From NEJM Journal Watch
January 14, 2019
By Amy Orciari Herman
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Parents are frequently unaware of their adolescents’ suicidal thoughts, and adolescents often deny the suicidal thoughts their parents report, according to a Pediatrics study.
A community-based sample of 5100 adolescents aged 11 to 17 were asked whether they had ever thought about killing themselves (suicidal ideation) or whether they’d ever had recurrent thoughts of death; parents answered the same questions about their adolescents.
Some 8% of adolescents reported that they’d ever thought about suicide, but parents were aware just half the time. Additionally, 15% reported recurrent thoughts of death, but parents were aware 25% of the time. Parents were particularly unaware of suicidal ideation in younger adolescents. Of note, teens denied parent-reported suicidal thoughts half the time.
The researchers write, «It is possible that a large number of adolescents with suicide risk may not be detected by brief screens at routine check-ups. This highlights the urgent need for continued training of pediatric primary care physicians in the evaluation and management of suicidal ideation and the importance of collecting information from multiple informants and rectifying discrepant reports.»
LINK(S):
Pediatrics article (Free abstract)
Pediatrics commentary (Subscription required)
Pediatrics early-release page (if above links don’t work) (Free)
Background: NEJM Journal Watch Pediatrics and Adolescent Medicine coverage of inadequate sleep and risky behaviors in adolescents (Your NEJM Journal Watch subscription required)
Cortical Chauvinism 
I could have been a statistic. When I was the new kid in town, being bullied in the 7th grade, I did not tell my parents how bad it was. I wash ashamed of being such a social outcast, a far to common occurrence with bullied kids. Things had changed a lot for my family, and older siblings were moving out of the house, both parents working double shifts to support our immigrant family. I was somewhat disconnected from my family support network, and friends from the other town I had lived in for three years (never mind my childhood friends from Chile). I slipped through the cracks in my family because my grades were finally really good (I escaped into homework and reading), so my parents thought I was OK, meanwhile I contemplated suicide. They had no clue as to how depressed I was, or how suicidal I was. I would go play with the litter of kittens our cat had, down in the basement den of our home, and cried as quietly as I could. Eventually, kittens would bring me out of my funk. I did this almost every day for two months. I credit those kittens as my therapy. I was in so much pain from bullying I couldn’t see the light. Eventually, the only reason not to do it, outweighed all the reasons I thought of to do it. My family might miss me, and it might hurt them. That was the only thing listed on the «reasons to live» side. And yes, I did make a physical list of reasons to kill myself, and reasons to live. I did write a note, I did think of how to do it. I was 12. Eventually, I found a way to cope with the bullying. There were still some pretty cruel things being said and done to me, but I learned to insulate myself and not give them the reaction they wanted. I started to tell myself that what they said didn’t matter, I was a good person and there was no way to please them, so just stand tall and keep going. I started feeling better, and emerged from the depression. Luckily, I have never since felt that way again. As an adult, anytime I read about a kid who commits suicide, especially from being bullied, my heart breaks. I know how they feel and wish I could hop in a time machine and tell them it’s going to be OK, I’ll be your friend.
Three years later, a friend from 4-6th called me, we were no longer in the same town and didn’t talk much, maybe 3-4 times a year. She was depressed and thinking of killing herself. She begged me not to tell anybody. I wondered what I should do for an few hours after our conversation ended. I broke my promise to her, and called her Mom to let her know. They got my friend psychological help. I though she would hate me forever for telling on her, she credited me with saving her life. She was really close to committing suicide, and because I told her Mom they were able to intervene in time. Educating kids and peers about the signs of suicide and the importance of telling an adult when your friend starts talking about suicide or death, is important. Identifying bullying, and responding to it is also important. I felt so let down by the adults at the school, and on the bus. I am so sad about the victims of the Parkland shooting and the father of the Newton shooting victim. They went through such an awful experience, and we retraumatized by profiteering carnival show barkers claiming that their trauma was made up as a way to justify confiscating arms. Grown up bullies with TV cameras.
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Sorry about your experience. It is interesting that the best outcomes I have seen in autism are those where the whole community takes the place of family. I was impressed by Krasnoyarsk, Siberia and some rural populations in China. They do not list bullying as one of their top complaints. It is a pity that this extended family atmosphere is usually lost in cities.
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i’ve felt suicidal in the past, but don’t think I’d ever commit it. I also believe it’s possible that the neurodiversity movement helps increase the suicide rate by encouraging individuals to self-diagnose themselves with autism instead of going to a doctor and being evaluated for depression, bipolar, schizophrenia, etc. or other conditions that could be confused with autism and are far more treatable and if they were properly diagnosed by a doctor they could get the treatment they need and not commit suicide.
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The main issue I struggle with is like dysphoria. My case, it’s not gender or body but wishing I could have it be different because this is so uncomfortable (there’s more), and also comparing myself to others.
Is this an accurate description for you too?
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