News

CDC releases preliminary findings from youth-suicide study

Report suggests stronger awareness, school connectedness critical to supporting youth in crisis

Editor's note: Resources for any person who is feeling depressed, troubled or suicidal are listed at the bottom of this article.

Preliminary findings from the Centers for Disease Control and Prevention's epidemiological investigation into youth suicides in Santa Clara County have shed some light on factors -- including mental-health issues and problems at school -- that played a role in the suicides of Palo Alto teenagers over the past 13 years.

The Santa Clara County Public Health Department, which on behalf of the Palo Alto school district formally filed a request for the CDC to conduct the study, released the agency's preliminary report on Tuesday. It is an early, incomplete analysis, subject to change, with a final report due out later this year.

The report was compiled by a team of five staff members from the Centers for Disease Control and the Substance Abuse and Mental Health Services Administration (SAMHSA) who spent two weeks in Palo Alto this February talking with organizations and people who work on suicide prevention and youth mental health as well as poring through county and local data, the report states. While the initial scope was limited to 2008 to 2015, the researchers expanded their data analysis to 2003 in response to community requests to consider an earlier youth suicide cluster in Palo Alto.

The majority of the report takes a countywide view, with the team examining data related to 232 suicides. However, the team also analyzed Medical Examiner reports to draw out locally specific data. In Palo Alto, these reports indicate that mental-health problems, previous or current treatment for mental illness, a recent crisis and problems at school precipitated the suicides of at least 25 percent of the Palo Alto youth, ages 10 to 24 years old, included in the study.

The report also identifies "current depressed mood," a previous suicide attempt and leaving a suicide note as precipitating circumstances among Palo Alto youth who died by suicide.

Those youth were less likely to tell someone about their plans than in other Santa Clara County cities. Less than a quarter of the Palo Alto youth had told someone they intended to die by suicide, the researchers found.

The CDC also found that more than half of all Santa Clara County youth who died by suicide during this time period had a recent crisis within two weeks of death, pointing to the vital importance of widespread training, awareness and education around suicidal risks and behavior. Recent crises youth experienced included problems with intimate partners, such as a breakup or argument with a family member; release from a medical facility, such as after a psychiatric hospitalization; legal problems; a suicide attempt; drug or alcohol use; and school problems, such as failing classes or getting suspended, the report states.

Current mental-health problems were also reported in 46 percent of the Medical Examiner reports, according to the CDC. The most common mental-health diagnosis was depression, followed by anxiety and bipolar disorder.

About a quarter of those who died were receiving treatment at the time of their deaths, and 41 percent had received treatment previously.

Young men were particularly vulnerable countywide. They were significantly less likely to have reported a current mental-health problem or to have received treatment than young women, the researchers found. The suicide rate for male youth is also greater than for female youth in Santa Clara County, as well as statewide and nationally.

The report notes that the many circumstances and factors that are associated with both fatal and non-fatal suicidal behavior "underscores the complex nature" of youth suicide.

"Factors associated with fatal and non-fatal suicidal behavior were found at the individual (e.g., mental health problems, sexual orientation, drug and alcohol use, past suicidal behavior), interpersonal (e.g., arguments, bullying, intimate partner, and family problems), and community level (e.g., connectedness to school, meaningful engagement at school)," the report states. "This suggests that suicide prevention efforts should take a multi-faceted approach to suicide prevention and should include programs, activities, and outreach that target factors at multiple levels beyond those that focus on risk factors at the individual level."

Despite the intense national spotlight that has been focused on Palo Alto over the last several years in the wake of several teenage deaths by suicide, the CDC's report indicates that Palo Alto school-district students are actually faring better than some of their peers.

Data from the 2013-14 California Healthy Kids Survey (CHKS) indicate that far fewer Palo Alto Unified high school students seriously considered suicide and reported mental distress than in three other county school districts for which the CDC reviewed data (Santa Clara Unified, Gilroy Unified and East Side Union High School District in San Jose). Only 12 percent of responding Palo Alto Unified high school students had seriously considered suicide in the 12 months before taking the survey, compared to 18 percent in Santa Clara, 20 percent in Gilroy and 20 percent in East Side Union. Palo Alto Unified also had the lowest percentage of high school students who had experienced mental distress in the previous year — 20 percent compared to Santa Clara's 32 percent, Gilroy's 30 percent and East Side's high of 34 percent.

High school students from all four districts who had considered suicide and reported mental distress, though, shared many characteristics. They were significantly more likely to have missed school in the past month (due to either falling behind in school work; feeling bored at school; or feeling sad, hopeless or angry), experienced bullying and victimization, used alcohol or drugs in their lifetime, engaged in binge drinking in the last month and self-identified as gay, lesbian or bisexual, the CDC found.

These students were also less likely than their peers to think that an adult or teacher cared about them and to have a high level of school connectedness, according to the CHKS data. Forty-one percent of suicidal high school students in Palo Alto said they felt a teacher or adult in school cares about them, compared to 67 percent of students who hadn't considered suicide.

In Palo Alto, 76 percent of students who had considered suicide reported feeling sad or hopeless almost every day for two weeks or more.

The top reasons these students missed school, in order, were illness (including physical problems); lack of sleep; feeling very sad, hopeless, anxious, stressed or angry; falling behind in schoolwork or feeling unprepared for an assignment; and feeling bored or uninterested in school.

The report also identifies bullying as a crucial problem for schools to address to better support struggling students. Just over half of all suicidal students in Palo Alto reported in the survey that they had been psychologically bullied at school.

In comparing Santa Clara County with other California counties, the team of researchers found that Mendocino, Humboldt, Lake, Shasta and Yuba counties all have significantly higher youth suicide rates — all double or more the local rate. The highest is Mendocino at 16.2 per 100,000, according to the report.

Santa Clara County's youth suicide rate from 2003 to 2014 was almost the same as California's. Since 2003, Santa Clara County has also had a consistently lower rate than the nation, according to the report.

Early recommendations

While still at a preliminary stage, the CDC's report offers "initial, broad" recommendations for how to address youth suicide.

Unsurprisingly, education, awareness and decreasing stigma around mental health are all central to these early recommendations. Given the fact that many youth who died by suicide had experienced some sort of recent crisis, the report suggests that those who live, work and are in close contact with young people should be "familiar with signs of distress so they are able to recognize and intervene with a youth in crisis."

Suicide-prevention efforts should also focus on "encouraging help-seeking behavior, and ensuring access to quality care," the report states. In communities where few youth were receiving treatment at the time of their death (this problem is more urgent in San Jose, Milpitas and Santa Clara than in Palo Alto), an effort "should be made to understand and identify barriers to help-seeking," the report reads.

Communities should also identify strategies to help young people feel more comfortable disclosing and seeking help during a suicidal crisis, including forging stronger relationships between students and teachers or other adults.

"Connections between youth and a teacher or another adult, feeling connected to school, and meaningful opportunities at school were found to be protective factors for suicidal ideation," the report states. "Enhancing relationships between youth and a teacher or another adult could provide opportunities to identify at-risk youth and provide ways for youth to seek help prior to and during a crisis.

"Activities to enhance the relationship between youth and a teacher or other adult should be implemented in tandem with educational programs focused on recognizing warning signs for suicide and how to respond to a suicidal individual."

Given the fact that suicide affects a diverse range of ethnicities and races, "both messaging and mode of delivery of prevention materials should consider linguistic and cultural differences," the report reads. The report also suggests offering programs and outreach targeted at young men, given the data that indicates they are at higher risk of suicide and yet less likely to seek help when struggling.

Palo Alto Unified Superintendent Max McGee wrote in a message to families on Tuesday that the preliminary findings "affirm our current efforts, validate available data, and offer important recommendations to help us persist in our work to address youth suicide" — which he called an "urgent health issue."

"As a school district, we've taken numerous steps in all of our schools to support youth well-being including passing new Board policies to promote mental and physical health, hiring additional staff members who are experts in the field of mental health, and implementing programs and initiatives to support our families and students," he wrote. "We will continue to collaborate very closely with other organizations and professionals including the Santa Clara County Public Health Department (SCCPHD), the City of Palo Alto, Project Safety Net (PSN), mental health experts, and parent, student, and community groups to review the recommendations and consider future policies and programs to address the findings and recommendations."

In a message announcing the report's release, Sara Cody, health officer and public health director for the county health department, cautioned that the purpose of Epi-Aid investigations is to provide short-term, emergency assistance for an urgent public health problem. They are not research and do not involve the collection of any new data, she wrote.

"This approach means that the Epi-Aid will answer some, but not all, possible questions about suicide and suicidal behaviors in our community. When questions come up that the Epi-Aid is not designed to answer, we will work with community partners on these issues and connect them with others, such as researchers, who may be able to address these questions through additional analyses or new data collection," wrote Cody, who is also a Palo Alto school district parent.

The final, more comprehensive report will include an analysis of trends in youth suicide and related behaviors countywide, and data permitting, in cities and school districts, according to Cody. The team will also have access to data from a recent survey that youth well-being collaborative Project Safety Net conducted to ensure that the CDC hears input from more community members than those who were able to meet with the CDC team in February.

The final report will also look at whether recent media coverage of youth suicide met established media guidelines, and compare local youth suicide prevention efforts to evidence-based recommendations. The final report will likely to include additional recommendations regarding suicide-prevention strategies at the school, city and county level.

"One of the first steps in reducing the stigma around depression and other mental health issues, including what may lead to a suicide, is to know the facts," Cody wrote. "This preliminary report begins to provide the facts about youth suicide in Santa Clara County. Individuals, schools, community organizations, businesses and government organizations, as well as the news media, all have a role to play in reducing stigma and preventing suicide in our community."

Project Safety Net will hold a meeting on Wednesday, July 27, 4-6 p.m. at Rinconada Library, to discuss the report and hear an update from the county health department. To RSVP, click here.

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Any person who is feeling depressed, troubled or suicidal is urged to call 1-800-784-2433 to speak with a crisis counselor. People in Santa Clara County can also call 1-855-278-4204.

People can also reach trained Crisis Text Line counselors by texting "HELLO" to 741741.

Links below provide more resources where one can receive help:

Resources: How to help those in crisis

Guest opinion: How to help those in crisis

Q&A about mental health: Local experts offer their advice, guidance

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Follow the Palo Alto Weekly/Palo Alto Online on Twitter @PaloAltoWeekly and Facebook for breaking news, local events, photos, videos and more.

Comments

5 people like this
Posted by focus, people!
a resident of Adobe-Meadow
on Jul 12, 2016 at 4:24 pm

Web Link

The first highest recommendation was a somewhat nebulous "multi-faceted" approach.

The next recommendation was more concrete:

"Based on these preliminary findings, the majority of youth suicides in Santa Clara County have been among males and among youth aged 20 to 24 years of age. Based on these findings, focused outreach to male youth, and those between 20 to 24 years old, may be needed. Strategies for mental health promotion and suicide prevention that are appropriate for male youth, and youth aged 20 to 24, should be identified."


29 people like this
Posted by Pretty Shallow!
a resident of Midtown
on Jul 12, 2016 at 5:16 pm

Pretty Shallow! is a registered user.

Seriously, just how in-depth did they think they could get in a mere two weeks of interviews??

How did they come to exclude high school- age teens as being at- risk? Sounds like the bulk and focus were college kids, not the high schoolers who killed themselves since 2009.

Really ruins my faith in the CDC!


12 people like this
Posted by Unimpressed
a resident of College Terrace
on Jul 12, 2016 at 6:05 pm

This is a very long article. Is there a single observation in this report that we didn't already know, or that will help prevent a single suicide? Is this really what everyone was waiting for? Many of these statistics are non-comparative, so we don't even know how much the various attributes of those who committed suicide are actual risk factors or harbingers of suicide. We certainly don't need the CDC to tell us that mental illness + stress are a toxic mix. I hope the final report tells us more than this.


11 people like this
Posted by Samuel L.
a resident of Evergreen Park
on Jul 12, 2016 at 6:11 pm

"Connections between youth and a teacher or another adult, feeling connected to school, and meaningful opportunities at school were found to be protective factors for suicidal ideation," the report states. "Enhancing relationships between youth and a teacher or another adult could provide opportunities to identify at-risk youth and provide ways for youth to seek help prior to and during a crisis. Activities to enhance the relationship between youth and a teacher or other adult should be implemented in tandem with educational programs focused on recognizing warning signs for suicide and how to respond to a suicidal individual."

Obviously, they don't know all of the Paly teachers. After the Farrell incident, I doubt there will be many teacher/student connections


22 people like this
Posted by outisders
a resident of Old Palo Alto
on Jul 12, 2016 at 7:33 pm

I do not think they have accurate data because they did not really talk to parents or students. This school district does not know or respect families even in their "hot washes" of their own mismanagement, they did not include the quiet, articulate introverted kids or parents who know their kids an would like to have shared their experiences. Also, every teacher was not given the opportunity to speak on behalf of their students over time.

Teachers that have large groups of kids over 4 years, like robotics teacher, theater, choir,music or sports really do have a clearer picture of the families because they are in contact with them over 4 years and not just one. I think they are the key to building a better community and better understanding of what families need and want for their kids. I would love to see all sports coaches actually be credentialed teachers that are on campus during the day-that could make a huge difference. Also, I think there needs to be a school presence at the larger tutoring clubs around as many of the kids are being quite abused at those places being forced to work ahead and get on top of the curved classes the PALY teachers have so poorly set up. I can not imaging going to school all day and then sitting in a poorly lit small, beige room after school for hours and then going home and doing more homework. This is the life of most kids at PALY because they want to be at the top of the curved classes that have not adhered to state standards.

I can say that any normal child would suffer depression and anxiety and those suffering from this would have a magnified degree of their emotions and fears. Music, sports, robotics, art at the school can help if they can be given time for it. Cancel Life skills so they can all take an extra music/theater class or dance classes. More than my 2 cents.


19 people like this
Posted by facts'n'figures
a resident of College Terrace
on Jul 12, 2016 at 8:16 pm

"Is there a single observation in this report that we didn't already know, or that will help prevent a single suicide?"

Well, they did point out that suicides in Palo Alto were statistically the same if not better than other California districts and significantly better than across the country as a whole.
They also found that Palo Alto had significantly less suicide ideation than neighboring districts.

So, yeah, I guess there were several points that we didn't know. Just not what you expected.


26 people like this
Posted by Marc Vincenti
a resident of Gunn High School
on Jul 12, 2016 at 9:32 pm

Marc Vincenti is a registered user.

Tuesday evening, July 12th

Hi, Fellow Onliners,

Here’s a thought experiment:

Imagine our city, rather than amid a rash of suicides, caught in a mysterious epidemic of devastating burglaries--houses ransacked, familiar objects looted, heirlooms gone, crimes unsolved.

And so the FBI comes to town.

But they don’t examine a single crime-scene, don’t interview the homeowners, don’t quiz neighbors about what they heard in the night, don’t consult home security experts or even the Palo Alto police. Instead they collect statistics on related “risk factors” (business break-ins, auto thefts) then report to us on our problems.

The CDC's study is no more convincing.

They haven't studied the lives and deaths of our ten (now eleven) recently departed teens. They haven’t talked with their parents, relatives, friends, or mentors.

And even though our youth spend more waking hours at schoolwork than anything else, and though our psych wards fill with teenagers during the academic year but empty out in summer, and though high-school is a developmental crucible that stays with all of us through decades of class reunions, the CDC hasn’t (contrary to Superintendent McGee's message today to the PAUSD community) met with or conducted interviews with school personnel in any numbers—not administrators or coaches, nurses or guidance counselors, our new therapists or the two-hundred classroom professionals who regularly spend more hours with our teens than any other grown-ups.

Not that this study is malicious; it just is what it is. Its methodology--stated up front--has ever been "the use and analysis of existing quantitative datasets": vital statistics, emergency department and hospital data, school survey data. This study was never meant to be about talking with people--not even with our teenagers who have come before school officials, begging to be heard.

No, the danger isn’t in the CDC study itself. It’s in our acting as if it is what it isn’t. We should be honest with each other about its limitations, and shouldn’t bow to its mystique or its recommendations.

Sincerely,

Marc Vincenti
Gunn English Dept. (1995-2010)
Campaign Coordinator, Save the 2,008


12 people like this
Posted by Sarah1000
a resident of Los Altos
on Jul 13, 2016 at 6:45 am

Sarah1000 is a registered user.

I believe the CDC report does provide useful information. Suicide has never been just a "Palo Alto" issue so our concern and advocacy in finding a solution must reach beyond its borders. I was shocked and concerned to read that over 20% of East Side Union High School District students had seriously contemplated suicide and to see that, consistently, we lose approximately 20 youth a year to suicide in our County. I think some of the recommendations were good, especially the one that urged reaching out to students who had been consistently absent from school for any reason. When my own son has an increase in his symptoms of major depressive disorder, he is unable to attend school. I'm sure that this is true for other kids as well. I would urge any concerned community member to read the report in full. There is a Teens and Screens event at CHC tonight which will address how technology plays a role in mental health issues. I'm sure this talk will be informative as well.


3 people like this
Posted by Alphonso
a resident of Los Altos Hills
on Jul 13, 2016 at 10:46 am

From above - "They haven't studied the lives and deaths of our ten (now eleven) recently departed teens. They haven't talked with their parents, relatives, friends, or mentors."
Has anyone else done that? It seems to me the community needs all of the information it can get - too many people are promoting actions based on assumptions rather than any real analysis.


15 people like this
Posted by Stop bullying
a resident of Palo Alto High School
on Jul 13, 2016 at 11:11 am

Motivations of the child are complex but not difficult to understand. But that is not a reason to not do anything.
What the schools can do is forbid bullying. Yes, forbid and enforce.

Talking privately to those accused of bullying could reduce its prevalence and does not require bureaucratic elaboration. And records can be kept by teachers and counselors to the effect that they spoke to the child or teacher.

And make it a public campaign. Of course it isn't the complete answer but that is no excuse to do Nothing.


7 people like this
Posted by mutti
a resident of Adobe-Meadow
on Jul 13, 2016 at 4:44 pm

One issue in Palo Alto is that so many of the youth suicides have been so public. Either on the tracks, or everyone at school knows it happened. So we all know all about them. There was a suicide in our neighborhood last year of a 20-something young man, but never a word in the newspapers.
And this isn't new since 2009. Friend of our children killed herself in Palo Verde neighborhood about 1995 (?). She was a senior at Gunn at the time.
In other cities there may also be 'car crashes' classified as an accident, but it was one car with one passenger. Near my Mom's last week (in another state) there was a girl on the freeway going 100 mph trying to kill herself in a crash. She lived, but killed two others. Very sad.


8 people like this
Posted by ConcernedNeighbor
a resident of Charleston Meadows
on Jul 13, 2016 at 6:03 pm

What an utter waste of time and a sham of an investigation. I can't believe they didn't talk to family, friends or teachers of the deceased. What does people and organizations who work on suicide prevention and mental health mean. How likely is that teenagers sought these organizations or people out? Per this report, it would seem like there is a high incidence of mental illness in Palo Alto and surrounding areas. A lot of the other factors cited are situations kids usually face during their teenage years. No insights on why these experiences tipped some kids over. They probably missed everything else that was going on in the kids' lives. Also its easy to blame things on mental illness and move on.

I just don't understand why bother with something half-assed like this, which will likely just mislead people and cause more harm or lull people into a false sense of security. If CDC cannot do the research needed to really understand the problem they should just save their team of five people two weeks of their time. I don't feel very good about the work the CDC is doing if this is the quality of work they do.


5 people like this
Posted by Overwhelmingly sad
a resident of Gunn High School
on Jul 14, 2016 at 11:59 am

It doesn't appear the CDC compared the Santa Clara county high school communities to each other, and to similar communities nationally?

The reality is that it's not age appropriate for the majority of teens to have the amount and intensity of pressure on them that they do. Sure some can handle it, but when 20-30% of teens are considering suicide, SOMETHING IS REALLY WRONG IN OUR CULTURE. The weight of the world is on their shoulders, and they haven't even finished high school.

Go here and click on "Explore the data" and select suicide.
Web Link

Male suicides just keep increasing by age group to epidemic proportions, and no one is doing anything about it. Our country has failed it's people.


2 people like this
Posted by Marc Vincenti
a resident of Gunn High School
on Jul 14, 2016 at 10:09 pm

Marc Vincenti is a registered user.

Thursday evening

Hi, Fellow Onliners,

Only after reflection has it struck me how strange the CDC's very first sentence is (in the body of their report):

"From May 2009 through January 2010, five known suicides occurred among incoming, current, or alumni members of one high school in one school district in Santa Clara County, California."

Why would the CDC have omitted the sixth suicide in that cluster--by a Gunn/Paly student in January of 2011?

Web Link

Her funeral filled the church; I was there. Perhaps this kind of omission is inevitable in a study done by people from so far away--a study with such limited sourcing and so little nuance. I'm sorry for whatever hurt this girl's family or friends may feel at having been set aside in this way.

Sincerely,

Marc Vincenti
Campaign Coordinator
Save the 2,008


Like this comment
Posted by Fact checker
a resident of Adobe-Meadow
on Jul 15, 2016 at 9:46 am

@ facts and figures
You write that the report pointed out that suicides in Palo Alto were statistically the same if not better than other California districts. That is not true. You have conflated Palo Alto with the whole of Santa Clara County. The report only gave statistical comparisons of Santa Clara County suicide rates against other counties, state and national rates. The report does not state the rates for Palo Alto.


6 people like this
Posted by anne
a resident of Another Palo Alto neighborhood
on Jul 16, 2016 at 12:32 am

The greatest factor of the ones the CDC identified (causing mental distress and suicidal thinking in the 30 days prior, see end of report) was physical illness that led to missed work/school. Not only is this concerning in terms of how well our district deals with sick students, it highlights one of the biggest unaddressed but fixable factors. There are proven and well researched ways to reduce illnesses in students and staff, that our district does not yet do.

PAUSD had the largest percentage of kids who checked physical illness, including breathing problems. Which reminds me, according to the data collected by the National Council on Teacher Quality, the average number of days absent for our teachers makes them "frequently absent".

There are well-researched, proven ways to reduce this. It's not rocket science, there is a huge consensus in environmental science. Some were promised in our facilities bond specifications but nothing really was done. In many ways, addressing these factors is easier and more straightforward than many of the mental health measures (which needed doing, too, don't get me wrong). When are we going to start treating our kids like whole people whose minds AND bodies are connected? Our teachers would likely benefit, too.






NOW will the community and pare


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