Talking About 13 Reasons Why & Teen Suicide: Tips for Parents

When the Netflix series “13 Reasons Why” premiered in March 2017, it quickly became one of the most watched—and most controversial—shows of the year. It was no surprise that the news of Season 2’s May 2018 release continued to get a lot of attention.

The drama-mystery centers on a high school student who commits suicide and leaves behind 13 audiotapes for people she blames for her action. Season 2 picks up as the community tries to deal with emotional and legal fallout from the suicide.

Raising Awareness–and Risk?

Fans of the series say it increases much-needed awareness about teen suicide, which is currently the second leading cause of death for children and young people 10 to 24 years old.  In addition to graphic portrayal of suicide, the show also focuses on bullying and cyberbullying, underage drinking, sexual assault, guns in the home, and other topics that can serve a tool to start discussions.

But some experts warn the show may do more harm than good. Although the series is fictional, teens can be impulsive and emotional. Watching a character decide suicide is the best option might trigger them to do the same. Researchers found a significant spike in internet searches using terms such as “how to commit suicide” and “how to kill yourself” for 19 days following the release of season 1 of “13 Reasons Why.”

Medical and mental health professionals also report teens listing their own 13 reasons why they wanted to kill themselves. Some families say they believe the show triggered their children to actually take their lives.

Critics of the show point to research that suggests exposure to a peer’s suicide can have a “contagious” effect—especially among 12- to 13-year-olds. There is specific public health recommendations for reporting on suicide in the media that this series goes against:

  • Presenting suicide as a tool for accomplishing certain ends, such as revenge or recognition.
  • Glorifying suicide or persons who commit suicide.

Who’s Watching?

The series is rated TV-MA (Mature Audience), appropriate for ages 17 and up, for its graphic violence, explicit sexual activity and crude language. But school officials and pediatricians say they’re learning of children as young as elementary-school age who are binge watching the show—sometimes without parents knowing, because it can be streamed privately on their phones, tablets, and computers. Parents are often surprised to find out their child has watched the series.

“It has come up quite a bit when I’ve been talking to my patients, especially those who’ve been depressed or anxious,” said Cora Breuner, MD, MPH, FAAP, a pediatrician and chair the American Academy of Pediatrics (AAP) Committee on Adolescence. “Quite a few of them already watched ’13 Reasons Why’—without the knowledge of their parents,” Dr. Breuner said. “It’s usually a major aha moment in my office, when the parents look at their kids and say, `Wait a minute, you watched that?'”

As a parent, it is your job to counsel your children and teens about smart and safe media use. Dr. Breuner said she also asks her patients (and their parents) how much time they spend on screens and what shows they watch.

Even if your child hasn’t watched…

Parents should be aware that their child may hear friends talking about the show at school or on social media—even if they haven’t seen it themselves. Regardless, Dr. Breuner said the series is “absolutely inappropriate” for children under age 13.

If you haven’t watched the show, look up episode summaries and be prepared talk with your child about the ways fictional shows don’t always reflect reality. Use the show as an opportunity to talk with your child about the very real situations teens face—and how your child can come to you with anything he or she may face in the future.

How to Help Teens Process the Show in a Safe & Healthy Way:

Despite concerns about ’13 Reasons Why,’ the show can serve as a powerful teaching tool with informed, adult guidance from parents, teachers, spiritual leaders, and others who work with teens.

What parents can do:

  • Co-view. The AAP media use guidelines encourage parents to co-viewing programs with their children and discuss values. This is especially important for shows such as ’13 Reasons Why’ with themes difficult to process and easy to misinterpret. Watching the show together lets parents pause and point out instances of cyberbullying, for example. Then parents can ask if their child has seen it happen at school, how he or she reacted, and what to do if it happens again. ​
    • Children in groups at a higher risk for suicidal thoughts and actions should not watch the show alone, Dr. Breuner said. This includes kids with a family history of suicide, a history of physical or sexual abuse, mood disorders, and drug and alcohol use, and/or those who identify as lesbian, gay, bisexual, transgender or questioning.
  • Discuss reality vs. fiction. Explain that the show gives an unrealistic view of the help available for teens who may feel suicidal. In particular, the lack of effective mental health care provided to lead character, Hannah Baker, is both troubling and unrealistic. Statistics show that a large majority of the time, teens with suicidal thoughts and behaviors are in the grips of treatable mental illnesses, such as depression. In the show, Hannah voices clear suicidal warning signs to her school guidance counselor. Yet, the counselor failed to connect her with other professionals and resources for help and told her simply to “move on.” Critics say this sends a dangerous message that adults can’t help.
  • Play it safe. If your teen does watch the show, make an extra effort to watch him or her a little more closely afterwards—in a mindful, nurturing way. Know the signs of depression, such as withdrawing from friends or family, eating or sleeping less or more, or losing interest in activities.
    • If you have a gun in your home, make sure it is stored unloaded and locked up separately from ammunition. Studies have found the risk of suicide is 4 to 10 times higher in homes with guns than in those without. And although Hannah Baker uses a different method to end her life, suicide by firearms is now the second leading cause of death among teens 15-19. More than 80% of guns used in teen suicide attempts were kept in the home of the victim, a relative, or a friend.
  • Provide access to help. Give your child su​​​ggestions for whom he or she can turn to in times of need—including you, as well as other trusted adults. Your pediatrician can also help. The American Academy of Pediatrics recently recommended all children over age 12 be screened for depression at their annual wellness exams. For any immediate concerns about your child, call the National Suicide Prevention Lifeline is 1-800-TALK, or text START to 741741.

Keep in Mind:

It may feel uncomfortable to talk with your teen about some of the difficult issues raised in “13 Reasons Why,” but talking about tough topics with teens is every bit as important as making sure a baby’s bath water isn’t too hot. Remember to talk with your child’s pediatrician if you have additional questions or concerns about your child’s media use or mental health.

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Youths Treated for Non-Suicidal Self Harm at Increased Risk of Suicide Within a Year

New research in the April 2018 Pediatrics found that youths treated for deliberate but non-suicidal self-harm, such as cutting, were more than 25 times as likely than demographically matched peers to die from suicide within the following year.

The study, “Suicide Following Deliberate Self-Harm in Adolescents and Young Adults” (published online March 19), followed 32,395 patients between ages 12 and 24 who were enrolled in Medicaid between 2001 and 2007. The risk of suicide within a year of self-harm varied considerably by age, race and other factors. It was more than four times higher for males (338.8 per 100,000) than for females (80.2 per 100,000). In addition, the risk was markedly higher for American Indians/Alaskan Natives than for non-Hispanic white patients, and for patients who patients who used more violent methods of self-harm, especially firearms.

The study also revealed differences among adolescents and young adults who were treated for the initial self-harm. Although depression and anxiety diagnoses were common in both age groups, for example, adolescents with self-harm were far more likely to have been recently diagnosed with attention deficit hyperactivity disorder (ADHD) and other disruptive behaviors, while young adults more commonly had substance use and personality disorder diagnoses.

Authors of the study said their findings underscore the importance of follow-up care for youths treated for self-harm to help ensure their safety.

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Suicide prevention

If you know someone who is at immediate risk of suicide, call 911 right away. Someone who wants to kill herself should see a doctor, nurse, or mental health professional right away.

If you know someone who might be suicidal, show that you care by:

  • Talking to the person. Your willingness to talk about thoughts of suicide with a friend, family member, or co-worker can be the first step in getting her help and preventing suicide. You won’t increase the risk of someone dying by suicide by talking to her about your concerns.
  • Sincerely listening to the person. Do not offer advice or judgment, but let her know she is not alone. Don’t worry about saying the exact, correct thing. Your presence in the person’s life is what is most helpful.
  • Sharing your concerns. If you feel that she may make a reckless decision, say that you are worried. The person needs to know that she is important to you and that you care.
  • Finding out if the person has a suicide plan. If the person has a definite plan, don’t leave her alone, and get help from other friends or family.
  • Offering help to find a professional counselor. Many counselors or therapists can see a new patient in an emergency. A person’s insurance plan, doctor, or nurse may be able to recommend someone right away.
  • Calling the National Suicide Prevention Lifeline, 1-800-273-TALK (8255)

It can be difficult when a loved one says she is thinking about suicide. All you can do is be supportive and let her know you care. You cannot control or change someone else’s behavior, no matter how much you love her. If a loved one commits suicide, it is not your fault.

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Make the Difference: Preventing Medical Trainee Suicide

Pressure in the high-stakes environment of medical training can be overwhelming. This video from Mayo Clinic and the American Foundation for Suicide Prevention explains how everyone can help prevent suicide by being alert for the signs of depression and escaping stress and how to be most helpful.

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To find like minded healthcare professionals, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up to be an in-network provider, connect with your fellow consituents, and securely share health records with your patients. Download our HealthLynked app available on Apple and Android devices.

The Often Misunderstood Diagnosis of Post-Traumatic Stress Disorder

PTSD stands for Post-Traumatic Stress Disorder and is a condition that many veterans and non-veterans alike suffer; PTSD can occur when someone experiences or witnesses a traumatic event. This condition wasn’t always understood properly by the medical or military community, and Department of Defense press releases often point to earlier attempts to identify PTSD symptoms in the wake of service in World War 2, Vietnam, and other conflicts.

PTSD Awareness Day is observed today, Wednesday, June 27, 2018.

The History of PTSD Awareness Day

In 2010, Senator Kent Conrad pushed to get official recognition of PTSD via a “day of awareness” in tribute to a North Dakota National Guard member who took his life following two tours in Iraq.

Staff Sergeant Joe Biel died in 2007 after suffering from PTSD; Biel committed suicide after his return from duty to his home state. SSgt. Biel’s birthday, June 27, was selected as the official PTSD Awareness Day, now observed every year.

How Do People Observe Post-Traumatic Stress Disorder Awareness Day?

Much of what is done to observe PTSD Awareness Day involves encouraging open talk about PTSD, its’ causes, symptoms, and most important of all, getting help for the condition. When today, PTSD is often misunderstood by those lacking firsthand experience with the condition or those who suffer from it. PTSD Awareness Day is designed to help change that.

The Department of Defense publishes circulars, articles, and other materials to help educate and inform military members and their families about the condition. The Department of Veterans Affairs official site has several pages dedicated to PTSD, and when military members retiring or separating from the service fill out VA claim forms for service-connected injuries, illnesses, or disabilities, there is an option to be evaluated for PTSD as a part of the VA claims process.

What Is Post-Traumatic Stress Disorder?

The current American Psychiatric Association’s Diagnostic and Statistical Manual, DSM-IV, says PTSD can develop through a range of exposures to death or injury: direct personal involvement, witnessing it or, if it concerns someone close, just learning about it.  Post-traumatic stress disorder is a form of anxiety that can happen after experiencing or witnessing actual or near death, serious injury, war-related violence, terrorism or sexual violence.  While most people typically connect this disorder to military veterans or refugees, it can happen to anyone.

Almost no other psychiatric diagnosis has generated as much controversy.  The diagnosis is almost four decades old.  PTSD is not a sign of weakness, and people can be affected by PTSD even when they were not directly part of the traumatic event.

The specific nature of the trauma can and does vary greatly. Experts are quick to point out, while combat and combat-related military service can be incredibly challenging, and while witnessing or being a victim of an event that rips the fabric of daily life can be traumatic, not everyone responds the same way. Some may develop symptoms of PTSD, while others may be unaffected.

Post-Traumatic Stress Disorder: How Widespread Is It?

Some sources estimate that as many as 70% of all Americans have experienced a traumatic event sufficient to cause PTSD or PTSD-like symptoms. That does not mean that all 70% of Americans WILL suffer from PTSD. Using these statistics, some 224 million Americans have experienced a traumatic event. Of that number, some 20% will develop PTSD symptoms, roughly 44 million people.

Of that 44 million, an estimated eight percent experience active PTSD symptoms at any one time. An estimated 50% of all mental health patients are also diagnosed with Post-Traumatic Stress Disorder.

PTSD: Often Misunderstood and Misidentified

“Shell shock” and “combat shock” were earlier attempts to define and understand the symptoms of PTSD. Post-traumatic stress disorder was often stigmatized in popular culture after the Vietnam conflict, and many films and television shows featured antagonists or unsympathetic characters suffering from “Vietnam flashbacks” or other issues.

The misunderstanding of PTSD slowly began to change in 1980 when it was recognized as a specific condition with identifiable symptoms. It was then the disorder was listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

This manual is a diagnostic tool for mental health professionals and paraprofessional workers in the healthcare field and is considered a definitive reference. The addition of PTSD to the DSM was a highly significant development.

Today, the symptoms of Post Traumatic Stress Disorder are better understood, treatable, and recognized by the Department of Veterans Affairs as a service-connected condition. PTSD is not exclusive to veterans or currently serving members of the United States military, but a portion of those who serve are definitely at risk for PTSD.

What Are the Symptoms of Post-Traumatic Stress Syndrome?

Some PTSD symptoms may seem vague and non-specific, others are more readily identified specifically as evidence of PTSD. In this context “non-specific” means that the symptoms may be related to other mental health issues and not specifically limited to Post-Traumatic Stress Disorder.

In the same way, more “specific” symptoms may be manifest outside PTSD, but when looking for specific signifiers, these issues are common “red flags” that indicate PTSD may be the cause of the suffering rather than a different condition. This is often circumstantial, and there is no one-size-fits-all diagnosis for the condition.

Suicidal thoughts or self-destructive acts are often a result of PTSD or related symptoms. Anyone experiencing thoughts or urges to self-harm should seek immediate care to prevent the condition from getting worse in the short-term. (See below)

That said, more non-specific symptoms include varying degrees of irritability, depression, and suicidal feelings. More specific problems-especially where veterans and currently serving military members are concerned-include something known as “hypervigilance” or “hyperarousal”.

Other symptoms include repeatedly experiencing the traumatic event(s) in the form of flashbacks, nightmares, persistent memories of the event(s), and intrusive thoughts about the traumatic event(s).

These symptoms vary in intensity depending on the individual and are not ‘standardized”. They may come and go, or they may be persistent over a span of time. Sometimes PTSD sufferers can be high-functioning, other times they may be more debilitated by the condition.

Get Treatment For PTSD

Those who experience symptoms of PTSD or PTSD-like issues should seek help immediately. Department of Veterans Affairs medical facilities, private care providers, counselors, and therapists can all be helpful in establishing an initial care regimen or refer those suffering from PTSD to a qualified care provider.

The Department of Veterans Affairs has more information on help for PTSD on its’ official site including help finding a therapist.

Those experiencing suicidal feelings or self-destructive urges should get help immediately. The Suicide Crisis Hotline (1-800-273-8255) has a specific resource for veterans and the Department of Veterans Affairs offers a Veterans’ Crisis Hotline confidential chat resource.

To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.

Adapted from https://militarybenefits.info/ptsd-awareness-day/

Teen Suicide Prevention

In this video created by Mayo Clinic, teens describe common signs that a teen is considering suicide and provide encouragement for communicating directly and immediately for support and safety. It also Includes suggestions for what to say to a teen who may be at risk for suicide and ways to keep them safe. Things can get better.

For more information-
Call: 1-800-273-TALK, 1-800-273-8255
Visit: http://www.suicidepreventionlifeline.org/

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To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.