Dr. Kevin Most: Recognizing PTSD and Suicide Prevention
When we talk about PTSD, we may visualize that soldier who returned home after a tour of duty, or the individual who was exposed to a mass casualty event. We don’t often think about children who may have experienced a trauma. This past Valentines Day we were reminded of the anniversary of the shootings at Stoneman Douglas High School. February 14, 2018 a shooter killed 17 people in a horrific shooting at the school.
This past week we lost another student from Stoneman Douglas, unfortunately it was a suicide. The concern is that this was the second suicide of a student from Stoneman Douglas within a few weeks of the anniversary of the shooting. Last week we also were informed of the suicide of a parent who lost a child in Sandy Hook. This should be a huge wake up that individuals who are exposed to tragedy may also have PTSD that continues beyond the near term and identification and treatment must be considered and continued.
Many had concerns when the students were placed back into the same school environment a mere two weeks after the shootings. Although they placed psychological help for the students one may ask was it enough help and was it right to put them back into that environment. The concern now is what is the true impact of a tragedy like this on the students and staff that were exposed and survived. Two suicides within a few weeks of the anniversary needs to be a wake up call for all of us. The thought of PTSD must be considered in all who had exposure to the shooting.
When we look at causes of death by age, it may surprise many that suicide is the number 2 cause of death for individuals between the ages of 10-24. Suicide is second only to accidental deaths in these age groups. The unfortunate statistic is the increase in suicide rates in these age groups. If we were to just focus on the age group of 15-24, which captures the High School ages, we have seen a large increase in two areas, death by suicide and homicide. The increase has been over 30% since the 2000. Between those two causes in 2017 we lost close to 12,000 youths.
Let’s put this in perspective, the recent plane crashes, which have gained national and international attention, had a loss of life for 346 individuals. Yet it was the lead story for a week and caused the grounding of the Boeing airplane. The death totals of 15-24 yo from suicide or homicide would be the equivalent of a plane crashing every six days. Remember this is only looking at this small age group of 15-24 y.o. This sobering fact often will not hit home until you feel the impact of one of these deaths.
This country is in the middle of a mental health crisis and yet it does not get the attention or funding that it deserves and needs. 1 in 17 people in the US lives with a serious mental health issue, and what is more concerning is that this number in children is 1 in 10 and increasing. A study out last month showed a staggering statistic. It was done by the NIH and it showed that one third of youths aged 10-12 years old screened positive for suicide risk. This study included all youths regardless of what they came to the ER for. The study highlighted that many preteens seen in the ER show up with medical problems and will not disclose their suicidal thoughts unless they are directly asked. The need for screening cannot be minimized, of the 6,000 youths who died by suicide in 2016, more than half had been in a medical setting the month before taking their lives. Doctors, ER’s need to do a better job with the screening of these patients. We do need help as many of the signs will not be seen in a doctor’s visit, we need your help.
The patient who comes into the doctor’s office or ER for a medical issue may not show the signs listed below. Healthcare team needs individuals to know what the signs of depression and stress are and look for them in the day to day exposure. If you see these signs exhibited, make an appointment with your doctor and share the concerns.
Signs to look for that would show if your child or teen may need help
- Often feels anxious or worried
- Has very frequent tantrums or is intensely irritable much of the time
- Has frequent stomachaches or headaches with no physical explanation
- Is in constant motion, can’t sit quietly for any length of time
- Has trouble sleeping, including frequent nightmares
- Loses interest in things he or she used to enjoy
- Avoids spending time with friends
- Has trouble doing well in school, or grades decline
- Fears gaining weight; exercises, diets obsessively
- Has low or no energy
- Has spells of intense, inexhaustible activity
- Harms herself/himself, such as cutting or burning her/his skin
- Engages in risky, destructive behavior
- Harms self or others
- Smokes, drinks, or uses drugs
- Has thoughts of suicide
- Thinks his or her mind is controlled or out of control, hears voices
The increase in depression and suicide in this age group has been linked to smart phones, social media as well as regular media. Each morning the news in Chicago is sharing with us the murders that occurred the day before, the treatment of immigrants, especially separating families, drug problems, racial discrimination, the current political climate, in some cases there is a child involved but what is more concerning to children is when it is happening in their neighborhood. The pressures placed on children these days is intense and often debilitating. Many children are exposed to traumatic events either personally or thru the media. The events that can cause PTSD include an extensive list, and for adolescents and teens they do not have to be directly involved. They may see something in the media and think that it could happen to them in their setting.
Traumatic events that can cause PTSD include:
- violent assaults
- physical or sexual abuse
- acts of violence (such as school or neighborhood shootings)
- natural or man-made disasters
- car accidents
- military combat (this form of PTSD is sometimes called “shell shock”)
- witnessing another person go through these kinds of traumatic events
- being diagnosed with a life-threatening illness
- Viewing these in the media and thinking how it could occur to you.
Patients with PTSD may have nightmare or flashbacks reliving the trauma with mental images. Anniversaries or coverage of new similar events may also be a trigger, as was noted this past week. The patients may also go out of their way to avoid a trigger. The trigger may be people, places or activities that remind them of the event. These individuals also may feel numb, detached or depressed about their world, they often lose trust and have strong feelings of anxiety.
PTSD will not just go away, treatment is needed. It may improve but in mostcases it will still be present and will come and go in waves. Treatment is important as the symptoms can lead to greater anxiety, fear, panic and in many cases depression. Some individuals also have a feeling of guilt as they survived the incident. The concern of suicide in these individuals is very high. We know that from the rate of suicide in soldiers and unfortunately in law officers. The recent suicides of the Stoneman Douglas students should be a red flag for us to be more aggressive in monitoring youths who have been exposed to traumatic incidents.
Another huge concern is the impact of social media on adolescents and children has on their mental health, especially depression. Social media is a relatively new phenomenon, yet the impact it has made on the mental health of children, adolescents and young adults is profound and in many cases disturbing. Studies are looking at many topics that include the following
- Anxiety and depression associated with technology based negative social comparison
- Anxiety from avoidance of social interaction because of substituted social media use
- Anxiety because of worries about being inadequately connected
- Anxiety, depression and suicide as the result of cyberbullying and related behavior
The impact getting the most attention is adolescent and teen suicide, it is because many of the other symptoms and signs are silent or not diagnosed and the individual is suffering but not noted. There are many studies looking at the impact of social media and depression and anxiety. In children and adolescents there appears to be an association with the use of social media and the rates of depression and anxiety however in seniors and adults it appears to be the opposite as the use of social media in adults actually shows a decrease in depression.
There are many studies looking at the impact of Cyberbullying. Adolescents who experience cyberbullying are at an increased risk for a wide range of mental and physical problems. Suicides associated with cyberbullying continues to increase at a dramatic rate. Individuals who are bullied, report negative feelings such as embarrassment, worry, fear, anxiety, depression and loneliness after receiving a cyberbully event. Couple that with the use of the internet in reviewing suicide is concerning. A web search of 12 suicide associated terms was run, they looked at the Top 10 sites and half of them were pro suicide.
It is important to be very open with your children about any cyberbullying against them, children may be embarrassed and afraid to show their parents. We must get the trust and support to the children so that they are able to receive the care they need to cope with the emotions and psychological problems associated with this.
Access to mental health
We certainly have a problem with access to mental health treatment and support in this country. We do not have enough drug treatment centers and the ones we do have will often be selective in who they admit. The ability to have a mental health professional in each school may be a lofty goal but is unrealistic with the current volume of providers needed. Numerous studies have shown that those needing care for mental illness are less than 50% likely to receive that care.
Mental health care continues to remain largely unaffordable to many, geographically unavailable to many and recent cuts to the treatment of these conditions only magnifies the problem. Many of these patients end up in the ER where treatment is less than ideal, others end up in jail where treatment can be nonexistent.
We also have issues with a lack of funding for research in mental health, the budgets have been flat for years and there is not the public support for this research as the stigma around mental health has not improved despite the incidents that have occurred in this country recently.
We are at a crisis where the impact on children and adolescence will be felt for generations to come unless we start making an impact, again the number of death by suicide in children is the equivalent of a major plane crash every 6 days, we must wake up and work on this.