Kevin: Even before the pandemic, suicide was the second leading cause of death among young people ages 10 to 24. Teenage emergency room visits for suicide attempts have risen sharply since 2020, with a 50% rise in cases involving young women alone. What has been driving these startling increases? What can we do to reverse the trends? And is there more that our schools can do to help identify and intervene with at risk kids before they attempt to hurt themselves or others? This is what I want to know.
Kevin: And today I'm joined by Dr. David Brant to find out. Dr. David Brant is a distinguished professor at the University of Pittsburgh School of Medicine. He is also the endowed chair in suicide studies. In addition to those roles, Dr. Brant is the academic chief of Child and Adolescent Psychiatry at the Western Psychiatric Institute and Clinic, and he directs services for Teens At Risk, an organization focused on suicide prevention, education and treatment of at risk youth and their families. Dr. Brant is with us today to discuss more we can do to help combat a problem that is reaching epidemic proportions. David, welcome to the show.
Dr. Brent: Thanks for having me.
Kevin: I want to talk about your work, which I think having read a lot of what you've done about what you've done and even some of your writings is so profoundly important for the country. But I also want to ask you about your background and, you know, why you decide to be a doctor. And and I guess more significantly, why choose the area of psychiatry? Because clearly that was a path that you were drawn to.
Dr. Brent: Well, I became a doctor because my parents practically insisted upon it and I had second thoughts. But then my draft number was five during the Vietnam War. So that motivated me to stay in medical school. And, you know, I like pediatrics, but of all the things that I did, I like the emotional part of of medicine. And so I like hearing about people's stories and the idea that you could help somebody without any technology. Appealed to me.
Kevin: What's fascinating about this particular area. Being a physician, a psychiatrist, and then with a specialty in suicide prevention. Many people would look at that and say, wow, that that can be a downer profession. But you've actually found it to be a motivator in terms of trying to find solutions.
Dr. Brent: It can be a conversation stopper when you ask somebody. When somebody asks you what you do. But, you know, it really it's based on the premise that life is precious and each life is precious and. The way I got interested in it, I kind of backed into it. I was working on an inpatient unit at a children's hospital, and my job was to decide which kids who had made a suicide attempt needed to go to the psychiatric hospital and which kids go home. And I realized I really I didn't have any guidance about how to really make a good decision. And you know, at one point, one of the parents asked me how I was making my decisions, and I kind of evaded the question. But I realized, like, this is pretty important. I ought to know more about it. And when I went to the library, which people did in those days. I was shocked that there was very little written about it. And so I decided that was something I wanted to pursue.
Kevin: That's pretty powerful because. You know, you mentioned that when you tell people your profession, that can be a conversation, conversation starter. But that reality, I think, in the past is always impacted on on research to some extent, you know, and and figuring out how to deal with those tough questions. You've taken that on and you looked at some of the behavioral aspects of young people that lead to potential suicide. Talk a little bit about your work as it's evolved to the point where you're able to at least begin to identify those signs.
Dr. Brent: I mean, it all wasn't based on my own work, but the work that we did was we did something called a psychological autopsy where we would interview the kids, friends, siblings and parents of kids who had died by suicide and then a comparison group. And through that, we were able to characterize what were the things that seemed to lead up to a suicidal crisis. And we were also trying to differentiate them from kids who were suicidal, but who had not, you know, taken their lives. And so we were able to identify some. Factors that differentiated the two groups, which gave us a bit more of a of a basis for deciding who was really at high risk.
Kevin: Now, what factors did you discern from your work that demonstrated the potential for a suicide attempt?
Dr. Brent: So one thing was the degree of planning. Although kids suicide still are often impulsive, there was more preparatory behavior, more planning, more timing so that they wouldn't be found. They were more likely to have access to a gun. Which, if they did have access, was something that they used in their suicide. They were more likely to have a mood disorder in combination with something else like substance abuse. And many of them had a bipolar disorder, a significant minority. And so that what you had is a mixture of kids who were despondent and depressed, but also impulsive and more likely to act on a suicidal impulse.
Kevin: Now, you also in that study, you and the other folks working on it were able to come up with an excuse, you description, magic words, you know, that folks would use. And if that would give you some idea about where they were headed in terms of intent, you understand what I'm saying? That careful, like, you know, they would say words that would lend you to think that they were more serious about the effort than others.
Dr. Brent: It was a a word or two, I think it was a description of their, you know, the fact that they had planned something and and. You know, so a kid who, like, saved up their medication for a month, you know, and then made a suicide attempt is a lot more worrisome than a kid who might have just got upset. And not that that also isn't serious, but that just got upset and took whatever it was available. The first person had a much more, you know, serious plan. And the other thing is that after a kid makes a suicide attempt, the kids who regret having survived you really worry about.
Kevin: Let me ask you this. You mentioned technology earlier, and there is there has been a growing role of technology in terms of even artificial intelligence, machine learning. Talk about how that's been utilized in helping with some of the studies.
Dr. Brent: Well, I don't think we've gotten to the point where we're able to apply it yet. But there are a number of individuals. We are one, but there are others who've done it before us that, for example, take a large number of health care records and then link the data in the records to either an outcome of suicide attempt or suicide. And machine learning basically is a way of taking a large amount of data and training the an algorithm to be able to accurately classify people either into having made an attempt or not or dying by suicide or not. And then you're able to develop an algorithm that it can classify people as in terms of their suicidal risk.
Kevin: Now, you've been doing this a long time, David, and the world has changed immensely since you started this work. And I think you've you've written or talked about the impact of of social media on young people and even in terms of the impact on suicide attempts. Talk about social media and and how that has changed the game, if you will, as it relates to kids who may have this tendency.
Dr. Brent: So I think there's still a fair amount of controversy about the degree to which social media is. Involved in suicidal behavior. We know just globally that the United States is a bit of an outlier in terms of our youth. Suicide rates are going up, but many other countries that are not and social media is ubiquitous, you know, not just in this country. So it's it's it's a little hard to say that it's being driven just by that. But having said that, there are some aspects of social media use that seem to be deleterious. One is the amount, if somebody is on it a lot like to more than 2 hours a day, if there's an addictive quality to it where they can't really seem to disengage. Kids that are being cyber victimized, who often have difficulty disengaging from so that they, you know, keep getting retraumatized. Kids who are on social media instead of sleeping also puts that puts them at risk. And it seems that it depends on the way people use social media so that kids who are communicating with other kids, commenting, you know, on their, you know, posts in a positive way, it actually may be protective for people. But kids who are using it as social comparison kind of lurking and saying, Oh, everybody else looks happy except me. I think they're that that seems to be a problematic.
Kevin: What about this notion of the United States and the suicide riots among our students compared to other countries around the world? You alluded to that. Why is that?
Dr. Brent: I wish I knew. I mean, there are other countries that also have a rising rate, South Korea. Some of the eastern European countries. But all of them seem like they have pretty different circumstances from one another. So in the United States, one thing that I think may be a factor that hasn't been talked about that much is the opiate epidemic. So, you know, if you have parents that are, you know, impaired, it's going to affect the kids and. We know for a fact that parents who that kids whose parents abuse opiates have a higher rate of suicide attempts. I don't. Yeah. I don't know how much of the of this we can explain, but but it probably is part of the issue.
Kevin: I also wanted to ask you about when you talked about patterns and factors that seem to be more evident with young people who attempt suicide. It. It bears noting that access to guns is an unavoidable aspect of this, and there's a lot of politics around this. But is it your view that if young people had less access to guns, there would be less suicide attempts?
Dr. Brent: I think to some extent, the fact of the matter is that the rate of suicide by hanging is going up and the rate of suicide by guns is going down in young people.
Kevin: And why.
Dr. Brent: Is it? I have no idea. But but it's guns are still the majority of suicides. So I would say yes, because almost any other method is reversible. You know, if you overdose and you get guns, you know, a very, very high fatality rate.
Kevin: Another impact that, you know, I've read about and I wanted to get your thoughts on it is the pandemic and how we've seen this rise. How much has that been a contributing factor, in your view?
Dr. Brent: Well, we don't have the I think we have the suicide rates for 2019. I don't know if we have also for 2020, the last couple of years, the rate has dropped and. So I'm not sure. One would expect, though, that with the pandemic that you would see an increase in suicide. There's been an increase in opiate overdoses for sure. So I don't think we know yet. We know that there's been an upsurge in suicidal thoughts and in suicidal behavior. So it would follow that. It would also affect the suicide rate. But I don't think we know yet.
Kevin: And we also know that there's been more prominence and attention given to overall student mental health over the last couple of years. But whether it rises to the level of of suicidal thinking, as you said, we we don't know.
Dr. Brent: Well, I think the difficulty there is. First of all, kids derive social support from school, although sometimes school is stressful. So the isolation is problematic for kids where there were school based mental health or other kinds of support services. They then didn't have that. So that was also a problem. And, you know, we probably although I think many attempts at trying to control COVID were well-meaning, you know, we may have overshot things as far as school, you know, school shutdowns and so on. And I think that in the end, you know, some of that was harmful for kids.
Kevin: Speaking of schools, what more should schools be doing? I know there's been talk about safety plans and the like, but as you mentioned earlier, oftentimes kids who have these these thoughts, they confide in a friend at school or it it emerges or as I said earlier, it's exacerbated by challenges at school. So what would be your message to school leadership in terms of this issue?
Dr. Brent: Teachers and schools are already so overburdened and are, you know, struggling to just meet their core. You know, requirements. So I hesitate to say now they should be doing this, that or the other thing as well. But I think to the extent that you can co-locate mental health services. In school or have nurses that have some psychiatric, you know, expertise so that if you have something worrisome, you know, you you there's a low threshold for checking it out. And there are preventive programs that work. There are programs some of them are cost free in schools. Programs that, you know, prevent substance abuse and promote prosocial behavior that are relatively inexpensive, that are protective against a range of mental health problems. And there there actually are ones that focus on what do you do if a friend discloses to you that they're suicidal or depressed? And, you know, it's a bit broader than that, but that's a large part of the focus. And there are a couple of those types of interventions that have been tested and shown to cut the suicide rate in high schools in half.
Dr. Brent: If I follow up.
Kevin: Yeah, that's phenomenal.
Dr. Brent: Yeah.
Kevin: And along those lines, Dr. Brant, I have one more question. This is what I really want to know when it comes to parents. What advice would you give them in terms of what they should do if they see or believe their children or their child has suicidal tendencies?
Dr. Brent: So they should ask directly if they're concerned and and then try and get their kid evaluated either by their pediatrician, family doctor, if you can get into a therapist to get an evaluation. And if the kid bucks at it, you know, saying, look, we're not talking about, you know, a year of therapy. Just we just want to get a better idea about what's going on and then we can negotiate about what we're doing. And I think there are also things, you know, upstream that families can do. I realize, you know, there's a lot of economic stressors that make it difficult to do, but. If families eat together, you know, if they try and do some pleasant things together. I mean, I think that part of the issue about not knowing what's going on with your kid is that this is an age when kids start to pull away from their parents. And so that if you don't have like this matrix of some, you know, relationship where they would feel safe disclosing, then a lot of times parents, you know, not through their own fault, don't find out. So that I think, you know, having family meals and having some kind of involvement that's regular and routine then makes it easier for kids to disclose when there's something difficult that's going on.
Kevin: Yeah, that makes a lot of sense. And in fact. You know, avoidance doesn't work. There has to be direct communication. And creating that environment, as you mentioned, is probably the most helpful way to ease that comfort level in having these conversations. Dr. David Brant, appreciate your work and thank you so much for joining us on what I want to know.
Dr. Brent: Well, thanks. This was a pleasure and I learned some things, too.
Kevin: So thank you. Thank you. Thanks for joining what I want to know. Be sure to follow and subscribe to the show on Apple Podcasts, Spotify or your favorite podcast app. And don't forget to write a review to explore other episodes and dive into our discussions on the future of education. Also encourage you to join the conversation and let me know what you want to know using hashtag W.E. Wbtc on social media. That's hashtag why wttc on social media? For more information on stride, visit Stride Learning Rt.com. I'm your host, Kevin Chavis. Thank you for joining what I want to know.
Meet Dr. Brent
Dr. Brent is a Distinguished Professor of Psychiatry, Pediatrics, Epidemiology, and Clinical and Translational Science at the University of Pittsburgh School of Medicine. He is also the Endowed Chair in Suicide Studies.
In addition to those roles, he is the Academic Chief of Child and Adolescent Psychiatry at the Western Psychiatric Institute and Clinic. And he directs Services for Teens at Risk, an organization focused on suicide prevention, education, and treatment of at-risk youth and their families.
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