This Op-ed First Appeared in the Print Edition of USA Today on February 28th, 2018
I must be a terrible doctor. At least that was one possibility I thought to account for the six teenage patients of mine who over a recent three-month period presented to emergency rooms for depression and suicidal thinking. They were all between fourteen and sixteen. Four of the six were girls. All of the girls had been actively self-mutilating, colloquially known as “cutting.” Four of the six were admitted to an in-patient psychiatric ward as significant and immediate “dangers to themselves”. In other words, they were deemed by the psychiatrist in the emergency room as a potentially dangerous suicide risk.
I’ve been in practice for forty years. I’d guess over those decades I averaged about two or so hospital admissions a year. I’ve been extremely fortunate that none of the children and teens I’ve actively managed have ever killed themselves. I’ve always felt I’ve been on the overly cautious side in sending these kids to ERs for evaluations. But I know I’ve also been just lucky as when that wayward, distraught boy I knew, gave the loaded gun he held to his head, to his mother and hadn’t pulled the trigger.
So, six emergencies in three months was unusual for me. Besides questioning my abilities, I had been noticing for a while how children’s coping had changed over the decades. I had wondered if it was just my experience until I read about a study that appeared in the Journal of American Medical Association (JAMA) this past November. The researchers examined the national rates of self-inflicted injuries (primarily poisoning and self-mutilation) between the ages of 10 and 24 that were evaluated in emergency rooms from 2001 and 2015.
They examined 43,138 emergency room visits for self-harm. The overall rate for ER visits for self-harm (measured per 100,000 population) went from 201.6 to 303.7, an increase of 51%. But more striking than this overall increase, was who was doing the bulk of the overdosing and cutting and when did this really get out of control.
It turns out that boys and young adult rates of self-harm have not changed very much in 15 years. The big increases are in girls ages 10 to 14 and girls 15 to 19. The rates for the younger girls increased by 166% and older group by 62%. Overall poisonings had only increased by 19% over this period but injury from sharp objects increased by 152%. Notably the vast bulk of the increase in cutting took place beginning in 2009. Since then, the rate of cutting by younger girls has increased by 18.8% a year!
So, it wasn’t just me being a bad doctor after all. I had sensed changes in my local area and wondered if this could be a national trend. This had happened to me once before in the early 1990s with ADHD. I now believe that depression and cutting are decimating our kids nation-wide, especially girls.
The researchers were understandably cautious in speculating upon the reasons for this disturbing trend which they said “warrant(s) further study.” I am not bound by the same constraints. We cannot wait for further study to address this mounting epidemic. Indeed, there are so many factors that go into the making of a national psychiatric disorder epidemic that studying it scientifically is an enormous challenge. But I am especially struck by the 2009 start of the major increase in teenage girls’ self-harm.
Facebook became available to children over age 13 in 2006. MySpace was the most popular social media site between 2005 and 2008 when it was overtaken by Facebook. Instagram went on line in 2010 and Snapchat in 2011. These last two are, to my best information, the current apps of choice for teens communicating with one another on their mobile devices.
Teenagers are probably the greatest users of social media and are certainly the most ill equipped to limit the dangers of it use to their emotions, self-image and self-esteem. Teens are more than ever involved with themselves and their peers to the exclusion of their parents and teachers. In this hot house atmosphere of exaggerated drama, many teens are losing control of their emotions, getting quite depressed and suicidal and cut to relieve their stress.
Google “how to cut yourself” and check out the first five website citations. The internet has created these special communities of interest. The irony of our concerns about our children killing themselves (teenage suicide rates continue to creep up) is that talk of depression and suicide are constantly in the air these days on high school and even middle school campuses. Honestly, I go so far back that I can remember when an unhappy eight-year old would threaten to hold his breath until his parents changed their minds. Now the kids are saying they will kill themselves!
Of course, there are many, many other factors that are creating this unhappy atmosphere for our children. Parents are unlikely to immediately change the social, economic and political conditions of our country overnight. However, they can ask their teenagers to turn over their cell phones, iPads and laptops to the parents at 9 PM to be retrieved the next morning before heading off to school. Parents, themselves, can work at disengaging themselves, especially around dinner time, from their own on-line activities and eat a meal with their kids and without electronics (including the old-fashion TV – does anyone watch it anymore?).
Like I said I’ve been lucky in that not one of my patients has committed suicide yet. But unless we take a close look and change our electronic habits, I fear my luck will run out.