Karina Shedrofsky

USA TODAY

Family doctors should screen teens for suicide risks in the wake of new information that shows suicide is the second leading cause of death among teens, an American Academy of Pediatrics report said Monday.

In the report, the academy provides pediatricians with guidelines on how to identify and assist at-risk teens between the age of 15 to 19.

Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention, the nation’s largest suicide prevention network, commends the report for shining light on the pediatricians’ role in having the right conversations with patients about mental health and providing practical examples of how to ask the right questions that keep adolescents engaged.

The original report was published in 2007, when suicide was the third-leading cause of death among adolescents. It has since passed homicide to become the second, with unintentional injuries, such as drug overdoses and motor vehicle accidents, claiming the most teen lives.

Ben Shain, author of the report and head of the Division of Child and Adolescent Psychiatry at NorthShore University HealthSystem, says suicide rates may have increased due to the stresses and anger levels induced by electronic media and a reluctance to use antidepressant medication.

In 2004 the FDA required “black box warning” labels on antidepressants to warn health care providers of increased risks of suicidal thinking and behavior among children and adolescents being treated with such medications. Fewer antidepressants are prescribed as a result.

Studies have since shown that the benefits of antidepressants significantly outweigh the risks for most patients, and are thus a valuable treatment option, the report says.

Dewey Cornell, clinical psychologist and director of the Virginia Youth Violence Project, says suicide is especially high among teens because of “the stressfulness of adolescence and the immaturity of the adolescent brain.”

According to Moutier, the risk of suicide is heightened by a convergence of multiple risk factors, with the most common being depression and other mental health conditions.

Screening for these risks, she says, “is the first critically important step in preventing suicide death.”

The AAP urges pediatricians to look for risk factors linked to teen suicide, which include a history of physical or sexual abuse, mood disorders, substance abuse, and teens who may be lesbian, gay, or bisexual. Bullying is a significant risk factor added to the 2016 report.

“Though bullying is not a new phenomenon, there is much more emphasis on it in terms that it is really bad and causes suicidality,” Shain said. Those at greatest risk, he says, are those who were both victims and bullies themselves.

Cornell says bullying doesn’t necessarily lead to suicidal thoughts or actions, but can have a powerful impact when combined with other stresses.

“The internet can have a magnifying effect on bullying because the adolescent’s humiliation is public and he or she feels helpless to stop it from continuing,” he said in an email. “It is bad enough to be teased and rejected by a few classmates, but far worse when it is visible to all of your friends and potentially everyone in the world.”

Shain says cyberbullying also increases the opportunity to be either a bully or a victim, and teens are at a higher risk of suicide if they use the internet more than 5 hours each day.

More specifically, suicidal teens may be at risk of searching the Internet for suicide-related topics. Pro-suicide websites that may describe methods in detail facilitate suicidal behavior among at-risk teens, the report says.

Media coverage of one adolescent’s suicide may lead to cluster suicides, which means the number of additional deaths increases proportionally with the amount of media coverage.

Though newspapers tend to be mindful of this effect and refrain from putting coverage of a suicide on the front page, journalists don’t have this type of control over the Internet, so the coverage can be pervasive, Shain says.

He asserts that Internet use isn’t all bad, however, as it has become a major way adolescents get their support and communicate with family and mentors.

When a teen learns of another suicide in the community through Facebook, for example, the Internet effect becomes neutral, as the coverage is accompanied by support for the person who has died and the person learning about it.

“I wouldn’t call the Internet a risk factor, but more an influence,” Shain said. “It’s not going away, so we just need to learn more about it.”

Suicide affects teens no matter their race or gender, but sexual minority youth — such as gay, lesbian, bisexual, transgender, or questioning — have more than two times the rate of suicidal thoughts, the report says.

While girls make more suicide attempts, boys die from suicide at a rate three times that of their female counterparts. The report suggests this is a result of boys choosing deadlier methods, such as firearms.

Firearms in the home are associated with a higher risk of adolescent suicide, and the AAP urges parents of at-risk teens to remove guns and ammunition from their homes.

Shain says pediatricians don’t see patients long enough for in-depth assessments, so the screening is intended to raise red flags so the physicians can make referrals for appropriate mental health evaluations and treatments.

According to Shain there is a severe shortage of pediatric mental health professionals and simply not enough psychiatrists or psychologists for pediatricians to refer their patients.

In such instances, he encourages pediatricians to seek additional training so they can handle mental health problems themselves.

It is hard to prove that screening programs have been successful in reducing actual suicides because they are so infrequent, but studies have proven them to be successful in reducing depression and suicidal behavior, Shain says.

"People generally keep their inner experiences of stress and negative thinking close and hidden very tightly,” Moutier said. “And that’s the reason this article helping pediatricians notice those signs, listen to parents, and ask the right questions invitingly is so important because they will be able to help.”