing mental disorders and that major causes or antecedents are mood disorders, psychosis, posttraumatic stress disorder, or substance abuse. This is a problem that has long been known and has suffered from inadequate attention, stigma, and underfunding (both in terms of clinical care services as well as biomedical research). And this problem continues to worsen, as reflected by the shocking statistics, with continued inactivity on the part of government policies, legislation, and funding priorities.”

Significantly, Sally Curtin, a statistician with the CDC’s National Center for Health Statistics, which prepared the report, points out that “our youngest have some of the highest percent increases” of suicides, adding that there are a lot more attempts than deaths, which, by themselves, “are but the tip of the iceberg.”

Urgency indeed.

While causality remains speculative, various hypotheses cover familiar ground, including economic woes, divorce rates and lack of access to mental health care – which appears to be especially acute on college campuses. Some reports even link the heroin and opioid epidemic to increasing rates of suicide.

In addition, earlier puberty may also play a role for both sexes, though perhaps especially for girls as they tend to experience that seminal event in ways both different and less positive than boys do. Among girls, early puberty has been linked to depressive symptoms, other internalizing symptoms, eating disorders and delinquency, according to the National Institutes of Health.

Stress is likely another contributing factor. A 2013 survey released by the American Psychological Association (APA) revealed that teens are experiencing levels of stress on par with, and in some cases exceeding, that of adults. APA also noted youth reporting feeling overwhelmed, sad, depressed and tired. Also like adults, young people suffering from stress may experience unhealthy changes in behavior. These include having trouble sleeping, exercising less and skipping meals.

Of all the potential disorders, it is believed that anxiety-driven ones are most prevalent among children and adolescents, affecting an estimated 15-20% of this cohort. These include Agoraphobia, Generalized Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder, Separation Anxiety Disorder, Social Anxiety Disorder and Specific Phobia. Individuals with anxiety disorders are generally highly vigilant and often perceive new environments and experiences as threatening rather than as positive growth opportunities. If unable to avoid the “threats,” these young people may become overwhelmed, “catastrophizing” what others may see as low risk situations. Such anxiety can manifest in physical ways (such as headaches, stomachaches and shortness of breath) and emotional ones (such as excessive worrying).

Aggie Chamlin, 17, a high school junior in New York who experiences anxiety, amplifies such descriptors, telling me, “My mind isn't able to shut off and calm down and ask, ‘What's the worst thing that can happen right now?’ I can't accept life how it is and live in the moment. Instead I find that I'm always one step ahead of the game and trying to figure what’s next. This is a painful and debilitating way to live. When I am feeling anxious about something I have learned to ask myself, ‘What's the worst possible outcome of this situation?’ This question usually calms me down because the answer is pretty simple. My anxiety often blinds me to what is right in front of me.”

Such self-soothing is good but not always enough. It is widely acknowledged in the mental health community that many young people who would benefit from professional health never seek it. Echoing that wellness conundrum, 17-year-old Chris Bell, also a junior and an editor at his high school newspaper in Massachusetts, told me, “I think mental illness is something that almost goes unnoticed. Too many people seem to be uncomfortable talking about it because it is a sensitive topic. Through the paper, I am hoping to open a discussion – or create a forum – for young people to talk about depression and other mental health issues. There are so many kids struggling who have a hard time opening up."

On that last point, NAMI advises, “For some, experiencing the first signs can be scary and confusing. Discussing what you are going through with others is an important first step to getting help. Speaking up … is a sign of strength. You will be amazed by the support you get simply by asking.”

Similarly, the CDC says, “It is just as important to take care of your mental health as it is your physical health. If you are angry, worried or sad, don't be afraid to talk about your feelings and reach out to a trusted friend or adult.” On the adult side of that proposition they go on to offer the following guidance.

Parents: Talk to your child's physician if you are concerned about the way he or she behaves with friends, at home or in school.

Health Care Professionals: Diagnose and treat children's mental disorders early. There are updated resources to aid you.

Teachers/School Administrators: Reach out to families and health care professionals if you are worried about the mental health of a student in your school.

Recognizing that for some, if not many, educators it is often difficult to distinguish between normative and non-normative behaviors, the American Psychiatric Association Foundation has developed a school-based initiative to help. Executive Director Paul Burke explains, “For more than 10 years the Typical or Troubled?® School Mental Health Education Program has been equipping teachers, coaches and other school personnel with the training and information to recognize warning signs of mental health problems and concrete guidance on addressing potential issues.”

The CDC also offers some guidance to older students, saying, “Going to college is an exciting time in a young person’s life,” and reflects on the opportunities they’ll have to learn new things, both in and out of class. Still, they acknowledge that the stressors of change can lead to unhealthy coping skills, such as substance use, and advise young people to maintain a healthy lifestyle (including diet and exercise) and manage stress (by getting enough sleep and making strong social connections, for example). Finally, if students are struggling, they are encouraged to talk with someone they trust (perhaps a friend or professor) or visit the college health center.

The bottom line? By serving as parts of an approachable, accessible support system, peers, parents and other caring, influential adults can help young people at risk … making it easier to imagine them here than to imagine them gone.