Nurses on Front Lines for Preventing Teen Suicide

Faced with a stressful world, teens often feel overwhelmed and depressed and then consider ending their lives. Thousands of them die annually, making suicide the third leading cause of death for 15- to 24-year-olds, according to the Centers for Disease Control and Prevention. Many more youngsters attempt to take their lives but do not succeed. Nurses are making a difference with active prevention strategies.

“Suicide is a serious issue in the United States,” said Cathy Strunk, RN,  program coordinator for the  Surviving the Teens suicide prevention and depression awareness program at the division of psychiatry at Cincinnati Children’s Hospital Medical Center in Ohio.

“It’s important for nurses to look at the mental health of their patients,” Strunk said. “Nurses who work with teens are in a prime position to making a connection with them. The simple act of caring provides a safe environment for the teens to open up and express their personal problems.”

Strunk developed the hospital’s Surviving the Teens suicide prevention program with a grant from the J.E. & Z.B. Butler Foundation in 2001. Since then, she has educated approximately 6,000 middle and high school students in Ohio and Kentucky annually, as well as parents and school staff members about suicide, finding positive ways of coping with stressors, recognizing depression and suicidal behaviors, responding appropriately, using adaptive coping measures, and communicating well at home. Students also role play with Strunk how to help someone depressed or troubled.

The program includes Strunk’s “Steps to Last,” a tool nurses can use when talking with a depressed or troubled teen. They include listening and looking for signs of depression or suicide, asking questions, supporting the person, and telling an adult who can help or referring them to a mental health professional.

In September 2011, Strunk and co-authors published in the Journal of School Health results of a study they conducted indicating the effectiveness of the free, four-day Surviving the Teens program. They administered a survey to 1,030 students before the presentation, immediately afterward and to 416 of them three months later.

They found at the three-month follow up that the students were significantly less likely than at the pretest to be considering suicide, 1.5 percent down from 4.2 percent; to have a plan, 5.2 percent down from 9.9 percent; or to have attempted to end their lives, 1.7 percent down from 5.2 percent.

In addition, the young people were more likely after the program to indicate an intent to seek help and to know an adult at school with whom they felt they could discuss their problems.

Strunk plans to develop a train-the-trainer program, so the program can expand across the nation, with mental health professionals and school nurses conducting the sessions.

Nurses already play a major role in identifying and helping depressed and suicidal teens.

“School nurses are often the first contact children have,” said Linda Davis-Alldritt, MA, BSN, RN, FNASN, FASHA, president of the National Association of School Nurses. “It is estimated that about one-third of the students that come into a school nurse’s office come in with a mental-health problem. There are very few resources in most communities for teen mental health. The school nurse is a safe haven.”

Linda Davis-Alldritt, MA, BSN, RN, FNASN, FASHA, said teens will often confide in the school nurse about their feelings of depression and thoughts of suicide.

Davis-Alldritt reports many of those students may have been bullied or had a traumatic stress situation at home and school.

“In the course of conversation, it’s okay to ask if they are considering suicide,” Davis-Alldritt said. “Research has clearly shown that talking about suicide in a caring way does not cause suicidal thoughts.”

Nurses can then link the children and parents with school and community services.

“The school nurse is a valuable resource for the child to initially talk to and to follow up and get the family the help they need,” Davis-Alldritt said.

Nurses and mental health professionals in the community also are addressing this issue. Boseung Halliwell, APRN, PMHNP-BC, at the Community Health Services of Lamoille Valley in Morrisville, Vt., works with psychiatrist Linda Zamvil, M.D., counseling depressed youth. She asks them about their environment, how they feel about their lives, and their relationships with family and friends.

“Medication helps dramatically, but trying to process their feelings is very important to me,” Halliwell said. “Teens don’t have the skills to deal with their emotions, and that can lead to suicide.”

Zamvil, an advisory board member for Families for Depression Awareness, helped develop a webinar for the organization to call attention to the issue of depression in young people. Untreated, Zamvil said, it can lead to substance abuse, academic failure, bullying, eating disorders and suicide. Biology, including genetics, as well as abuse and stressful life experiences contribute to depression.

“There is a lot of hope and help for kids, but there is a stigma attached to it,” Zamvil said. “People don’t seek help or seek it too late.”

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