“It’s really 12 and under, the pre-teen group, that have taken something, usually it’s a medication, either to hurt themselves or to kill themselves. They’re suicidal,” said Bruce Ruck, managing director of the New Jersey Poison Control Center at Rutgers New Jersey Medical School’s Department of Emergency Medicine.

Ruck said the circumstances of the suicide attempts are often opportunistic: Whatever medications are available in their parents’ medicine cabinet, they will take. Much of it is over-the-counter medications, from acetaminophen to cough and cold products, but it’s prescription medications as well.

Ruck, who has worked at the poison control center for 30 years, said in that time he’s never seen data like this.

Seventy in 2018

“We're definitely seeing a spike,” he said. “If I look at 2009, I had 21 children under the age of 12 that you determine they were trying to harm themselves or kill themselves. In 2018, the last full year for the data, it was 70.”

And his data is just for the teens who were not successful. If they were, the call from the hospital would not be to the poison control center. It would go to a medical examiner.

The question is, why? Ruck doesn’t pretend to have the answer, but he says he hears from people all the time who say how anxious and stressed-out children are these days.

“There’s pressure on these kids, whether it’s bullying, whether it is just social media, whether it is TV, whether it is home life, nobody knows, but it’s an opportunistic situation where these medications are around the home, and we're not just talking about drugs of abuse. We’re talking about all medications,” he said.

In terms of actual suicides, while the number of 15- to 24-year-olds in New Jersey who have taken their own lives over the last five years has fluctuated — and as a whole, is higher — the number of those aged 10 to 14 has risen and stayed at that higher level — though the numbers are still small. Only two 10- to 14-year-olds committed suicide in 2013. In 2015, that number rose to eight and has remained at about that level each year since, according to the New Jersey Department of Health. (By contrast, the number of suicides last year for 15- to 24-year-olds was 27, and for 20- to 24-year-olds, that figure was 57.)

Trend is not unique to New Jersey

The figures aren’t unique to New Jersey and reflect a larger trend. Among people in the United States ages 10 to 19, suicide has become a leading cause of death. Mental health officials typically point to higher stress levels and bullying that children now face as possible causes. If there’s more to the story, Ruck doesn’t have the answer.

The CDC on its website lists the risk factors as people having had a prior suicide attempt, alcohol and drug abuse, mood and anxiety disorders, and access to lethal means. Most don’t apply to children — except for the last one: their parents’ medicine cabinet.

The higher female attempted suicide rate in New Jersey parallels new research that shows the suicide rate among young teenage girls nationwide has been increasing faster than it has for boys of the same age. The largest percentage increases in the rates of suicide occurred in girls aged 10 to 14 years, according to the CDC. In an unprecedented escalation, rates of suicide in this subgroup tripled between 1999 and 2014. A study published last month in JAMA Network Open found that while boys are still more likely to take their own lives, the gap between boys and girls was narrowing.

Researchers looked at more than 85,000 youth suicides in the CDC’s WONDER database that fell between the years 1975 and 2016 and found that following a downward trend in suicide rates for both sexes in the early 1990s, suicide rates increased for both sexes since 2007, but the rate for females increased more than for males. The increase was highest for girls ages 10 to 14, rising by nearly 13 percent since 2007. For boys of the same age, it rose just 7 percent.

More lethal means

Sadly, their study also found that females are committing suicide by more lethal means, such as firearms or hanging.

“So we saw that increase significantly among girls, and that was a cause for concern — because if females have a higher rate of attempt and then all of a sudden they’re switching to this more lethal means, that could obviously have more fatal implications,” said one of the study’s authors, Dr. Donna Ruch, a post-doctoral researcher in the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Columbus, Ohio.

Some experts attribute the rise in female suicides to social rather than biological determinants, especially given data pointing to the rise of social media use among youth. Because social media is the primary form of interpersonal engagement, in what is a very important developmental period for adolescents, it has great potential for influence and importance. And because these engagements are occurring online, the amount of social contact is now limitless.

While social media is starting to be implicated in higher rates of depression, anxiety and suicide, what is less clear is why it’s having a differential impact on girls.

“Everyone today has social media and media friends. But instead of really connecting kids and providing strong support, it tends to isolate them and make them feel more alone,” said Debra Wentz, president of the New Jersey Association of Mental Health and Addiction Agencies.

It doesn’t help that people only put their brightest moments and highest achievements online, making those whose lives are not going well feel worse, she said.

Social media’s negative effects

“So in comparison, it may magnify feelings of insecurity or inferiority in kids who have low self-esteem and make them feel different from their peers. That’s also leading to increased depression,” Wentz said.

A study published in March in the Journal of Abnormal Psychology, found the rate of individuals reporting symptoms consistent with major depression in 2016-2017 rose 52 percent in teens and 63 percent in young adults over a decade. By 2017, one out of every five teenage girls had experienced major depression in the prior year, the study found.

“That ‘one out of five’ really correlates to the same rate of prevalence for overall mental illness in the general population, universally, but is appearing earlier,” Wentz said.

That study also reported that rates of psychological distress rose by 71 percent among people ages 18 to 25, with suicidal thoughts, plans and attempts increasing. And death from suicide increased by 56 percent among 18- to 19-year-olds, between 2008 and 2017.

“In that particular study, the researchers speculate a possible strong connection between increased significant use of social media and smart use and depression,” Wentz said.

Cliques and rumors

She also cited bullying and noted that females are much more susceptible to it than males. It comes in the form of exclusion from groups or cliques and rumors either in cyberspace or in person that can ruin someone’s reputation.

“With males, the bullying is much more physical. With females, it leads to a lot more depression and suicide ideation plans and attempts, because females tend to ruminate more,” Wentz said.

Ruch said her group plans to research the impact of social media, though she says it has to be done on a granular level. The concept of social media covers a lot of ground. She wants to look at what kind of texts or apps young people are on just before they attempt suicide. The problem will be privacy.

“It’s challenging to get that kind of data, from the parents,” she said. “Getting access to children’s cellphone usage, text messaging, internet browsing history, all of that, there’s a lot of implications from a security standpoint. But yes, that is a future area of research, and we’re looking ways at to get around that.”

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