The American Academy of Pediatrics (AAP) issued Monday new recommendations to identify patients at risk of suicide, the second leading cause of death among teenagers. The academy is urging doctors to screen patients for suicidal thoughts, which can be influenced by family history of suicide, history of physical or sexual abuse, mood disorders or questioning sexual orientation, according to a report by CBS News. Bullying is considered a risk factor, as well as the use of drugs and alcohol.

Teen boys are twice less likely than girls to try to kill themselves, but they are three times more likely to successfully complete suicide, the report reads.

A teenage patient with depression talking with a physician. Image Credit: Shutterstock/Healio

Dr. Benjamin Shain wrote in the journal Pediatrics that about 1,750 teenagers between the ages of 15 and 19 committed suicide in 2013. Although that rate dropped 28 percent from 1990, Shain noted that the real number of suicide cases may be much higher due to the fact that authorities often rule them “accidental” when kids kill themselves.

Dr. Cora Breuner, a pediatrician at Seattle Children’s Hospital, said there is no doubt that those kids who have been bullied are more likely to think about hurting themselves or committing suicide, according to the report by CBS News. Dr. Breuner said pediatricians can early diagnose their patients if they kindly ask them about the risk factors “before they do something tragic to themselves”.

Experts say patients should be asked during routine checkups whether they have been bullied online or face to face, given that spending too much time on the internet is associated with depression and suicide. However, Shain addressed the use of online resources to seek help as the internet can also be a useful source of support at the most difficult times.

Shain, director of a child and adolescent and psychiatry at NorthShore University HealthSystem, told Fox News by email that doctors and families must be alert to the warning signs of suicide as social media is on the rise and the number of psychiatrists who treat mental health problems in teenagers is not sufficient. The doctor pointed out the importance of parents and doctors to recognize how complex life is for teens.

Crisis Text Line

Crisis Text Line reaches teens across the country that works 24/7 by answering texts from those who struggle with suicidal thoughts. There are 1500 volunteer counselors, including Tessa, who told CBS News that the teens sometimes just write something as simple as “I want to die”.

“It’s definitely hard for these kids when they don’t feel like they have anyone to turn to,” says Tessa.

The support hotline has exchanged 19 million messages over the last three years. Around 80 percent of their clients are younger than 25.

Recommendations to prevent suicide among teens

The AAP strongly advises pediatricians to educate themselves and their patients about the risks and benefits of using antidepressants, as well as to learn how to identify the needs of teens who are at risk or have tried to commit suicide. The report states that doctors should work hard to create and maintain working relationships with the families and colleagues in their patients’ communities in order to ensure an adequate communication that can allow continuity through the process of overcoming the situation.

The report authors also advise to seeking local, state and national resources in order to find support to prevent suicide in youths. Additional training should be considered in terms of early diagnose and treatment of teens who have mood disorders.

One question that should be addressed during routine evaluations is related to firearms that might be kept in the patients’ home, especially when treating youths at high risk of suicide. Parents should be advised to remove guns and ammunition from their place.

The role the internet plays on individuals at risk of suicide

The internet has a place for everyone. It can be used to seek help to overcome difficulties but it can also be used to do harm to other people. The AAP’s clinical report mentions four factors associated with suicide, particularly in vulnerable youths.

Pathological internet use is strongly associated with increased levels of depression and suicidal thoughts, especially when teenagers spend more than five daily hours playing video games and using the internet, according to the report. The second factor is about searches for topics related to suicide, which mostly lead young adults and adolescents to pro-suicide websites which promote suicidal behavior.

It is astonishing how much information about others’ suicides is available online. Online news sites lead with 44 percent, while social media sites contain 25 percent and online discussion forums provide 15 percent of such information. Video websites have 15 percent of those stories. Vulnerable individuals with access to information from others’ suicides do not appear to increase their suicidal thoughts maybe because exposing their negative idea is most likely to attract social support.

But taking part in online forums does represent a much greater risk of committing suicide. Discussions in such spaces tend to be anonymous and many times encourage susceptible youths to conduct suicide attempts.

The final factor mentioned by the APP in the report was the use of antidepressant medications and the risk of suicide. The U.S. Food and Drug Administration in late 2004 ruled that all pharmaceutical companies must label their antidepressant medications sold in the country with a black-box warning of higher rates of suicidality in children and teenager treated with these components.

The FDA did not prohibit the use of such medications, but it urged clinicians to closely monitor their patients “for clinical worsening, suicidality or unusual changes in behavior”, particularly during the first few months of treatment and following dose changes.

However, the latest evidence has shown that the risk of suicide is higher when vulnerable patients are not prescribed antidepressant medication. In fact, researchers say antidepressant prescribing is not linked to completed teen suicide. Still, the FDA has not changed the black-box warning rule despite the most recent findings.

Health experts wrote in the APP report that doctors prescribing antidepressant medications should discuss the warning with parents and carefully monitor emotional and behavioral status when changing treatment.

Source: AAP Publications