Editor’s note: By Dr. Elizabeth Menefee is Medical Director at Child Guidance & Family Solutions.

Suicidal behavior has nearly doubled among American children over the past eight years. (Montreal Children’s Hospital using data from the National Hospital Ambulatory Medical Care Survey by the CDC). The group at highest risk for suicide are white males between the ages of 14 and 21.

Every day in my role as Medical Director at Child Guidance & Family Solutions, I see the association between stress and mood. More children and teens come into my office without adequate coping skills. This is compounded by increasing stress, anxiety and depression around school and social media. Youth mental health deserves to be addressed as a public health problem, because that is what it has become.



I am interested in helping parents, teachers and others who play a major role in a child’s life to become knowledgeable about the signs of toxic stress and risk for suicide. Toxic stress and trauma affect the developing brain in varied and often unexpected ways, including irritability, trust issues, difficulty focusing, sleep disturbances and even self-harm behavior or suicidal behavior.

We know that the biggest risk factors for suicide are depression and prior suicide attempts. Suicide is now the second leading cause of death in people aged 10 to 24 years (CDC Youth Risk Behavior Survey, 2017). Diagnoses of either suicidal ideation or suicide attempts, has increased to 1.12 million in 2015 (JAMA Pediatrics). Half of the patients in the study found to have suicidal thoughts and attempts leading to an emergency department visit were younger than 13, with 43 percent between 5 and 10 years of age. Just last week, it was published in the Columbus Dispatch that the number of youth attempting suicide with poison more than doubled over the past eight years (Suicide Attempts By Poisoning Double, The Columbus Dispatch, May 1, 2019).

The symptoms of trauma and/or toxic stress vary in how they present, particularly in younger patients. It is important to distinguish among the kinds of responses to stress:

Positive stress response, which is a normal and useful part of healthy development. Learning to cope with stressful situations and develop coping skills is an important part of every child’s development. Toxic stress response, which can occur when a youth experiences strong, frequent or prolonged strain without adequate adult support. When toxic stress is experienced for an extended time period, it can have a cumulative toll on physical and mental health (Harvard University Center on the Developing Child).

Common signs of toxic stress in youth include:

• Poor coping skills;

• Behavior and learning difficulties;

• Mood swings;

• Sleep problems;

• Overeating and other compulsive behaviors; and

• Fear and anxiety triggered by places or people that remind them of past trauma

So how much anxiety or depression is too much? It can be hard to judge, but it can be useful to look for changes – something outside the norm for the particular child or teen. If you think your child’s worry has gotten out of hand, an expert opinion can provide clarity. Meeting with a therapist, social worker or psychiatrist can help you and your child to determine if his/her anxiety issue can be classified as a disorder, and which one.

Resources:

www.cgfs.org, (330) 762.0591

Crisis Text Line: Text4HOPE to 741741

National Suicide Prevention Lifeline: (800) 273-8255

Trans Lifeline: (877) 565-8860

Military & Veterans Crisis Line: (800) 273-8255, press 1