THE IMPORTANCE OF HELPING OUR CHILDREN'S MENTAL HEALTH

The American Academy of Child and Adolescent Psychiatry [AACAP] has a new initiative called "Break the Cycle" to fund new research; increase the number of child psychiatrists; and help mentally ill children to get the treatment they need. The May/June 2017 issue of the  AACAP News contains statistics including that: 50% of all mental illness cases are diagnosed by age 14; 79% of children ages 6-17 with mental illness do not receive treatment; more than 50% of children age 14+ with mental illness drop out of school [a very high rate]; and 13% of 8-15 year olds have severe enough mental illness that they have trouble with day to day living. Importantly, on average it takes 8-10 years for treatment to start after symptoms begin and sadly, more than 4600 children die from suicide. Of these deaths, it is estimated that 80% [3680 children] could be saved.

What can we do to help our children? Well, we can be open about our own needs and things that we have done to help ourselves.  Also, we can then encourage children to feel that they deserve to get help and do not need to feel embarrassed.  It is important to share your experiences with parents as they need to be ok about their children getting help.  You don't need to know if children have mental illnesses as encouraging people seeking help and not being ashamed is vey important to share with everyone.  Regarding the risk of suicide, if people, including children, talk about suicidal feelings, they are much less likely to act on these thoughts. So, if you are worried about someone, even a child, ask them if they have been thinking about hurting or killing themselves.  You can also ask if they have felt that life is not worth living.  A yes to any of these justifies talking to the child's parent[s] or to a significant other, best if the person who has said yes to one of these is with you when you tell someone else. I will do the same thing with my patient's as I let them all know that I am strict about confidentiality except when it involves their safety.

Just like with anyone we are with, listening to a child without our own reactions, then sharing our own experiences with fears, anxieties, sadness and any support we have received, can help that child to choose to seek and accept help for themselves. 

TANNING BEDS...MELANOMA AND OTHER BAD THINGS

In the News Updates section of the May/June edition of the AACAP News a study by Guy, et al. reported in the JAMA Dermatol (epub ahead of print) found that according to the 2009 and 2011 national Youth Risk Behaviors Survey using a representative sample of 15.5 million high school students each year that included 25,000 students who used tanning beds.  

These tanning bed users were more likely to be female, older and non-hispanic white.  Nearly 30% of 18 years of age or older of these students used tanning beds.  Among male and female students, tanning bed use was associated with increased binge drinking, unhealthy weight control practicing and having sexual intercourse.  Just among the female students, tanning bed use was associated with having sexual intercourse with four or more persons and illegal drug use.  Among male tanning bed users, they were more likely to have used steroids, smoked cigarettes daily and to have attempted suicide.  

So, it seems that there might be additional reasons to encourage our teenagers to not use tanning beds, besides the risk of melanomas.  Thus, it is important that we talk to our teenagers about tanning bed use and also that our pediatricians and family care physicians also ask about the use of tanning beds.  Of course, it is also important that we remind our adult children about the risks of tanning bed use.

CYBERBULLYING AND SUICIDAL THOUGHTS AND ATTEMPTS

I have previously blogged about the impact of bullying including an increased suicide risk.  There is evidence now that bullying online or via social media is at least as traumatizing as other forms of bullying. A recent study by Van Geel, et al. reported on their meta-analysis of 34 studies involving over 284,000 children.  They found that being bullied [peer victimization] increased the odds ratio for suicidal ideation to 2.23 and for suicide attempts to 2.55.  In their study, cyberbullying was at least as toxic as other forms of bullying.  The odds ratio number represents the odds of having suicidal ideas or actions and having been bullied.  Thus, of the children with suicidal ideas or actions, they were two and a forth to two and a half times as likely to have been bullied.  This is one way of determining the link between being bullied and developing suicidal ideas or suicidal actions.  

It seems clear that cyberbullying is both traumatic for children and adolescents and significantly increases the risk of suicidal behavior.  It is important for mental health professionals to always ask about bullying, including cyberbullying.  It is also important for parents to be aware of what types of experiences their children and adolescents are having on the internet and social media as well as what they are experiencing at school.  Parents must risk being considered intrusive and controlling since their children or adolescents lives might depend on them being this way.

RISK OF SUICIDE AND OF SUICIDE ATTEMPTS

It is difficult to assess the risk of suicide and suicide attempts in children and adolescents although it is possible to identify risk factors.  

One risk factor that seems to be important involves how a parent talks to their child or adolescent.  If statements are mostly negative that are directed to the child or adolescent, this increases the risk of suicidal behavior.  This clearly indicates that children and adolescents are influenced by what and how parents talk to them.  It is also clear that negative communications are damaging and not effective in achieving behavior change.  Being encouraging and supportive with our children and adolescents will lead to positive behavior change and increased self-confidence.  A study looking at what indicates whether a child will be successful as an adult [be able to function successfully independent of their parents] correlated significantly with the amount of positive communication parents directed to their children during their preschool years.  Successful children were talked to more and with a much higher percentage of positive and encouraging comments. It is never to late to start emphazing positive and encouraging statements to our children, yet it is just better if it starts out that way from birth.

Other risk factors related to suicidal behavior in male and female adolescents include: if they disobey their parents; don't talk to their parents; have had a recent argument with their parents; and if there is a family history of depression or substance abuse/alcohol problems. Risk factors for female adolescents include: death of a family member or illness in a family member.  Risk factors for male adolescents include: parents separated or divorced; parent recently lost a job; the adolescent is adopted; or a parent has been jailed.

It is important to pay attention to a child or adolescents statements about suicide and also important to ask your child or adolescent if they are thinking about suicide or have ever thought of it.  If you are concerned about a behavior change in your child or adolescent, ask about suicidal thoughts or impulses. Just talking about suicidal thoughts/impulses will reduce the risk of your child or adolescent acting on them.  In addition, talking about how to handle feelings and stress and offering your support to listen to your child or adolescent, can be very helpful.  Listening without immediately offering suggestions, is very supportive.  Finally, talking about a safety plan with your child or adolescent is important with a focus on ways that your child and adolescent can ensure that they will be safe.