By

Lauren Slagter

and

Martin Slagter

, Aug. 30, 2017

The Ann Arbor News | MLive.com

ANN ARBOR, MI - With tears streaming down her cheeks, Elise Boyd crept down the hall to kiss her brother goodbye in his bed, knowing that in a few minutes she would swallow enough pills to kill herself.

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Her plan was in place for weeks. The 14-year-old had stored up antidepressant and anxiety medications provided by her psychiatrist - collecting 90 pills in all, because "it had to be an even number."

If she followed through on her plan, Elise would become part of some grim statistics: The suicide rate among teenage girls in the United States climbed to reach its highest level in 40 years in 2015, the most recent information available from the Centers for Disease Control.

In Washtenaw County alone, 17 people ages 15 to 24 died by suicide in 2016, the highest number since the county's medical examiner began keeping track in 2004.

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What is causing them to take their lives? Experts say anxiety is replacing depression as a culprit as young people feel pressure to succeed.

In Elise's case, the blonde gymnast from the Livingston County community of Howell had tried to conceal her feelings of intense anxiety and depression.

She explained away the cuts on her wrists and arms as a byproduct of practicing on the bars in gymnastics, rather than evidence of self-mutilation. She purposely burned herself, and then said it had been an accident from chemistry class.

To avoid the paranoia she felt simply by classmates looking at her, she would eat lunch in the bathroom or a teacher's empty classroom. Her parents' marital difficulties and her father's adverse reaction to her brother coming out as gay caused deep tension in their family dynamic.

It became difficult for Elise to maintain a facade of happiness. She withdrew from her friends and eventually admitted to her mother that she didn't want to be alone for fear she might harm herself.

In seventh grade, she was hospitalized in a pediatric psychiatric ward in Grand Rapids. While there, she attempted to strangle herself with her hoodie in one of the 10-minute intervals between hospital staff checking on her. A nurse found her unconscious, and staff performed CPR to revive her. When Elise regained consciousness, she was angry that she didn't even have enough control over her life to end it.

"I thought, 'This is my life, why are you trying to control what I do with my life? How can people tell me I can't die?' I was really angry at everyone trying to help me at that point. I just wanted out," she said.

As her eighth grade year at Highlander Middle School came to a close, Elise again grew fed up with struggling to make sense of the world around her.

She thought by dying she would be doing herself and her family a favor.

"I was like, 'Clearly there is nothing out there that can help me. I've tried medicines, I've talked to different people - this is just how I am,'" she said. "'I can't live like this, no one should have to live like this. I'm doing myself a favor, I'm doing my family a favor.' You just think you're doing it to better the world, better your life, better everyone's life. So you talk yourself into it being a good thing."

On a spring night in 2013, Elise pulled out the old first aid jar where she'd stored the pills and poured them onto her bed. She crafted letters to her family and friends and tucked them under her pillow, ready to die.

But then fate intervened.

When she entered her room after saying goodbye to her brother, half of the pills were missing. Her dog, Kama, had eaten them.

The dog stood by the bed coughing. Elise screamed for her mother and admitted what had happened. In the moment she reserved to take her own life, Elise instead was hysterical that her pitbull-collie puppy might die.

The family rushed Kama to a vet clinic, where the dog was given medicine to induce vomiting and get around 50 pills she had swallowed out of her system. The dog - and Elise - were saved. Nicole Boyd refers to that night as a "blessed interruption" of her daughter's plan.

Elise finally had a breakthrough after her third hospitalization following that suicide attempt. She connected with noted clinical social worker Gigi Colombini, who specializes in suicide prevention. It was a departure from more "informal" conversations she had with psychologists at hospitals, and Elise said it forced her to face her issues head-on, rather than simply block them out through medication.

Today, looking back at her transformation, Elise, now 18, talks about looking forward to starting her freshman year at Grand Valley State University this fall and a mission trip this summer to Nicaragua. She described how Colombini helped her understand that she wasn't alone in wrestling with feelings of depression and anxiety.

"She completely laid out what was going on in my life and knew how I was feeling," Elise said, smiling frequently even as she described her painful past. "It was crazy to know that someone knew what was going on with me. I thought I was the only person who was having those feelings."

Suicide rates rising

As Elise Boyd looks forward to the future, others aren't as fortunate.

State and national suicide rates for people ages 15 to 24 have been on the rise for years, and surveys show many young people have contemplated death by suicide.

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About 15 percent of ninth and 11th graders in Washtenaw County seriously considered attempting suicide in the previous 12 months, according to a Michigan Department of Education survey from the 2015-16 school year.

One-third of college students seeking mental health services reported they had seriously considered suicide in the 2015-16 school year, according to a 2016 report from the Center for Collegiate Mental Health.

As recently as June, a seventh grader died by suicide in Dexter. Other high school and college-aged students who have died by suicide in Washtenaw County since the beginning of 2016 include:

A 15-year-old from Ann Arbor who played hockey and football.

A 26-year-old University of Michigan student from Illinois who was majoring in computer science and had a history of depression

A 17-year-old from Milan taking college courses at Eastern Michigan University.

A 15-year-old artist, writer and social justice advocate from Ann Arbor who battled depression and anxiety.

A 17-year-old on the Chelsea High school robotics team who enjoyed video gaming.

A 17-year-old mechanically-inclined artist from Chelsea who loved cats.

A 14-year-old from Ypsilanti who loved comics and UM football.

A 15-year-old from Ann Arbor who liked spending time outdoors and playing guitar and drums.

Each case has its own circumstances that led to the person's death. But experts say there are some common themes that come up when discussing suicide involving young people.

The vast majority of suicide attempts are linked with some type of mental health issue, said Dr. John Greden, founder and executive director of the University of Michigan Depression Center in Ann Arbor.

Young people face unique pressures that can affect their mental health at a time when the peak onset of clinical depression occurs, Greden said.

"Suicide is the culmination - an endpoint, if you will - for negative view of self, negative view of world, negative view of future. 'I don't want to go on living,'" Greden said, adding that those feelings are often linked with depression, anxiety, stress, sleep disturbances or substance abuse. "Those are often not picked up and treated."

Stephanie Salazar, program coordinator for outreach and education at the Depression Center, said student anxiety continues to come up in her conversations with educators.

"I would agree with our school partners in terms of the pressure (on students) to succeed academically and be in a million extracurricular activities and get all A's," Salazar said.

Chelsea High School counselor Jason Murphy said he sees it as well.

"I think that's a big piece of why our kids are struggling so much - we tell them to relax, but we don't teach them how to relax," Murphy said. "There's a lot of pressure to do well and (college admissions) is more competitive. There's no down time because they've always got to be doing something else."

Pressure to achieve

Marquaun Kane is a high-achiever who will be a senior at Ann Arbor's Pioneer High School this fall. He has enrolled in multiple AP classes his junior and senior years of high school, holds two or three part-time jobs at a time and is in involved in advocacy work related to school discipline reform, homelessness and other social justice issues. The 17-year-old wears suits most days.

Kane also has been haunted by thoughts of suicide for years. It started when he was in seventh grade and felt helpless to do anything about his tumultuous home life.

"Starting back in middle school, I just thought about it, the concept of it. I never picked up a knife or a gun or anything like that," said Kane, who grew up in Ypsilanti and Ann Arbor. "It was just something like, 'Oh my gosh, man, if my teachers can't help me and no one can help me get out of my situation, I feel as if this is the only way out.'"

Those suicidal thoughts became more frequent and intense as he got older.

Kane does not talk to his mother about his suicidal thoughts. He recently began seeing a new therapist, and he said meditation helps to calm his anxiety. He has found hope through the support of his middle school teachers, parents of his friends and people he's met through Peace Neighborhood Center, a nonprofit for those with socio-economic problems.

Marquaun Kane (Melanie Maxwell | The Ann Arbor News)

Kane struggles at times to see how what he learns in class relates to work he'd like to do tackling issues like climate change and poverty, and feelings of helplessness set in again.

"Here I am a young kid trying to help save the world because people have tried to save me," said Kane, who speaks with an eloquence that would serve him well in the political career he hopes to pursue. "I can't do all of that because I don't have that circle of influence. So there's that trade-off because I see all this going on and I know I can't do anything, so I feel helpless. I feel hopeless, and it makes me think, 'What is my worth?'"

His activism gives him a purpose in life, but also adds to the pressure he feels of people's high expectations for him.

"Sometimes I feel as if I have to deliver, I have to be that black kid from the ghetto who goes to Harvard University or something like that. That's kind of what everybody throws at me," Kane said.

"I feel as if I were to just go and say, 'I'm struggling with this,' they kind of would say, 'Take a break, kid,'" he said. "Which would make sense, but the thing is, that's been stopping me from committing suicide - finding meaning in the world around me."

Anxiety fueling problems

Historically, depression was the primary reason students sought services offered by the University of Michigan's Counseling and Psychological Services, known by the acronym CAPS.

But about a decade ago, CAPS Director Todd Sevig noticed a shift to anxiety being the No. 1 reason students sought help. Since then, anxiety has been the top reason CAPS has set up one-on-one, group therapy and crisis appointments for UM students.

This shift could reveal some of the inherent issues students face when trying to live up to UM's noted "Leaders and Best" slogan, Sevig said.

"This notion of 'Leaders and Best' is a wonderful part of our identity and who we are as a university," Sevig said, surrounded by mounds of books and paper inside his office on the third floor of the Michigan Union. "At the same time, there are some students that experience that with this high, somewhat unrealistic expectation to be top-notch almost all the time, without being able to fail, explore or let themselves relax.

"So this really led to the idea of let's be 'Leaders and Best,' but let's also be leaders at their best, where you can perform really well and take care of yourself emotionally and psychologically," he added.

A similar trend is evident at universities across the country, according to the 2016 report from the Center for Collegiate Mental Health. Anxiety was the top mental health concern reported by college counseling centers, the report found, applying to 61 percent of clients. Depression was the next highest, at 49 percent, among 44 listed concerns.

Kevin Wehmhoefer, a clinical social worker and outreach coordinator for mental health services at Harvard University, said there's no doubt students are experiencing an increase in anxiety related to the pressure to achieve.

High-achieving high school students can become singularly focused on being accepted to a prestigious university, Wehmhoefer said -- often at the expense of maintaining a sense of balance in their lives.

Once in college, those students may receive the first B+ of their lives or go through a break-up, and they're facing those challenges without the support system they had at home, he added.

Add to that a desire to avoid admitting they can't handle what's asked of them - something Wehmhoefer calls the "Harvard game face" - and many students will delay seeking help to address their anxiety or depression, he said.

Social media and other factors

The spike in suicides among 15 to 24 year olds in Washtenaw County last year was "alarming," said Dr. Jessie Kimbrough Marshall, medical director for Washtenaw County Public Health. But it was not a new development, she added, noting that the suicide rate for that age group has been rising in recent years.

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A health department specialist took a closer look at data from the past decade and found the number of single-parent households, the number of substantiated child abuse cases and the poverty rate had increased during the same timeframe as the rise in deaths by suicide among adolescents, Marshall said.

That correlation does not equate to causation, she emphasized.

"We certainly aren't saying the profile of youth who are suicidal is coming from an impoverished background. This correlating data says something more broadly about the society that we live in," Marshall said. "While we don't have any concrete answers, we do think we know some of the underlying circumstances. One being that we know that resiliency and coping skills is something among our adolescents that needs to be addressed."

Greden also pointed to untreated mental health conditions like depression, anxiety and post-traumatic stress disorder; substance abuse; bullying, which often affects people who identify as LGBTQ; and the availability of guns as contributing to the rising suicide rate.

Social media adds to pressure on teens and young adults, said Murphy, the counselor at Chelsea High. The online connections mean students are never fully alone with time to process their emotions. The internet also opens them up to cyberbullying, Murphy added, and even positive social media posts can lead to students comparing themselves with others and feelings of inadequacy.

While social comparison in general has always impacted children and young adults, CAPS Associate Director of Community Engagement and Outreach Christine Asidao said college-aged students are sometimes forced to confront those comparisons on a daily basis through a number of different social media platforms.

"I think with the rise of social media, though, it is so much more available to them, not just to check on a group of their friends they see every day, but maybe thousands of people they may be friends with online," she said. "That does influence how they perceive themselves and what they think is sort of the standard, and maybe that standard is skewed, because most people only put the good things out there, so that's not necessarily based in reality."

Beyond social media, factors contributing to suicide across all ages and demographics were recently explored by southeast Michigan film director Keith Famie in the 2016 PBS documentary, "Death is NOT the Answer."

In it, Famie speaks with many people impacted by suicide, including Elise Boyd, who has shared her experiences to encourage others who may be struggling with suicidal thoughts, depression and anxiety. Elise said she was glad to be part of the project.

"I had shared my story so many times. I never realized the effect it had, just telling my story," she said. "When I went to the first viewing (of 'Death is NOT the Answer'), there were parents there whose kids were depressed or they had lost children and so many people came up to me and thanked me for sharing my story. I just thought, 'How could that make such an impact?'"