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Before Their Time: Preventing Teen Suicide
Laurie Flynn

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 behaviors.

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 materials.

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 (

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 University.


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