While much media attention has been focused on the fact that gun-wielding students killed 28 people in school shootings in the past three years, scant attention has been paid to the 2,000 teenagers who kill themselves every year.
“Suicide is the end stage of depression that hasn't been effectively treated,” notes Martin Glasser, a Phoenix child and adolescent psychiatrist and a spokesperson for the American Association of Child and Adolescent Psychiatrists (AACAP).
Indeed, some say many of the boys who went on the shooting rampages were acting out depression in suicidal ways. “I don't care if I live or die,” shooter Eric Harris had written on his Web site before the April 20 shooting at Columbine High School in Littleton, Colo.
A week later, T. J. Solomon, a 15-year-old at a suburban Atlanta high school, told a friend, “I have no reason to live anymore” after his girlfriend broke up with him. Three weeks later he opened fire on classmates, injuring six students. Solomon was on the verge of suicide when he was disarmed.
“While depressed and suicidal kids and adults can engage in violent and destructive behavior,” says David G. Fassler, author of “Help Me I'm Sad,” “homicidal behavior, thankfully, is relatively rare.”
A recent study in the Journal of the American Medical Association found that adolescents diagnosed with depression as youths were 14 times more likely than their healthy peers to commit or attempt suicide during their lifetime.
“One child in four thinks about suicide at least once a year,” says Fassler. “By the end of high school, one child in 10 has actually made at least one suicide attempt, and usually the parents and teachers don't know about it.” Some experts say for every child who commits suicide, up to 100 have tried and failed.
According to federal health statistics:
-- The rate at which Americans ages 15-24 commit suicide has tripled over the past four decades, from 4.5 per 100,000 in 1950 to 13.3 in 1995. Among children under 15, the rate quadrupled.
-- In 1996, suicide was the third leading cause of death among Americans ages 15-24 and the fourth leading cause of death among those 10-14.
-- Hispanic girls are twice as likely as non-Hispanics to commit suicide, and homosexual and bisexual adolescents also have much higher rates of suicide than heterosexuals.
-- Up through age 14, boys and girls kill themselves at about the same rate, but after that boys are six times more likely than girls to commit suicide.
Girls actually attempt suicide more than boys, but boys are more successful because they choose more violent means, Fassler points out. “Boys shoot themselves or crash their cars into trees,” he says. Girls take overdoses or slit their wrists, he says, which are less-effective methods.
That may change, says child psychiatrist Diane Schetky, of Rockport, Maine. “Guns are becoming the favorite means of suicide for girls,” she says.
Children apparently are starting to think about suicide at younger ages. “We've seen children who express thoughts of suicide as young as 4 and 5 years of age,” says Glasser. In children that young, he says, the precipitating event is usually a divorce. “When you ask a child to choose between parent A or parent B, it can create tremendous feelings of desperation and hence depression, or acting out on self-destructive thoughts.”
Others say suicide rates have escalated because kids today have greater access to effective methods of killing themselves -- drugs, cars and weapons. “Historically, a suicidal person would have taken an overdose of pills, which is often unsuccessful. Now they have access to firearms,” says Glasser.
Many argue that the escalating suicide rates prove that more kids are depressed today than at any time in history, and thus the skyrocketing rate of antidepressant prescriptions for kids is justified.
Others are not so sure. David Shaffer, a professor of psychiatry at Columbia University School of Medicine and an expert in suicide, points out that suicide rates are cyclical and have recently begun to go down. They began declining for whites -- more dramatically for boys than for girls -- in 1988 and for blacks in 1994.
“The drug companies like to claim that these recent declines are due to the increases in the use of the new antidepressants among kids,” he says. “But there's no evidence of that.”
For one thing, he says, the decline is part of a worldwide pattern. Secondly, recent dramatic declines in suicide rates have been limited to boys. The suicide rate for females has been almost static for the past decade, he points out. “It never went up, and it never went down,” Shaffer says. “If the declines were due to medication we should have seen a decline in the female suicide rate, especially since girls are more likely to seek help when they are depressed, and antidepressants are only available through prescription.”
Instead, he suggests, variations in suicide rates across time are probably drug- and alcohol-related. Alcohol can cause depression, especially when taken intermittently and in large quantities, like the binge drinking done in high school and on some college campuses, he says. “Binge drinking plays havoc with your mood,” says Shaffer.