How common are teen suicide attempts?

Firm estimates are difficult because countries and researchers define "teen" differently, with some using definitions as broad as 10-24 years old, while others use definitions as narrow as 17-19 years old. On average, worldwide, roughly 3/10 teens consider suicide, and roughly 1/10 make suicide attempts. 1-2% of teens who attempt suicide will "complete" the suicide, or die from their attempt.

In the United States, we have approximately 200,000-400,000 attempts per year, with around 2000 completed.

How often do teen suicide victims survive?

Approximately 98% of teens who attempt suicide survive those attempts. In the United States, as many as 50,000-100,000 teens may suffer permanent injury from their suicide attempt.

What type of injuries might result? 

Injuries vary depending on the method--and there are many, many methods. Some of the most common methods and resulting injuries include the following:
  Slicing/stabbing: Scarring, nerve damage, loss of use of hands/fingers/arms, amputation due to infection, brain injury from systemic infection.
  Overdose: Major organ damage (kidney, liver, heart, eyes), major organ destruction (especially kidney--dialysis is a common outcome), brain injury from toxicity or metabolic imbalance, brain injury from hypoxia or anoxia (lack of air to the brain)
  Motor Vehicle Exhaust:  Major organ failure, brain injury from hypoxia or anoxia (lack of air to the brain).
   Hanging: Scarring of the neck, damage to vocal cords, damage to the windpipe requiring permanent tracheotomy, paralysis (high cord, like Christopher Reeve suffered from his fall), brain injury from hypoxia or anoxia.
  Gunshot to Head: Blindness, aphasia (loss of ability to talk), hemiparesis (paralysis of one side of the body), brain injury of varying degrees depending upon caliber of the weapon, how and where the shot was fired, the bullet's trajectory--the possibilities are limitless.

What are the most common reasons for teens to attempt or commit suicide? Are the reasons different for boys vs. girls?

When thinking about reasons for suicide, two important concepts emerge: triggering events and risk factors.
  Triggering Events. For teens, triggering events can be (or seem) amazingly small, such as a bad test grade or report card grade, failing at an activity or sports event, losing a job, getting grounded, having a fight with a friend, having a fight with parents or teachers, or breaking up with a love interest. It's important to understand that triggering events are usually surface reasons--things we can see, tangible events we can point to, or those proverbial last straws. Triggering events rarely, if ever, fully explain the teen's decision. For that, we turn to context.
  Risk Factors. The context, or background, of a suicide attempt is much more complex than the triggering event. Risk factors include Major Depression, Bipolar Disorder, other mental health conditions, substance abuse, family conflict, recent losses, family history of suicide, recent exposure to suicide (family, friend, or acquaintence), and the presence of guns, especially loaded guns, in the home.
   Boys vs. Girls.  In my experience, which is supported in the literature, boys are more at risk for completed suicides following the loss of a significant love relationship--a breakup they did not initiate. Also, boys tend to have more difficulty with grief over the loss of a loved one such as a parent, grandparent, or other person of prominence.

You have said that because suicide is a violent act, it is more common for males to succeed. Why?

For reasons we don't fully understand, boys choose more lethal methods of killing themselves, and complete suicide attempts at a ratio of roughly 100:1 over girls. Girls often turn to poisoning or overdose, while boys more often choose guns or hanging. One working theory for this difference is that teenage boys tend to be more aggressive than teenage girls, and more prone to acts of violence, and thus more likely to choose an aggressive and therefore more lethal method. Because of social roles, however stereotypical, boys often have more access to lethal means (ropes, hunting rifles, pistols).

Does this mean that suicide attempts by girls are less serious?

Emphatically, no!

Girls attempt suicide much more often than boys, and research has shown that the strength of a person's wish to die is not necessarily related to the method they choose. Also, in the United States, we have ready access to treatment for poisoning and overdose. In countries where such access is limited, completed female suicide attempts far outnumber completed male suicide attempts.

All suicide attempts are serious. All of them.

How does the availability of firearms impact the incidence of teen suicide?

A firearm in the home is considered a separate stand-alone risk factor for suicide. Almost all gun-related teen suicides (over 90%) occur in familiar homes (theirs, a friend's home, or family member's home), with around 75% occurring in the teen's own home.

Consider these facts:

* Gun safety training does not protect teens from the emotions that
  lead to suicide.
* Knowledge of or training in proper usage and handling of guns does
  not prevent suicidal thoughts.
* The availability of firearms allows a teen to act immediately--and
  often lethally--on the impulse to die.
* The presence of a gun in the home increases the risk of suicide for
  teens with or without mental health issues or other risk factors.
* Suicide attempts by firearm are completed 70-80% of the time,
  compared to around 10% for most other methods.
* Some large, longitudinal studies have shown that teens in homes with
  guns are up to 7 times more likely to complete a suicide attempt than
  teens in homes without guns.

Consider this conclusion:

If a parent or supervising adult is not present, a firearm should not be present--period.

What is neuropsychology?

To put it simply, neuropsychology is a specialized branch of psychology that deals with brain-behavior relationships. As a field, neuropsychology is interested in how disturbances in the structure and functioning of the brain or central nervous system affect how people think and act.

Longer, more complicated and official definitions can be found through the National Academy of Neuropsychology's .pdf, or on the American Psychological Association Division 40 website.

How do you, as a neuropsychologist, treat patients differently than a psychologist does?

To ethically practice as a neuropsychologist, I had to have extra training, with classes in neuropsychology in graduate school, classes in neuroanatomy and neurophysiology, a focus on neuropsychology during my internship, and a year of fellowship focusing on clinical neuropsychology.

Neuropsychologists use specialized tests and assessment techniques to identify cognitive and behavioral problems resulting directly from damage to or diseases of the brain or central nervous system. Our patients have emotional, behavioral, social, or thinking problems caused by conditions like brain injuries, strokes, tumors, neurological diseases, developmental disorders, or severe medical illnesses.

Traditional psychological testing or mental health therapy techniques like analysis, insight-oriented therapy, group therapy, or in fact any talking-based therapy often don't work for this population. They don't have the thinking skills, memory skills, or language skills to participate. Because of those special needs, I use more behavioral and educational approaches, and work more with rehabilitation, cognitive retraining, environmental modification, and family/social supports. I can't assume that any problem has just a functional (e.g., non-medical) basis, and I have to modify my treatment frequently.

How is treating teens who have attempted suicide different from treating patients with brain injuries resulting from other kinds of trauma?

Teens with brain injuries from suicide attempts often have fewer family and social supports, as reflected in Jersey's experience in Trigger. Their friends and family members often feel angry or guilty. Caregivers tend to keep too much distance to protect themselves, or too little distance in an attempt to protect the teen--or both! Many people, parents and teachers included, have no idea what to say, or how to treat someone who wears the physical and behavioral scars of trying to take their own life.

Teens who have brain injuries resulting from suicide attempts often have more anger with themselves as well, and more anger at their deficits. They deal in larger measure with guilt over the anguish they have caused loved ones, and essentially cannot escape the immediate memory of the choice they made. Another group, like Jersey Hatch, have difficulty believing or accepting the truth of what they did, because they can't remember the event, or much of the time leading up to the attempt. It doesn't seem real to them, and they become angry with or suspicious of support persons repeatedly insisting that their brain injury resulted from a suicide attempt.

In your book, the main character goes home from the hospital after suffering traumatic brain injury as a result of a suicide attempt, but he does not continue with any kind of therapy. Is that unusual? What kind of support services are/are not available for teens who attempt suicide?

Jersey's experience is typical of teens with brain injury, irrespective of cause, especially in this era of limitations in insurance coverage and managed care. No special provisions are made for the cause of the brain injury. Outpatient care needs are typically focused on functional level and current treatment needs as opposed to why the teen was injured many months--often a year or more--ago. In the real world, by this time in treatment, most people have exhausted their lifetime medical or mental health benefits. If they qualify for Medicare or state-based Medicaid, the services they need might not be covered. If they do not qualify for public assistance, families face loans, debts, severe financial distress, or even bankruptcy to continue care on an inpatient or outpatient basis. In addition, both the injured person and the family are often tired of hospitals, doctors, and medical care.

Jersey goes home after several serial hospital stays, four in fact, and many months of treatment including acute medical care, subacute medical care, initial rehabilitation, and (now more rare and much harder to find) post-acute rehabilitation. He is long past qualifying for "medical necessity" for outpatient physical, occupational, or speech and language therapy. He does need counseling and family counseling, and his family has the resources to afford that care. Unfortunately, Jersey doesn't live in a large metropolitan area like New York, Boston, Chicago, Philadelphia, Los Angeles, or San Francisco. He also does not live near a training center for neuropsychologists, and the therapists at his hospital do not offer outpatient treatment. Thus, the nearest neuropsychologist or therapist competent to work with a teen with brain injury is many miles/towns away, with a long waiting list. This is also typical to real life, as most brain injury associations and hospitals can confirm. The list of available practitioners who will see people with brain injuries is small, and smaller still for adolescents or children.

Even under the best of all possible circumstances, compliance with outpatient treatment recommendations is often 50% or less, and worse if it is up to the brain injured person to set up appointments and provide or arrange their own transportation. Follow-up, continuation of care, and continuity of care represent the largest problems in the service delivery system for persons with brain injury, and these problems are only magnified for adolescents and children, who require even more specialized care.

In Trigger, Mama Rush quotes Pat Parker's poem in Jonestown and other Madness, stating, "Black folks do not commit suicide." Is this true?

As Mama Rush goes on to mention, it is absolutely not true. Suicide rates have been rising steadily among black teens, especially males, and especially black teens from higher socio-economic backgrounds. Suicide rates among Hispanic teens have also been rising, and suicide rates among Native American teens are traditionally high as well. Only Asian teens seem to have a slightly lower suicide rate, while Chinese teens (indeed the entire Chinese population) living in China have rates that may be up to three times higher than other countries.

Has your work with teens who have attempted suicide changed your thinking about the nature of adolescence?

I once thought children were most vulnerable and delicate in infancy, but now I know differently. In my opinion, adolescence is the true crucible, the absolute "moment of truth," and the most difficult period to survive on the journey to adulthood.

My work with teen suicide survivors brings home the depth and severity of pain teens feel when they cope with life's disappointments and tragedies--and the abysmal inadequacy of telling them all things pass with time, or get better when they're older, or any of the other weak platitudes we reach for to minimize the darkness they face.

Working with teen suicide survivors also keeps me constantly reminded of the intense amount of pressure teens struggle to tolerate, and the real and heart-wrenching burdens they bear. I have on occasion instructed parents who minimize or discount these hardships to obtain proper permissions and simply sit in the hallways of a middle school or high school during class changes. Most have come back gray-faced, disheveled, and overwhelmed by what they've learned in just those few key minutes of their teen's day.

It is a grievous error for parents, educators, practitioners, or caregivers--any adult--to judge or weigh teen stress or teen experiences based on their own adolescence. The world moves on, charges on, and those stressors have doubled, tripled. Those experiences have darkened. They come sooner, stronger, and faster now. The best way to judge teen stresses is to listen to the teen. Listen to what they say, what they say they feel, without judging, dismissing, minimizing, or filtering their words through "what I went through when I was young." Listen, watch, and be aware. Those are the best ways I know to understand the nature of adolescence today, as today's teens experience it.