As a community we are grieving. We have lost precious youth to treatable health conditions. We want our youth to feel encouraged in all they aspire to do, and will support them in finding their own way in the world.
In this endeavor, our schools are very aware of the need to prioritize teaching students how to understand and manage their busy lives beginning in the early grades through curricular elements, healthy activities, electives in wellness and mindfulness, and many other ways to address social and emotional health. However, we all know that care and support of our youth is a shared responsibility in our community and works best when we all take accountability and work together.
In our community forums, there has been much discussion about whether we can attribute any particular factor to the recent tragedies. Suicide does not have a single "cause." Many factors and life circumstances must be taken into account when trying to understand why someone would take their own life.
In response to the 2009-10 suicides among our youth, a detailed investigation with interviews of dozens of family, friends, and teachers was conducted. Academic stress in itself was not a major factor. For most of these young people (as is true nationally) depression, anxiety, sleep problems and severe distress about relationship issues, life transitions, and other aspects of mental health were key factors.
We must continue to address the myriad development and health issues in our youth, including mental health and resilience. It is also important to evaluate other possible contributing factors, such as academic and other performance stresses and expectations. These expectations can emanate from the youth themselves but, crucially, may be perceived by the youth as coming from their families and others involved in their lives, even when such messages about high performance expectations were well-intended or misinterpreted.
Solutions must come from all those who interact with youth, including schools, parents and family, friends, medical and mental health providers, community and faith leaders and mentors. All of our messages of support must be very clear.
Following national guidelines, we have conducted depression education and suicide-prevention training sessions with several thousand students at both Gunn and Palo Alto High Schools in Living Skills classes since 2010. The teachers in these classrooms have been a very important part of the "Wellness" effort that began after the PAUSD Board of Education enacted the Board Policy on Suicide Prevention in June of 2010.
Students have asked many questions regarding mental health in these classes. Common topics include "When does stress become distress?"; "My friend's been sad: When do I worry something is really wrong?" Below are a few of the most common questions and answers.
Q: When a friend is depressed, is it better to try to help them first or just go straight to a parent or psychiatrist?
A: It depends. If you feel like you can approach your friend and talk to them about your concerns, this can be a great first step, just as you would want your friends to take if they were worried about you. When you talk to your friend, encourage them to get help from a counselor or other trusted adult. If you've already tried this or aren't comfortable approaching them, talk to a parent, teacher, counselor, doctor or other trusted adult and let them know what changes you've noticed in your friend.
This adult should check in with your friend and make sure they get the help they need. Remember that by talking to an adult when you're concerned about a friend, you're not getting them into trouble you're getting them out of trouble.
Q: Why do so few teens get help for their depression or anxiety?
A: Some teenagers might not recognize that what they're feeling is depression. Others might not know where to get help for depression or realize that depression is a treatable health condition. Others might be afraid to let other people know what they're experiencing because of stigma or because they think that it's something they should be able to "get through" on their own.
Clinical depression is common (11-15 percent of all teens will experience some form of depression before high school graduation). It can be treated successfully with professional help, so it's important for you to reach out for yourself or for a friend once you notice the signs of depression we talked about in class. Depression isn't something you can or must just "deal" with on your own.
Q: About how long can it take for stress to turn into "distress," and then distress into depression?
A: It depends on the individual and the degree of stress. Not everyone responds the same to a given stressor, and although everyone feels some stress at times, not everyone develops "distress" or eventually, depression.
You may be more likely to develop depression as a result of a stressor, if you have a sibling or parent who has had depression, or you've experienced depression in the past, or you're dealing with other challenging stressors at the same time.
Coping strategies and resources (such as supportive friends, trusted adults, relaxing and fun activities, etc.) can help you effectively deal with a stressful event or circumstance. True depression is not something that can be dealt with effectively on one's own, and that good help is available in our schools and community.
Q: Is anxiety a form of depression?
A: No, anxiety is a different mental health issue, but research shows that anxious people may be more likely to develop depression. Anxiety can precede depression, but the two are commonly experienced together. For more information, see here.
Q: Can depression be cured by positive thinking alone?
A: Though positive thinking can be an important part of having a healthy and resilient life, positive thinking by itself does not treat clinical depression. Talk therapy with antidepressant medications, if needed, are the only proven treatments for teen depression.
Some forms of therapy work on correcting the negative thought patterns that people who are depressed might find themselves trapped in. This is a process that requires professional help and supervision.
Q: What if I get signs of depression but it's on and off?
A: It's important to recognize the difference between an occasional depressed mood, which everyone feels transiently at some time, and true clinical depression. A clinical diagnosis of depression requires that the symptoms be present nearly all the time, every day for at least two weeks. However, if you're concerned about how you're feeling, talk to someone who can help.
Signs and symptoms of depression include the following:
Feelings of sadness
Loss of interest or pleasure in normal activities
Irritability, frustration, or feelings of anger, even over small things
Changes in sleep habits (either insomnia or excessive sleeping)
Changes in appetite (decreased or increased)
Agitation or restlessness (pacing, hand-wringing, inability to sit still)
Fatigue, tiredness, slowed thinking, loss of energy even small tasks seem to require a lot of effort
Feelings of worthlessness or guilt, fixation on past failures/mistakes or self-blame when things aren't going right, worrying
Trouble thinking, concentrating, making decisions, and/or remembering things
Frequent thoughts of death, dying, or suicide
Crying spells for no apparent reason
Unexplained physical problems (especially pain-related), such as back pain, headaches, or stomachaches.
Q: How can we get help in our community?
A: There are lots of resources! Talk to your parent or the parent of a friend you're concerned about to determine the cause for the feelings and if anything can be done to help (answers: yes, it may be depression, and yes, something can be done to help!). You can talk to a guidance counselor or school-based mental health counselor through Adolescent Counseling Service (ACS) , or another trusted adult at school. Of course, primary care doctors can be a great first contact as well and can evaluate and often treat directly. If needed, they can refer to mental health professionals.
There are other resources in the community, such as the ones listed here.
Shashank V. Joshi, MD, is Director of the School Mental Health Team at Lucile Packard Children's Hospital; Meg Durbin, MD, is Regional Vice President for Care Coordination at Palo Alto Medical Foundation; Sami Hartley is the School Mental Health Coordinator for LPCH and the HEARD Alliance in Palo Alto.