13 Reasons Why: A Trigger for Teen Suicide?

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Concerns and controversy are being raised by school officials, healthcare providers, and parents about the Netflix series 13 Reasons Why that depicts the story of a teenage girl who commits suicide and delivers 13 audiotaped cassettes to classmates who played a role in her decision to kill herself. Critics have posited that the series may romanticize suicide and stir a contagion among teens who are prone to depression or may have underlying mental illness. On the other hand, some suggest that the series may promote the dialogue providing an opportunity to discuss teen suicide more openly and directly.
In a suicide fact sheet published by the National Institute of Mental Health (NIMH, 2016), the National Center for Health Statistics of the Centers for Disease Control and Prevention (Heron, 2016) reported that suicide was the second leading cause of death for individuals between the ages of 10 and 24 in 2014 in the United States. These data were confirmed again recently by the American Psychological Association (APA, 2017). As detailed in the NIMH fact sheet, research has shown that risk factors for suicide include depression, anxiety, other mental disorders, and substance abuse, all of which if present in combination place already vulnerable teens at increased risk. Additional stressors that may be more prevalent during adolescence can include disciplinary problems, interpersonal losses, bullying, self-mutilation, sexual orientation confusion, family violence, and physical or sexual abuse (APA).
Pediatric nurses are well positioned to recognize warning signals and to start the conversation among parents and their children. According to the APA (2017), these include: any mention of dying; any manifestation of self-harm; recent losses including death, divorce, relationship break-ups, or loss of self-esteem or confidence, loss of interest in friends and/or previously enjoyed activities; any changes in personality, behavior, sleep, and eating patterns; fear of losing control and of harming oneself or others; and, no hope for the future.
Whether we approve or not of the controversial Netflix series, pediatric nurses can seize the opportunity to discuss it with at-risk teens and to guide parents in their conversations. Letting parents know about Stop a Suicide Today (http://stopasuicide.org/index.php), a school-based suicide prevention program well-documented outcomes as well as the National Suicide Prevention Lifeline and Web site (www.suicidepreventionlifeline.org) is certainly a good first step (APA, 2017). Suggestions for parents on how to discuss these issues are offered by child psychologist Robert Myers (2017) on the Child Development Institute Web site (https://childdevelopmentinfo.com/authors/bobby/). Although in direct response to the show, these suggestions offer helpful guidance for parents to discuss depression and suicide in general with their adolescent. Key concepts include making such a conversation an ongoing dialogue that is not fearful or punitive but fact based and hopeful while within a context of genuine concern. Pediatric nurses, whether practicing in an ambulatory clinic, private office, school-based health center, or in-patient unit, are often the front line of defense for identification of vulnerable teens at increased risk for suicide. Being knowledgeable and aware of risk factors, behaviors, and conversational cues are useful tools in this identification.
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