Youth Suicide: An Invisible Public Health Crisis

Carolyn Frommer

Toni Ireland

Dr. Maura Rossman

Intern/Mentor Pd 6

May 15 2019
 Abstract

Suicide is a growing problem among today’s youth, especially high school aged children.

The culture of mental health in this country is full of anxiety and depression linked to constant

stimulus from constant electronic connections. Environmental factors such as cell phone usage,

hours of sleep in a day and socioeconomic factors also play a huge role in a student’s mental

health. This paper will detail research done on each of these environmental factors and their link

to suicide and mental health and the conclusions they came to. The paper will then detail a study

done in Centennial that addresses the stigma surrounding mental health and high school and the

willingness to utilize any resources provided. The study found a general negative culture of

mental health at Centennial and a lack of plausible resources for it’s students.
 Nationally, suicide is one of the leading causes of death in young people; the rates of

suicide and suicide attempts are only increasing. In the past few years, mental health has been

frequently talked about in the news and in the healthcare field, and great strides have been made

towards increased education and acceptance. Though this is important, suicide is still very

stigmatized. Because people don’t talk about suicide, we are not identifying individuals suffering

with suicidal thoughts effectively and many aren’t given the help they need. One in five children

will suffer from a mental health disorder and 80% of the children who need help won’t receive it

(Anderson and Cardoza). This isn’t just a national issue; it is a sad and serious concern that is

impacting the local community. For instance, in Howard County, 16% of high school students

have seriously considered suicide (Magill). Many studies have been conducted concerning

suicide and the various statistics and age groups that are more commonly affected, but the

following research concentrates on populations that are similar to Howard County. Howard

County is unique in its extremely high pressure in academic settings and the unique and diverse

population. This research can help identify individuals in our community who are at a greater

risk for suicide by a variety environmental factors, and provide resources to get them the help

they need. In high school students, irregular sleep patterns and a lack of sleep correlate with an

increase in suicide ideation, a lower socioeconomic status relates to higher suicide ideation rates

and increased cell phone usage correlates with higher suicide ideation rates.

An average adolescent needs 9 to 9.5 hours of sleep each night, but the average student

gets around 7. Before a test, that number seems to drop even more. The hours of sleep a person

get greatly affects their mood, immune system, cognitive functioning, risk taking behavior, and

mental health. As the hours of sleep decrease, the chance of suicide and suicide ideation rises.
“The insomnia-suicide link may be mediated by serotonergic mechanisms”(McCall). Serotonin

is a neurotransmitter greatly related to both sleep and mental disorders and studies link a lack of

sleep to the chance an individual will complete suicide. “One of the most replicable biological

findings in suicide is reduced CNS serotonergic (5-HT) function, as reflected by low levels of

serotonin main metabolite, 5-Hydroxyindoleacetic acid (5-HIAA), in the cerebrospinal fluid

(CSF) of suicide victims and perpetrators of violence upon others” (McCall). So as the amount

of sleep an individual receives goes down, so do the levels of serotonin; and low levels of

serotonin are common in suicide victims.

Insomnia is defined as an individual’s difficulty in falling asleep or staying asleep. There

are a variety of factors that can cause insomnia, but insomnia over a long period of time is linked

to mental health conditions. In terms of suicide, an individual who completed suicide is more

likely to have sleep disturbances leading up to their suicide. “Suicide completers had higher rates

of overall sleep disturbance, insomnia, and hypersomnia as compared with controls within both

the last week and the current affective episode” (Goldstein). Eveningness, a terms used to

describe an individual’s circadian rhythms and their peak alertness, is when an individual is most

awake at night which can be a sign of insomnia. “Eveningness...raises the likelihood of

experiencing nightmares, difficulty falling asleep, poor sleep quality, fewer hours spent asleep,

feeling worse in the morning, and has a well-established correlation with depression. The

eveningness chronotype even correlated with a higher degree of impulsivity and lethality of

suicide method in contrast to morning-type individuals” (McCall). Because society functions

during the daytime, individuals whose circadian rhythms are naturally geared to be more awake

at night are chronically lacking sleep and are thus more likely to commit suicide.
 The adolescent sleep cycle is irregular and choppy which leads to a lack of quality sleep

and increased suicide ideation. “Adolescent sleep is characterized by widespread sleep

restriction, irregular sleep schedules, daytime sleepiness, and elevated risk for sleep

disturbances” (Liu). Teenagers get, on average, two hours less than the recommended amount.

“Sleep loss or disturbances are likely to signal an increased risk of future suicidal action in

adolescents” (Liu).

Teenagers often have an increased state of stress due to a multitude of factors, and the

socioeconomic status of their family could be a huge stressors in someone's life. As a family’s

income level decreases, the change of suicide or suicide ideation rises. Lower socioeconomic

classes are more likely to have a single parent home and a more contentious relationship between

family members stemming from financial concerns which increases suicide ideation. “Poor

quality of the parent-child relationship, and maltreatment, are associated with an increased risk

of adolescent suicide and suicidal behavior” (Cash and Bridge). Another population that is

disproportionately affected by mental health are African Americans. Because that sector of the

population are also disproportionately in lower economic class, African American males have a

high chance of mental health disorders and “an increase in suicide among African American

males” (Cash and Bridge).

It is natural to compare yourself to others, but if an individual is of a lower economic

class and comparing themselves to others, that could lower self esteem and create increased

pressure to appear as financially stable as their peers. “Relative deprivation can also be measured

as a subjective state, as in the individual’s sense of whether he or she is better off or worse off

than other people (subjective social status). There is reason to think that subjective social status
might be important”(McLaughlin) If an individual views themselves as better off than their

peers, they are less likely to be diagnosed with a mental disorder. “Subjective social status, such

that adolescents who rated themselves as being 1 step higher on the ladder had 14% lower odds

of meeting criteria for a mental disorder” (McLaughlin).

Socioeconomic status can also trigger other stressors in an individual's life. If the

socioeconomic status of an individual is low, there is less access to healthcare and resources.

“Social factors such as poverty and income inequality are “fundamental causes” of mental

disorders because they limit access to important health-promoting resources” (McLaughlin).

Medicaid is a government sponsored program to provide healthcare to citizens who wouldn't

otherwise be able to afford it. “Significantly high HRs (suicide hazard risks) were observed for

Medicaid recipients, as well as those in the 1st, 2nd, and 4th deciles compared to 10th-decile

subjects” (Lee).

Wherever you go, cell phones are a constant sight. Because teenagers spend so much time

on their devices, cell phones have a huge effect on their mental health. Although cell phones

have some positive effects, as teenagers spend more time on their phones and on social media,

their chances of suicide or suicide ideation go up. Social media is a great way to stay connected

to friends and socialize, however, the fear of missing something when not online can cause an

addiction to social media. The photos are only of the good times in people’s lives and none of the

bad which can create self esteem issues. “SNS may be associated with depressive symptoms is

the fact that computer-mediated communication may lead to the altered (and often wrong)

impression of the physical and personality traits of other users” (Pantic). Studies show that “100

Facebook users at York University provided self-esteem and narcissistic personality self-reports.
The results indicated that individuals with lower self-esteem are more active online in terms of

having more self-promotional content on their SNS profiles” (Pantic).

Before cell phones, teenagers would spend the day with their friends, and then had a

chance to come home and recharge by themselves and with their family. Cell phones now give

teenagers constant access to their social lives and no chance to take a break. “My belief is that

today's technology never allows children to truly disengage from their social lives. When we

were kids we could hang out with our friends during the day and then at night, we'd have down

time with the family or we might go shoot hoops or play Legos away from friends, so we could

gain some kind of balance” (Vickroy). It is also shown that “teens who spend five or more hours

per day on their devices are 71 percent more likely to have one risk factor for suicide. And that's

regardless of the content consumed” (Garcia-Navarro).

As the hours of screen time go up, teenagers are talking online, but they are less likely to

spend time doing things that are important for a healthy balance. They may not be sleeping,

spending time with their family, etc. “In this research, the authors found that increased time spent

online is related to a decline in communication with family members, as well as the reduction of

the Internet user's social circle, which may further lead to increased feelings of depression and

loneliness” (Pantic). Cell phone usage increases an adolescent’s time awake; “teens who spend

more time on their phones are more likely than others to not be getting enough sleep” (Twenge).

To address this growing problem seen in both scientific literature and the Howard County

Community; the following research question was developed: In suburban communities, how do

high schoolers experience mental health and what resources do they know about to turn to? The

hypothesis to address this question is as follows: in high school students, mental health is not
talked about and generally negative and students have very few ideas about where to turn to for

help. Because this study is looking into information that is not quantifiable, this hypothesis is to

be tested through a set of interviews. To do this, five participants were selected from a variety of

grades. Unfortunately, due to the nature of the study I had to do convenience sampling because

only participants the researcher knew personally were selected. The questions were developed

before hand so that each participant was asked the same questions.

Interview #1 Interview #2 Interview #3 Interview #4 Interview #5

Question #1 Difficult to adapt No, he nor any Limited, hasn’t Poor, very Turbulent, good
to high school, of his close dealt with mental stressful and bad points
causes stress and friends have. He health struggles environment
the stress just understands and herself
continues all four sees mental
years. health as a
Competitive problem due to
environment. competition and
Learned how to stress
deal with it.

Question #2 Student services He’s heard about Counselors and Outside of Friends,
is a good hotlines teachers school, afraid of counselors
resource, one of stigma
her trusted
teachers, friends
to rant to

Question #3 Yes but a hotline Yes a hotline, She would rather Yes to private Yes to friends,
would also be but not a use online resources, No to no to others
helpful counselor in the resources community or
school school resources

Question #4 Some people Somewhat Teachers and Belittling, some Competition of

dismiss mental dismissive, it is students are very teachers care but, stress
health or do not encouraging but for the most part, measurement
 see it as a valid hard for people to the school stress is widely
excuse but there understand environment itself accepted and
are also is very stressful expected.
understanding
people. Overall,
good support
system

Question #5 Yes, the Yes he had a No, not that she Yes Yes
competitive friend, but he knows of, but
environment adds doesn’t talk about some friends
to that. it with friends. might be hiding
their struggles

​Figure 1.
Across the board, people mentioned Centennial as a stressful, competitive environment.

Three mentioned friends or themselves, two others were aware it existed but hadn’t personally

talked to friends about mental health. People mentioned student services as an option, but only

one would be comfortable actually going to talk to a counselor. The other four recognize the

stigma and would prefer to deal with it on their own or outside of school. A few people also

mentioned feeling more comfortable talking to an anonymous hotline or online source. Many

people also cited a trusted teacher or friend. Every single person mentions that people are often

dismissive or don’t see it as a real problem. One person mentioned how it seemed like it is a

competition at Centennial to see who is the most stressed. Finally, four of the five people know

people with a mental health struggle and the fifth admits to not knowing if some of her friends

did or not. This data answers the research question by assessing the general attitude and

resources available that five random participants have noticed in high school. In the hypothesis,

it was predicted that there was a generally negative environment. In the interviews, the

respondents all knew or had experiences mental health conditions in the past and talked about
how stressful and competitive Centennial was. The other part of the hypothesis predicted that

students wouldn’t know where to go for help. This held up as well, because although respondents

mentioned student services, many said they wouldn’t feel comfortable going there and would

need to be treated outside of school.

Suicide is the leading cause of death for teenagers ages 10-19 in Howard County.

(Howard County Health Department) Mental health and suicide often appear as an

insurmountable problem that will never improve or go away. This assumption is partly right,

mental health disorders will never go away, but communities can improve stigma and create a

supportive environment where treatment is always an option. What matters is the reaction and

resources that can be provided to those suffering with any kind of mental health challenge.

Unfortunately at Centennial, the data shows students either don’t know about or aren’t willing to

get help from the resources the school provides. Howard County isn’t the only county with this

problem so it is suspected that this resistance to resources is a common trend. This implies that as

much as we can provide more and more resources, these resources won’t be helpful if students

aren’t willing to put them to use. This data is very limited considering only five people

responded and those people could be biases, but it brings up important points in the mental

health care field. Suicide is a problem that can be solved through detection, education and

treatment. Often, the friends of an individual who has suicidal thoughts are the ones who should

notice something is wrong and start a conversation. There are two education and prevention

trainings; gatekeeper training (Burnette) and Signs of Suicide (SOS) prevention program

(American Journal of Public Health) that have proven odds of increasing the knowledge or

participants. Knowing the warning signs to look for, and knowing when to get help, is crucial to
decreasing suicide rates and saving lives. Cognitive-behavioral therapy is also a great treatment

and prevention option for individuals suffering from suicide ideation, or any mental disorder at

all. (Alavi) Suicide is not a problem that can be solved on a case by case basis, it takes a shift in

the culture of a community to improve the mental health of all of our children.
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 Appendices - Copy of Interview Questions

Interview Questions :

1. Please talk about your experience with mental health in high school.

2. What resources were available to you if you were looking for help with mental health?

3. Would you be comfortable going to one of those resources and if not, what resources

would you turn to?

4. Please talk about the attitude you observed towards mental health in high school from

teachers, administrators, or other students?

5. Have any of your friends dealt with a mental health issue that you know of? Please

expand on that.