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Published in Print: April 12, 2000, as Complex Set of Ills Spurs Rising Teen Suicide Rate

Complex Set of Ills Spurs Rising Teen Suicide Rate

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Two teenagers burst into their Colorado high school one year ago this month and gunned down 13 people. But nearly lost in the avalanche of reaction to the shootings at Columbine High School was the fact that the young men were also on a suicide mission.

PART I: April 12, 2000 Complex Set of Ills Spurs Rising Teen Suicide Rate

Three stories:
Jason Flatt, 1981-1997;
Mekye Malcolm, 1981-1998; and
Kerby Guerra, 1985-1999.


PART II: April 19, 2000
Suicide: Many Schools
Fall Short on Prevention

Prevention: Los Angeles
Reaches Out

One School Strives
To Be Kinder, Gentler

Memphis: A District Under Emotional Renovation

S.D. Psychologist
Alone on the Range

Budget Battles
And Mental-Health Care

Gay Students: A Vulnerable Group

For More Information


About This Series
To Learn More

The high school seniors had meticulously planned their own deaths—down to the last bullet and explosive—for nearly a year. They fashioned homemade pipe bombs and attached them to their bodies, apparently intending to blow themselves up along with the school. But instead, after shooting their victims, they turned their weapons on themselves, punching bullets into their own heads.

"They wanted to do as much damage as they possibly could and then go out in flames," John Stone, the Jefferson County, Colo., sheriff, said that day.

By committing mass murder, Dylan Harris, 18, and Eric Klebold, 17, joined a small group of other American teenagers. In their suicides, however, they had plenty of company.

For every adolescent who opened fire at schools from West Paducah, Ky., to Springfield, Ore., in the past few years, thousands more shot themselves, slit their wrists, or gulped down pills in suicides or attempts.

In the 1998-99 school year, eight students committed homicides in schools, and 26 students died in violent incidents on school grounds. That same year, an estimated 2,700 young people ages 10 to 19 took their own lives.

While suicide rates among adults have steadied or even declined over the past few decades, teenage suicide rates have tripled. In 1960, the suicide rate among 15- to 19-year-olds was 3.6 per 100,000. But by 1990, 11.1 out of every 100,000 teenagers 15 and older committed suicide, according to the U.S. Centers for Disease Control and Prevention.

In 1997, more than 30,000 suicides were recorded in the United States; about 9 percent of those were committed by people age 19 or younger. "Where it used to be your grandfather, now it's your son," said Tom Simon, a suicide researcher at the CDC. He added that more Americans under age 19 now die each year from suicide than from cancer, heart disease, AIDS, pneumonia, lung disease, and birth defects combined.

Likely Victims

Which teenagers are most likely to take their own lives? Federal statisticians say the surge in suicides among the nation's youths is fueled by unprecedented increases in such deaths in certain populations. For example, suicide rates among 10- to 14-year-olds have nearly doubled in the past few decades. And black teenagers are now more than twice as likely to kill themselves as they were just 20 years ago. But white teenagers, particularly boys, still tower over their peers in their rates of self- destructiveness.

For every teenager who commits suicide, 100 more will try. Every year, one in 13 high school students attempts suicide, a 1997 federally funded Youth Risk Behavior Survey found. Half of all high school students report they have "seriously considered" suicide by the time they graduate, the survey says. That's an estimated 700,000 American high school students annually who attempt to kill themselves, and millions who say they have contemplated doing so.

MARK HUSTON, 15: Mark killed himself in a park not far from his Overland Park, Kan., home on Aug. 28, 1995. Mark had been diagnosed with depression; he was receiving counseling and had been prescribed medication.

According to a report released last fall by the U.S. Department of Education, Indicators of School Crime and Safety, 1999,a quarter of the deaths that occur on school grounds are actually suicides. Students who kill themselves on school property tend to do so in highly public venues—such as their classrooms or the school parking lot. Of the 34 students who died violently at school in the 1997-98 school year—the year of the multiple killings in Springfield and West Paducah—nine were suicides.

Teenage girls attempt suicide three times as often as boys do, but males are four times more likely to finish the job. This gender gap, reported in the 1997 survey, reflects the fact that boys tend to employ more lethal means, such as firearms and hanging; girls favor more survivable methods, such as overdosing on pills.

Girls attempt suicide more than boys, experts say, because their act is an effort at communicating their desperation. Boys tend to keep their emotions hidden. "Girls cry out for help, while boys are taught to be tough and never to act like a 'girl,'" said Dr. William Pollack, a professor of psychiatry at Harvard University and an expert on adolescent mental health. As a result, Dr. Pollack said, "boys are so ashamed of their feelings they figure they'd be better off dead" than express their pain.

A small percentage of the increase in teenage suicide rates could reflect improvements in reporting over the past few decades, according to Lloyd Potter, an epidemiologist and suicide expert at the CDC. But, Mr. Potter said, rates have been and continue to be artificially low because suicides are often masked or misclassified.

A child's suicide is often camouflaged by parents who rearrange the site of the death or hide suicide notes. And some medical examiners classify a death as a suicide only when a note is found, something that occurs in less than a third of all cases.

"There's no doubt there are families who don't want it to appear on the death certificate, and the coroner obliges them," said Dr. Tom Shires, a trauma surgeon with the National Suicide Prevention Institute in Las Vegas. In some states, Dr. Shires added, the person designated to determine the cause of death may be a lawyer or a justice of the peace with no medical training who is ill-equipped to investigate such cases.

Dr. Shires, who is compiling a comprehensive database on suicide attempts among people of all ages, added that police are often complicit in the undercount of suicides. Law-enforcement officers across the country so consistently record single-car collisions—even those showing no skid marks on the pavement—as accidents that doctors have coined a term for them: autocides. Such misclassification disproportionately affects youth suicide rates because the category of "unintentional injuries," primarily from automobile accidents, represents the leading cause of death for 15- to 19-year-olds in the United States.

Another way suicide is hidden from the record books, say experts who study gangs, is that some teenagers who want to escape gang life but see no way out choose to die the "honorable" way by provoking police to fire at them.

"We call that 'suicide by cop,' " said Gloria Grenados, a psychiatric social worker at Bell High School in Los Angeles, a school whose students are nearly all affiliated with a gang, she said. "There are kids [that survived] who literally tell me they ran to meet the bullets because they so much wanted to die."

Taking note of such subterfuges, U.S. Surgeon General David Satcher recently called suicide "the nation's hidden epidemic." Suicide, Dr. Satcher said as he launched a suicide-prevention campaign last fall, must be destigmatized and addressed as a public-health problem.

Impulsive Youths

Young people are more vulnerable than adults to thoughts of suicide, experts say, because they often don't comprehend in a rational sense that death is final. Suicide notes collected by researchers show children fantasizing about what they will do when they are dead. Young people often see suicide as the end of their problems, not their existence. "The developmental stage of adolescence is consistent with not thinking of the long- or short-term consequences of behavior," said Mr. Simon of the CDC.

Another tenet of child development is that adolescents are risk-takers by nature who change friends, clothing styles, and attitudes constantly and for no apparent reason. Such impulsivity still rules when teenagers want to chuck more than their wardrobes.

But those traits are most often coupled with environmental stresses before a young person decides to commit suicide.

The impetus for inner turmoil in the hearts of American adolescents in recent years cannot be gleaned from superficial clues such as whether a teenager plays violent video games, listens to Marilyn Manson CDs, or dons black trench coats, school psychologists say. Young people, they say, rarely wear their angst so conveniently on their sleeves.

In his 1991 book, The Enigma of Suicide, journalist George Howe Colt writes that searching for a single cause for suicide is as futile as "trying to pinpoint what causes us to fall in love or what causes war."

Finding an answer to the riddle of self-murder is not like tracing the origins of a disease to a single genetic marker. Suicide is more akin to a multicolored tapestry whose yarn must be unraveled strand by strand.

Looking for Reasons

Sociologists and mental-health experts point to a tangle of cultural, psychological, and medical factors that have in the past 30 years fueled teenagers' heightened self-destructiveness: a higher divorce rate, parental abuse, poor impulse control stemming from exposure to television, the availability of handguns, lack of access to mental-health services, and a general sense of isolation and alienation from caring adults both at home and at school.

Some experts argue that the leading reason why young people are more at risk for suicide now than they were a generation or two ago is the decline of the traditional family unit.

The teenage suicide rate began its climb just as the divorce rate started to surge upward in the 1970s. Half of U.S. marriages now end in divorce, compared with 28 percent in the 1960s; 70 percent of children who attempt suicide have parents who are divorced. In addition, the percentage of children living with two parents declined from 85 percent in 1970 to 68 percent in 1996, federal statistics show.

The dissolution of a two-parent family, whether from divorce, desertion, or the death of a parent, makes children more vulnerable, experts say. Ultimately, though, it's the quality of the parenting, not the constitution of the family unit, that matters most, children's advocates say.

Whether married, divorced, or single, most parents are now working more than in the past and, as a result, have far less free time to spend with their children.

"We are benefiting in this society from everyone working, women working, the gross-national-product productivity per dollar increasing," said Kevin Dwyer, the president of the National Association of School Psychologists. "But now kids are growing up without the supports they had in the past." The term "latchkey kid," for children left to fend for themselves at home after school, was coined in the 1980s.

To fill the parenting void and the decreasing ratio of caring adults to children, television increasingly has become children's stalwart companion after school. Parents spend an average of just two minutes a day communicating with their child, while the TV set spends an average of 31/2 hours a day with that child, Mr. Colt writes in his book.

Studies are mixed on how exposure to media images of murders and assaults affects children's behavior, though many youth advocates are convinced that violent television shows, movies, and computer games inflame destructive tendencies. More than 86 percent of television shows and movies depict characters who solve interpersonal problems with violence, according to NASP.

By the end of elementary school, the average child will have witnessed more than 100,000 acts of violence on television, including 8,000 murders, according to the Center for Media Education in Washington.

Served the common fare of shootouts and knifings on TV, children come to believe that violence is an appropriate solution to problems, Mr. Dwyer said.

In today's media-saturated, high-velocity society, youths with poor impulse control are given the message that it's only natural that they should want everything yesterday.

While the video-game industry rejects the idea that some of its games are virtual training classes for potential gunmen, some recent, controversial studies contend that playing violent video games helps youths' dexterity with real firearms and desensitizes them to the visceral realities of violence. In one recent study, high school students interviewed after suicide attempts expressed surprise that their actions were so painful because it didn't look that way on TV.

The Media Factor

Some research suggests that the news media may foster children's self-destructive and violent behavior simply by reporting horrific events.

A 1986 study by Madelyn Gould, a professor of psychiatry at Columbia University who examined media coverage of suicides, found that the suicide of a person reported either on television or in newspapers makes at-risk individuals who are exposed to the coverage feel that suicide is a "reasonable, and even appealing, decision."

After last year's shootings at Columbine High School, which touched off weeks of intensive coverage by the national news media, there was a spike in teenage suicides across the nation, according to several experts. In Los Angeles County alone, six students killed themselves within six weeks of the shootings. In the four of those cases in which notes were left, three mentioned Columbine as an inspiration. "If you plaster their face up on the news for 20 minutes, that's going to make the difference," said Dr. Pollack of Harvard. Media coverage of suicides isn't the reason for a child's decision to kill himself, Dr. Pollack said, but it's a contributing factor.

"These things open the floodgate," he said of news accounts. "But to flood, the waters have to already be at a high level."

Keeping afloat emotionally is challenging for many young people because the violence they're exposed to is not just on their television screens. Not surprisingly, children who suffer chronic physical or emotional abuse at home or who witness domestic violence, are much more likely to kill themselves than their peers who do not witness such violence.

"A child doesn't just wake up suicidal," said Richard Lieberman, a school psychologist with the suicide-prevention unit of the Los Angeles public schools who handles distress calls from school officials 24 hours a day. "Kids are dealing with more loss. Families are under more stress."

In all areas of the country—poor, rich, urban, suburban, and rural—reports of child abuse have accelerated dramatically in the past few decades. Though a small portion of the increase is attributable to better reporting, the bulk represents a real and disturbing trend, according to federal health officials. In 1997, 42 out of every 1,000 children in the United States were reported as victims of child abuse, a 320 percent leap from 10 per 1,000 children in 1976, figures from the U.S. Department of Health and Human Services show. Newspapers regularly report stories that were once rare: children locked in basements without food; battered and bruised toddlers entering shelters; teenage girls sexually assaulted by their fathers.

Changing School Climate

While home environments in general seem to have become more hazardous, so in large part have schools, say researchers who monitor school climate. Apart from the increasing rates of assaults and shootings since the 1970s, garden-variety bullying behavior is rampant, says Dorothy Espelage, a professor of educational psychology at the University of Illinois at Urbana-Champaign. In a study published last fall, Ms. Espelage found that 80 percent of the 558 Illinois middle school students surveyed reported they had been "threatened, ridiculed, or been physically aggressive" with at least one classmate in the past 30 days.

Other experts suggest that the increased emphasis on raising academic standards and student-achievement levels adds pressure to the mix.

"We have become so focused on raising standards and testing students, and we are paying very little attention that this is working against creating a motivating environment for kids to come to school," said Howard Adelman, a professor of psychology at the University of California, Los Angeles, who runs a project to promote mental health in schools.

Of course, not every student who feels pressured at school, is harassed, or even has a chaotic home life becomes suicidal.

A suicidal teenager is often fundamentally unstable, mental-health experts say.

Currently in the United States, they note, an estimated 11 percent of children ages 9 to 17—or 4 million children—have a diagnosable mental disorder, ranging from obsessive-compulsive disorders to major depression. The rate of depression has been rising among the young, researchers say, in part because the average age of puberty has declined, and depressive illness tends to emerge after puberty.

JEFF MILLER, 17, ANDREA GARRETT, 15: Jeff and Andrea shot themselves in the head in an apparent double-suicide pact in a girls' restroom at Central High School in Carrollton, Ga., on Jan. 8, 1999. Classmates told police the couple was under pressure to break up.

Clinically depressed adolescents are five times more likely to attempt suicide than their nondepressed peers, according to a 15-year study that tracked 73 depressed adolescents and compared them with peers who were not clinically depressed.

Psychiatrists who have been enlisted to analyze the motivation of the Columbine shooters point to the fact that Mr. Harris was being treated with an anti-depressant.

In a new book, Night Falls Fast: Understanding Suicide, Dr. Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins University, says clinical depression is quite distinguishable from common adolescent angst. "In its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, fatiguing, deadened state," she writes.

In Darkness Visible, the author William Styron describes his own severe depression as "a hurricane of the mind." And five years before killing herself, poet Sylvia Plath said of her depressive moods: "I felt as if I were smothering. As if a great muscular owl were sitting on my chest, its talons clenching and constricting my heart."

A growing number of children are now being treated for mood disorders. In 1996, 600,000 children under age 18 with clinical depression were prescribed the antidepressants Prozac, Paxil, and Zoloft, according to IMS America, a research group in New York City. Because no long-term studies on the use of anti-depressants by children have been conducted, it is difficult to determine whether such medicinal remedies can lift the suffocating darkness that Dr. Jamison describes.

Whatever the effect, the upsurge in prescribing psychiatric medications has occurred mainly in middle- and upper-class populations, in which children have more access to health care. For millions of teenagers, the last trip to any kind of doctor was for childhood inoculations.

A study released last fall by the University of North Carolina at Chapel Hill found that one-fifth of teenagers said they had had no health care in the past six months, even though they had a condition that warranted a medical visit. That situation represents a lost opportunity, suicide experts say, because family doctors can detect sudden changes in mood, sleeping patterns, and eating habits—indicators of depression.

Some depressed teenagers, who are either embarrassed to seek help or can't afford it, eschew traditional medical care in favor of illicit drugs to elevate their moods. There is a strong link between the use of illegal drugs and suicide; alcohol and certain drugs are depressants and can often have the effect of deepening one's mood. And, because they knock down inhibitions, teenagers feel freer to act on their suicidal fantasies.

Autopsies of adolescent suicide victims show that one-third to one-half of the teenagers were under the influence of drugs or alcohol shortly before they killed themselves, according to HHS statistics. The rate of overall teenage drug use has fluctuated over the past three decades, peaking in the 1970s and then receding somewhat in the 1980s. Use of marijuana and alcohol—both depressants— surged in the 1990s.

Teenagers haven't been gravitating much toward church for comfort. Religious affiliation as a buffer against the harsh realities of the world has a solid grounding in research. For example, studies have shown that elderly people who participate in church-based activities—such as social events and bingo games—have a decreased risk of mortality. That finding, researchers say, could be due as much to the balm of faith as to the fact that attending places of worship decreases isolation.

But while teenage attendance at religious services rose in the late 1990s, far fewer adolescents attend than did 20 years ago.

Means and Reasons

The burgeoning numbers of isolated, despondent teenagers now more than ever have lethal means at their fingertips.

The federal Bureau of Alcohol, Tobacco, and Firearms reports that in 1960, 90 million guns were in circulation; today, there are an estimated 200 million firearms in private hands. That's enough weaponry, if distributed among the U.S. population, for three out of four Americans to be armed. Despite state and federal laws banning possession of handguns by anyone under 18, for many young people, finding a firearm is no more complicated than pilfering from a parent's closet. Other teenagers know where to buy guns illegally on the streets.

Guns are the method of choice for suicidal youths: More than 67 percent of boys and nearly 52 percent of girls ages 10 to 19 who kill themselves use a firearm. Hanging or suffocation follows far behind—the choice of roughly 23 percent of both male and female suicide victims. Smaller percentages die by overdosing on drugs, drowning, in falls, or by slitting their wrists.

Before a youth pulls the trigger, experts say, some event usually has to set him or her off.

A recent survey of 15- to 19-year-old students in Oregon who had attempted suicide found that the top three things that spurred them to act— while none was the sole reason—were conflict with parents, relationship problems, or difficulties at school.

Whatever the eventual catalyst, every suicidal youth's life story has a uniquely tragic plot. More often than not, it's a circuitous route that leads him or her toward suicide. The profiles of three youths that follow show how a particular combination of character traits, circumstances, and events conspired to usher each of them to an early death.

Vol. 19, Issue 31, Pages 1,22-25

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