The report was compiled by 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 young people 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 of the Santa Clara County youth 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 contributed to 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."
A comparison of Palo Alto youth
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 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 had a consistently lower rate than the nation, according to the report.
The CDC's 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 Sara Cody, health officer and public health director for the county health department. The team will also have access to data from a recent survey that Palo Alto 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 will compare local youth-suicide prevention efforts to evidence-based recommendations. The final report will likely include additional recommendations regarding suicide-prevention strategies at the school, city and county level.
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, go to tinyurl.com/PSNrsvp0727
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