There’s no easy way to say this: In the past decade, there has been a dramatic rise in the number of teens attempting to kill themselves with poison.

The data appear Wednesday in The Journal of Pediatrics, and come from poison control centers. Overall, the study finds the rate of poisoning attempts more than doubled among boys and girls.

Girls, however, account for most of the rise. The study finds poisoning attempts by girls ages 10-12 increased 268 percent from 2010 to 2017, for instance. For girls ages 13-15, the poisoning rate increased 143 percent.

Overall, it’s estimated that in 2018, close to 60,000 girls ages 10-18 tried to poison themselves. In 2008, that figure was closer to 30,000.

The current study doesn’t describe the poisons used (that analysis is forthcoming), but anything from too many gummy vitamins to a high dose of opioids can be considered a poison if the intent was self-harm.

The following is one of the most heart-wrenching set of graphs I’ve seen in an academic paper. In red, are the number (and rate) of girls poisoning themselves in suicide attempts since the year 2000.

The first one shows boys and girls ages 10-12; the second one shows boys and girls 13-15.

The Journal of Pediatrics

Another graph in the paper shows 29,000 girls ages 16-18 poisoned themselves last year — and it’s a significantly higher rate compared to 2011.

The Journal of Pediatrics

The report finds upticks in women ages 19-24 as well.

The Journal of Pediatrics

In general, attempts by poisoning are only fatal less than 5 percent of the time. In this study, which looked at all suspected self-poisonings from 2000 to 2018 in people ages 10-24, there were 1,627,825 poisonings and 1,404 deaths.

The results are a wake-up call to the unsettling scope of the suicide crisis among teens in the United States. Deaths, says John Ackerman, a study co-author and Suicide Prevention Coordinator at Nationwide Children’s Hospital, “are just the tip of the iceberg” of pain. Underneath that, “you got attempts, and millions of kids are entertaining the idea that life might be better if they weren’t alive.”

Though researchers don’t have a clear explanation for this sudden uptick, they’re adamant that it must be addressed. Because as this latest data shows, the trends show no recent signs of abatement. It should be a wakeup call.

Teen suicide is still rare in America. But it is increasing.

Around 16 percent of adolescents, the CDC reports, consider suicide in a given year. “That’s an epidemic,” says Mitch Prinstein, the director of clinical psychology at the University of North Carolina Chapel Hill, who was not involved in this research.

But it’s definitely a tough one to talk about. And if we talk about it carelessly, we might make the problem worse. Just this week, a study found the television show 13 Reasons Why — which depicted a young girl taking her own life in retaliation for bullying at school — might have led to a small uptick in suicide deaths.

One thing that can put a person at risk for suicide, researchers warn, is exposure to the idea that suicide is an effective way to deal with their problems. It can be harmful to expose young people to “blueprints for how to harm yourself,” Ackerman says, or the notion that suicide is common.

The problem is big enough that policymakers now need to take it much more seriously.

Between 2009 and 2017, the number of high schoolers who contemplated suicide reportedly increased by 25 percent. Deaths by suicide among teens increased by 33 percent in that time period as well. Suicide is now the second-leading cause of death among teens after accidents (traffic, poisoning, drownings, etc). It’s important to stress: Teen suicide deaths are still rare. Just 10 out of 100,000 teens ages 15 through 19 die this way. But even a single death is one too many. And all the attempts, anguish, and depression that can lead to them needs to be dealt with too.

While adolescent girls tend to poison themselves in suicide attempts more often than adolescent boys, boys tend to turn to more lethal means, like firearms. The result is that while girls attempt to take their lives more often, boys die in higher numbers.

Experts are unsure of the exact cause of these unsettling trends: Hypotheses include stressful fallout from the recession, the changing way teens interact with each other on in digital spaces, increasing social isolation, stressors of the opioid crisis trickling down to kids, suicide contagion, the fact that teens can more easily look up how to kill themselves online, and others. But there does not seem to be one single cause.

“The reason why we don’t know why kids are doing this is because suicide isn’t a single diagnosis, it’s an outcome that many, many paths can lead to,” Prinstein says.

Access to lethal means plays a role, too. Kids are more likely to die from suicide when a gun is accessible. The greater availability of opioids could play a role as well.

We don’t need to know the cause of the increase in suicide and poisonings to help

We may not know the exact cause of the recent suicide trends. But we do know ways to help teens at risk. Therapists can help and science-backed therapies that help (see the sidebar above for resources.) Schools and teachers can help. Parents can help. Friends can help. Anguish is not inevitable.

But as we’re seeing it’s not enough. “Based on the sheer numbers, you don’t have enough psychologists, social workers, counselors, other therapists, to actually physically address the need that is clearly out there,” Ackerman says. “Even if you had everyone in the mental health workforce dealing with treating suicide and life-threatening behaviors, you would not be able to fully address the need.”

So as a society, we can do more to work toward potential policy solutions.

“If you replaced depression or suicide with the flu, then you’d see a flu shot warning on every street corner, urging us it’s a public health crisis,” Prinstein says. “We should be doing screenings, we should be doing education programs in every school. Every parent should be talking to their child about suicide. It’s time for less talk and more action.”

He says teacher and schools need to be better trained to spot kids at risk, and parents need to be comfortable asking their kids directly if they are suicidal.

“There has long been a myth that simply asking a child whether they are suicidal might put an idea into their head, and increase risk,” he says. “And we know now that’s completely not true.”

Kathryn Gordon, a clinical psychologist and researcher who recently left her academic job for a private practice, says parents can learn to “listen in a nonjudgemental fashion.” Just listening, she says, can be a first step.

“As a parent,” she says, it’s easy to want to jump in and start solving the problem immediately. “But kids often view that as dismissive, or discomfort,” she says. “If you’re open and listen, often children and adolescents can start to problem solve on their own, or they’ll ask for help.”

Caring adults can make a difference in saving lives, a recent study showed. But it’s going to take more than just parents, and professional therapists, to help.

States can work with schools to screen more kids for suicide and depression. And there needs to be more funding into research.

In 2017, the National Institutes of Health spent $37 million on research grants for suicide prevention. That’s trivial when you compare it to the $6.6 billion it spent on cancer research. Out of 295 disease research areas the NIH funds, in 2018, suicide prevention ranked 206. Research on West Nile virus — which kills around 137 a year — is ranked higher. In 2017, the Centers for Disease Control and Prevention reported there were 2,877 deaths by suicide among those ages 13 through 19 across the whole country.

Interventions “have to start early — even elementary school,” Ackerman says. “And certainly by middle school, you need to be getting into what to look for how to respond.”

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