Suicide is now the third leading cause of death
for young people between the ages of 15 and 24 years old. Coming
from a family dealing with three generations of suicide, I know the
personal toll is overwhelming, but there is something that can be
done. Over the past three decades youth suicide rates have increased
dramatically. Since 1960 the suicide rates for males 15-19 years old
has tripled. More alarming, suicide is increasingly claiming its
victims at younger ages. From 1980-1996, suicide rates among
children 10-14 years old increased 100 percent.
Mental illness is the leading cause of suicidal feelings.
Evidence suggests that more than 90 percent of young people who
commit suicide had a mental disorder. This is especially disturbing
given that experts estimate between 10 and 15 percent of children
and adolescents suffer from a mental illness. Yet, mental illness
among the young often goes unrecognized and untreated. There is a
better way to help detect teens at risk. The TeenScreen Program
developed 10 years ago by Columbia University and offered in
partnership with the National Alliance for the Mentally Ill helps
communities across the nation identify teens with mental illness who
might be at risk for suicide.
The mental disorders most frequently suffered by children include
major mood depressive disorder, dysthymic disorder, and bipolar
disorder. The symptoms of depression include: sadness, lethargy,
disinterest in activities normally enjoyed, self-criticism,
pessimism, and thoughts of suicide. Depressed children and teenagers
are often irritable and can appear aggressive and hostile. The
average episode lasts from seven to nine months.
Dysthymic disorder, similar to major depressive disorder, but
with fewer symptoms is more chronic. Because of its persistent
nature, the disorder often interferes with normal development and
adjustment. The average dysthymic period lasts four years.
Bipolar disorder is characterized by alternate episodes of mania
and depression. Bipolar disorder begins in the teenage years and is
frequently marked by a depressive episode. Manic symptoms may not
appear for months or years after the first depressive episode and
can include high levels of energy, confidence, difficulty sleeping
without accompanying tiredness, rapid speech, and racing chaotic
thoughts. Manic episodes frequently result in high risk and reckless
While five percent of youth suffer from major mood disorders,
only one in three is actually diagnosed. Parents, teachers, and even
health care providers often do not know that a youth is experiencing
symptoms of a mental illness. Most youth do not voluntarily discuss
their symptoms with adults. Without an asserted effort and
systematic means of identifying and assisting youth, self-medication
with drugs and alcohol and suicide may continue to increase.
The rise in youth suicide has touched communities throughout the
country without regard to race or socioeconomic status. While the
risk for suicide is greatest among young white males, black males'
suicide rates have increased rapidly since 1980. Hispanic females
were twice as likely to attempt suicide as white females. The Indian
Health Services Areas have long reported the highest suicide rates
in the nation.
Previous attempts, current thoughts of suicide, mood disorder and
drug or alcohol abuse are the leading risk factors for suicide.
Identifying these risk factors is the first step in preventing child
and teen suicide.
The long-term goal of TeenScreen is not just identification, but
treatment for those in need. The TeenScreen program is a five-step
process. The first step is parental consent. Step two is a brief,
self-report questionnaire that helps to identify teens with suicidal
thoughts, past attempts, symptoms of depression or substance abuse.
The next step is a self-administered computer-assisted interview
that is based on the Diagnostic Interview Schedule for Children
(Voice DISC). It is at this step answers provided in the
questionnaire from step two are confirmed and expanded.
The Voice DISC is a comprehensive, structured interview that uses
DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, the
reference manual used by psychologists) criteria to assess more than
30 mental health disorders found in youth. In step four a licensed
mental health professional reviews the Voice DISC information and
conducts a brief interview with children or teens who show signs of
mental disorder or suicide risk. In the final step, a case manager
meets with high-risk teens and makes referrals for further
evaluation and treatment. Case managers continue to work with
high-risk youth to ensure that they seek and are able to access the
help they need.
The Voice DISC is the most widely used and studied psychiatric
interview tool of its kind. Administered via computer software, the
Voice DISC allows youth of varying educational levels to
self-administer the screening interview. Voice DISC is able to
provide a full diagnostic profile, allows for more focused and
efficient clinical assessment, gauges the severity of symptoms, and
increases disclosure of suicidal tendencies and substance abuse.
The TeenScreen program provides assistance with targeted,
community-based mental health awareness and coalition building,
pre-training consultation, on-site training, Voice DISC software,
post-training technical assistance and TeenScreen background
If you would like to learn more about the TeenScreen program or
to initiate a screening program in your community, call the Division
of Child and Adolescent Psychiatry at Columbia University at (212)
543-5016 or visit our website at (http://www.teenscreen.org/).
Laurie Flynn served as the executive director of the National
Alliance for the Mentally Ill for 16 years. She is now the Director
of the Center for Child Mental Health Policy at Columbia