But it happens. Kids kill themselves.
Her research found rates rising dramatically among Black kids even as they fell among white ones.
We don’t know why but we can hypothesize, she says. It could be because Black children are more likely to be exposed to the kind of violence or trauma that can put them at increased risk of self-inflicted death. It could be caregivers’ reluctance to seek help from institutions that have historically betrayed their trust. But this is a field of research we don’t know enough about because the necessary resources have not been put in place to explore it.
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EVERYONE HAS A THEORY about what’s behind the rise in child and youth suicide broadly.
Madelyn Gould, an epidemiologist in psychiatry at Columbia University, tells me she worries about shifting norms—that kids see suicide as an option now when they didn’t before. Decades ago, “You might be depressed, you might have serious psychiatric problems, but people wouldn’t kill themselves. It happened, but it was still rare.”4
It’s easy to blame the media. It’s easy to blame social media. It’s easy to blame shows like 13 Reasons Why, a Netflix series chronicling a high schooler’s suicide (which I’ve never seen nor want to see) in which, as Gould says, “help-seeking wasn’t accessible but dying by suicide was very accessible.”
Norms matter. Her research shows that youth who think their peers have considered or attempted suicide are more likely to consider or attempt themselves.
Options matter. She has a problem with coverage that doesn’t emphasize—to kids and caregivers—that there’s help (whether help is actually available, as we’ve seen, obviously depends).
But the truth is, no one knows for sure what’s driving this increase across the board that’s especially pronounced among the youngest suicide victims, Arielle Sheftall points out.
“People will say a number of things—‘It’s social media, it’s this, it’s that’ and people want to grab on to these things and believe that they’re the culprits, but we don’t know. We don’t know. And I don’t want to say, ‘Yup, it’s all Facebook,’ because we don’t know that’s the case.”
One thing she wants to drive home, that she repeats a couple of times during our conversation, is the need to pay attention to kids’ disclosures of suicidal thoughts—no matter how jokey or flippant they seem. “Statements like, ‘Oh, I just want to die’ may come off as ‘funny,’ quote-unquote, but the kid might really mean that. And if we don’t address that, how can we get them the help they need?”
People are afraid to have those conversations with anyone, let alone a little kid. Shit, I’d be terrified of mentioning it. Arielle Sheftall says I shouldn’t be. Maybe I’d be more likely to do so, though, if I knew what to do if the answer was affirmative. Jane Pearson, the suicide-prevention expert with NIMH, has said primary care clinicians are more likely to ask if you’re suicidal if they know where to send you if you say yes, and I don’t doubt it’s the same, if not more so, for the layperson.5
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IT’S BAD FOR YOUTH, and it’s especially bad for some kids of colour, but suicidality seems to be worse for LGBTQ youth. Three in ten queer high-school students attested to having tried to kill themselves in the past year—more than quadruple the rate of straight students. One in ten made a suicide attempt so serious it needed medical attention.6 The Centers for Disease Control’s study makes no mention of trans youth, which is telling. We know trans young people are also at elevated risk of trying to kill themselves, and evidence suggests similar factors around rejection and discrimination are at play.7
It’s harder to know for sure whether gender and sexual minorities are more likely to die by suicide; that kind of data tends not to be collected at the medical examiner level, and studies involving individual-level psychological autopsies have been inconclusive. But the relationship between sexual orientation, gender identity and non-fatal suicidal behaviour is much clearer, and has been found in North America, Europe, Australasia and elsewhere.8
I called Ann Haas, a veteran suicidologist with the kind of deep voice you’d want narrating your documentary, to figure out how it’s possible that we know so little about the risk of suicide to a group of people we know to be at heightened risk of trying to kill themselves.
She and her colleagues at the American Foundation for Suicide Prevention designed a way to ascertain and record a person’s gender and sexual orientation in death reports, but the catch is you need to do it in every single death or your records are of little use. And uptake has been scant.
America remains squeamish about sex and gender to a damaging degree, she said.
Haas, who is lesbian, found herself drawn to the study of LGBTQ suicidality—especially among young people—because of what she saw in her own community.
“I just saw so many people struggling and it seemed like a different pattern—it just never quite seemed like it fit with what we knew about other groups. And the more I work with these populations the more convinced I am that there are some very unique factors that are driving suicidal behaviour. And at the same time, we know so little.”9
Among those factors is discrimination, and the way it erases your stability and your selfhood. LGBTQ people living in US states without protections against discrimination reported higher prevalences of mood, anxiety and substance disorders compared with straight people in those states or gay people in other states that boasted better protections.10 A similar trend was found in the wake of state bans on same-sex marriage following the 1996 Defense of Marriage Act—even in states that didn’t enact bans themselves but where homophobic rhetoric made itself felt.11
One study of lesbian, gay and bisexual-identifying individuals in New York City found that while white participants had higher rates of mood disorders, Black and Latino individuals had higher rates of suicide attempts. This could be because suicide attempts among queer people of colour are more related to external stressors than internal disorders;12 or it could be because we’re bad at recognizing mood disorders in people who aren’t white.
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WE’RE SCARED OF making kids crazy and we’re scared of giving kids crazy pills, and in 2004 when the US Food and Drug Administration mandated warning labels on antidepressants cautioning clinicians that they could make kids want to kill themselves, it reverberated. The fine print of the precipitating analysis,13 which found an almost doubled prevalence of suicidality among kids on antidepressants versus placebo, is worth noting: the trials included in the analysis weren’t designed to measure suicide risk; and they focused on ideation, not attempted or completed suicides.
The black box warning and the scary headlines it brought had a significant impact.14 In the years immediately following, antidepressant prescribing for kids and adolescents dropped sharply after having risen for several years, even as the number of self-poisonings with psychotropic drugs rose and other kinds of depression treatment stayed stagnant.15
It would be too simplistic to attribute the spike in youth suicides to black box warnings fifteen years ago. But if they played even a small role in making doctors reluctant to treat depression in youth, that’s damaging.16
There are some risk factors we know about, however.
Childhood trauma is one. A family history of mental illness is another. And there are ways depression manifests itself in children that make the adults in their lives more likely to miss it.
More so than adults, young people are responsive to their environments. It means the things happening to them and around them can help trigger a descent into mental illness. And it means mental illness may not manifest the way you think it does, which means it goes unnoticed or is confused with something else, Betsy Kennard, a researcher and director of Outpatient Psychological Services at UT Southwestern, informs me over the phone.
“You could have a depressed kid and put him in the computer lab and he enjoys the computer game so he mi
ght not look, to the teacher, as depressed because he’s smiling and interacting. Or you have a kid who is maybe irritable and oppositional and your tendency is not to see that kid as depressed: you see them as maybe being willful and uncooperative and maybe spoiled.”17
“Whereas depressed adults tend to have a flat affect—they will be sad in every different environment—children can show, you know, positive affect because they’re doing something they like and then they go back to their routine and they may look depressed.”
And many adults often have a hard time coming to grips with the possibility that their child is depressed—especially when this little person they provide for has an objectively easier childhood than they did themselves.
“Even though there’s been a lot of years of work on childhood depression, it’s still hard for people to really grasp that a child can be depressed….It’s hard to see in your child. It’s hard to know what to do.”
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THERE ARE PEOPLE about whom the hackneyed phrase “you’re stronger than you know” feels true. Maybe Marcella, raising daughters on her own on a Navajo reservation in Utah, knows it now. I hope the kickboxing helped.
MARCELLA AND BREANNA
By the time Marcella entered her daughter’s room, sixteen-year-old Breanna was mottled grey-blue.18
It wasn’t unusual for Breanna to stomp into her room in a sudden jarring rage and lock the door. It was weird, though, that there was no response when Breanna’s younger sister banged on the door and yelled, when their Australian shepherd, Jake, whined outside the bedroom, agitated and disconsolate.
“He kept scratching at her door, he kept trying to crawl underneath the door and he’s just whimpering and running up and down the hall and then finally he just lay down and didn’t move.”
It was probably around noon when they heard the big thud.
“And that’s when we go back—and we always go back; me and the girls keep going back to the minute we heard that thud. ‘We should have done this; we should have done that; why didn’t we do this,’ you know. And we go back to those woulda-coulda-shouldas.”
Marcella goes back to the moment she finally got fed up and barged into Breanna’s room, hours after the teen had shut herself inside. Breanna’s shift at McDonald’s started at three o’clock and it was unheard of for her, obsessively conscientious, to be late for work. “I actually was so mad. I was like, ‘What is wrong with you, kid?’ I ended up unscrewing the doorknob because for some reason I didn’t want to break the door down because I didn’t want to spend $70 on a new door. And that was so stupid for me to even think about that. I should have broken that door down. Seventy dollars would have been nothing. And I go back to that.
“I opened the door and that’s when I saw her. She was probably less than an inch off the floor; just a little bit more and she would have, she would have made it….‘You could have just wiggled just a little bit and you would have hit the floor.’”
Breanna had hanged herself from her closet by a belt her mother’d never seen before. “I was wondering, like, ‘Where did this belt come from?’…
“The first emotion I felt when I found her was anger. At her. I mean, because my mind hadn’t coped with the fact that she’s gone.” She took out her rage on the contents of her daughter’s room—everything in the closet, band posters on the wall. “What was the point of you putting up a poster? What was that whole point if you were going to do this?”
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FIVE YEARS AFTER her eldest child killed herself Marcella’s pain has begun to ebb but the image still materializes, unbidden. “Cutting her down was probably the hardest thing. It comes back and comes back.”
Everything Marcella didn’t see now throbs, obvious—childhood trauma, cataclysms of rage, punishing self-recrimination when Breanna couldn’t meet her own high standards. Breanna had been sexually assaulted when she was five years old. She started cutting herself at ten. “She would cover up with bracelets and I never saw them.”
It was easy for warning signs to fly under the radar. In Marcella’s family, dysfunction was the norm.
“It was a lot of domestic violence. And I think for Native Americans it’s really common to see that kind of a dysfunctional family. Not only that, but noticing the alcohol that’s also involved. To us, it was normal. I mean, when we were growing up. And then it’s kind of like it’s passed on from generation to generation.”
Marcella didn’t even think of it as a suicide attempt when as an adolescent she leapt from a moving car, or when, later, she overdosed on pills. “It didn’t seem to me like it was that bad, in a way.” And teenage Marcella “acted out.” “I would get in trouble a lot with the police, and [had] a juvenile record….I would always be going to court for dealing or looting or vandalism or something that, just, I can’t imagine my kids doing right now.”
Breanna’s birth when Marcella was fifteen years old saved her, she said. “That’s when reality and responsibility kicked in.”
A mother of two before she turned twenty, Marcella worked full-time to cover a $300-a-month apartment. She can’t imagine her own teenage daughters doing the same. “My little one, she’s sixteen right now and I can’t even fathom seeing her raising a little child at her age.”
Marcella’s partner abused her for years—“not just emotional: physical, mental, everything….It got pretty severe.” He never hit his children but they saw everything. Breanna, who’d always been close to her dad, felt especially conflicted. Finally, “I said, ‘No. I can’t do this anymore.’” But when he walked out he took most of their income with him. “He was the primary breadwinner. So there’s the mortgage, there’s the car payments, everything. We ended up losing everything….I ended up having to get two full-time jobs, and that’s when I gave [Breanna] the primary responsibility of taking care of her sisters, because I would go to work at six in the morning, get off at three thirty and go to my next job at three forty-five and get off at twelve midnight. So I never really saw my kids.”
When they moved three, four times in their Utah reservation within a couple of years, Breanna was there beside her mother at two in the morning, moving their furniture while her little sisters slept. “It was a huge burden on her growing up, because I depended on her. It was like, ‘Okay, Breanna, did you cook for your sisters? Breanna, did you pick up your sisters? Breanna, did you…?’ It was constant. At some point she probably felt like she didn’t have her own life….I might have given her a bit too much responsibility for her age.”
Through high school Breanna “was such a good kid”—good grades, no drugs, no booze. Long-term boyfriend. She relished the discipline of Junior Reserve Officers’ Training Corps, a pre-military program for youth. “She had a path…she knew exactly where she wanted to go. She wanted to go to the art institute. She was going to travel the world.”
It’s easy, now, for her mom to see that driving perfectionism as something more ominous. “She wouldn’t give herself any little bit of room to make mistakes….She always had to be perfect….She had so much that she wanted to do. And she piled all of that on herself.”
And then there was the anger—roiling, violent outbursts out of nowhere. She’d run at her sisters with a knife at the least provocation. “I would question her, like, ‘Are you okay? Are you depressed?’…She would brush it off.” The outbursts intensified in the last months and weeks of her life. A group of girls beat her up to the point her mom transferred her to another school. She had a wrenching argument with one of her best friends.
The summer morning of her death featured an escalating fight over the most seemingly minor things: Marcella, hungover from the night before, was slower to get up to register Breanna for school that fall. Breanna was anxious and angry at the prospect of spending her own hard-earned money for new tires on her car. “I think she just made herself even more upset just thinking about all of that. So we had an argument and she ended up slamming the door in my face”
so hard that picture frames toppled off the wall.
Breanna’s final text was to her boyfriend at around 11:50 a.m. “I’m doing it now.”
He didn’t freak out: she’d said that before. Marcella says he told her later: “‘I didn’t take her seriously because she didn’t do it the last couple of times.’ I never knew.”
In the immediate aftermath of Breanna’s suicide, “I don’t remember even being. I don’t even remember what time or the hours or the days were….I noticed that time would pass because the flowers were beginning to die.”
For the first time she found herself seeking psychological help for herself and her family. She barely knew where to start. Her younger girls went to a child-centred counselling group but found it alienating to be around kids talking about uncles’ or grandparents’ accidental or natural deaths when their hurt felt so much worse.
“We didn’t know how to cope. We didn’t know how to get back to normal….It’s a pain that is so indescribable. It’s like your body is trying to find a way to fix it and fix it and there’s no way that it’s ever going to be fixed.”
For a year Marcella was in the depths of depression. “I kind of had no motivation to work anymore. I couldn’t.” She used her employer’s family medical leave “because I felt I was not worthy to even work. I felt that I was not worthy of anything.”
Counselling for herself and her girls is more obtainable now than it was several years ago, she says. “Back then it was really hard to get it on your insurance. You had to go through several evaluations and you also had to get a referral in order for you to see a psychiatrist or any kind of mental health [practitioner]….We had to go through hoops and ladders in order for us to get to see anyone.”
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