In our practice, we have teens fill out a confidential questionnaire before we even walk into the exam room.
We start with questions that may not seem medical, such as, "What do you like the most about yourself?" and "What do you do for fun?" Then come more traditional issues about home life, school, alcohol and drug use, sexual identity and orientation.
Finally, teens are asked about emotions, including thoughts of self-harm and even suicide.
We know that 80 percent of deaths in teens are caused by accidents – risk-taking activities such as driving, especially.
But when a teen patient admits feeling depressed, having thoughts of suicide, or even struggling to come up with anything they like about themselves, my antenna goes up.
This is a medical emergency, a sign that my young patient is at high risk of hurting himself or herself, or someone else.
The warning signs emerge several times a week in our practice. Most often, the signs show up away from medical visits: social withdrawal; declining academic performance; increasing irritability; appetite and sleep changes. All fairly silent cries for help.
On Aug. 4, the U.S. Centers for Disease Control and Prevention released a stunning report that showed rates of suicide for girls in this age group doubled since 2007, and climbed nearly a third for boys, who already were at higher risk.
The story was all over the news. Then it wasn't, pushed aside by Hurricane Irma, then Hurricane Maria, now Las Vegas.
I've waited until now to write this, hoping to revive the conversation about teen suicide.
Major news happens all the time. But for the sake of the more than 2,000 American teens who lose their lives to suicide every year, we cannot let this story fade.
Young men are up to four times more likely than young women to die from suicide. Yet females are up to four times more likely to attempt suicide and much more likely to have suicidal thoughts.
Almost 90 percent of people who commit suicide have a diagnosable and potentially treatable mental illness. But for many reasons – stigma, poor access to care, and racial disparities among them – many times their care isn't adequately addressed.
Why are more teens suicidal? Among the possible risk factors are increased substance abuse with more lethal drugs such as opioids; more social isolation; even lingering effects on families from the recession of the late 2000s.
Teens are especially susceptible to these risks because even if they appear fully grown, their brains are still developing. The prefrontal cortex, the decision-making portion of the brain where emotions and peer pressure are paramount, is still being formed. When a vulnerable teen is faced with a break-up, a bully, an identity crisis, a slew of poor grades, suicide can become a permanent solution to a temporary problem.
A 2015 study in the journal Medical Care showed that most people who attempt suicide visit some kind of health-care provider in the weeks or months before the attempt. That's why it's so important for providers to always be on the alert.
Our constantly connected culture is likely another factor. In the age of "FOMO" (fear of missing out), social media, especially for girls, has become a gauge of popularity. An unkind text, an unflattering Instagram photo gone viral, being "unfriended" on Facebook – the provocations are endless.
Then there is 13 Reasons Why. This Netflix series about a teen getting revenge by committing suicide sparked massive media coverage, with some arguing that the show increased awareness, and others fearing it would trigger copycats.
A July 2017 article in JAMA Internal Medicine reported a 19 percent increase in online queries seeking suicide instruction after the release of the show. In the same issue, an editorial noted World Health Organization recommendations against showing suicide scenes in movies and TV shows, and for displaying hotline numbers with any show on the topic.
Philadelphia's crisis response line at 215-685-6440 is always available to help anyone in need, as is the nearest hospital emergency room. The National Suicide Prevention Line is 1-800–273-8255. Every parent, teen, and anyone who works with teens should know about and distribute the Crisis Text Line at crisistextline.org for free, 24/7 support.
In the meantime, I'll keep asking the teens I meet how they are, what they like about themselves, what they do for fun. I'll keep screening for signs of depression. I'll listen closely for the answers.
I've waited until now to write this to remind us all of the boys, girls — and adults, too — who need help and must not be forgotten with the next news event that threatens to distract us from this epidemic of depression and suicide.
We must find room in our minds and lives to do what is needed for those who are suffering from newly arrived crises, like Hurricane Maria, as well as the continuing and growing threat of suicide.