In the last year and a half, about 16 youths (people 19 years old or younger) were admitted to Martha’s Vineyard Hospital for attempted suicide, according to hospital data recently acquired by the Gazette. In the year-and-a-half prior to that, seven youths were admitted for attempted suicide.
Of the 16 attempted suicides by youths in this past year and a half, 14 occurred between January and May of this year.
The director of emergency medicine at Martha’s Vineyard Hospital, Dr. Timothy Tsai, is quick to caution that culling information from the hospital database is tricky. Attempted suicides may be listed as drug overdoses or self-inflicted injuries, and the computer must be asked questions carefully to yield accurate answers. Therefore, this new data may lack accuracy.
But if valid, the data would lend credence to the middle school and high school survey results released in late August by the Dukes County Health Council’s Youth Task Force.
The survey shows a jump in the percentage of both middle school and high school students who said they attempted suicide in the previous 12 months.
“What a hard time young people have on this Island,” Vineyard psychiatrist Charles Silberstein told the Gazette this week, noting that teen suicide rates have increased nationwide. “It may also reflect a national trend, but it’s pretty clear we have more depression here on Martha’s Vineyard. It’s also clear we have more alcohol abuse. We see it in adults and we see it in the parents of our youth and for genetic and environmental reasons, we’d expect to see it in the youth as well.”
Tom Bennett, associate executive director of Community Services, said drug and alcohol can be closely tied to depression and ideation of suicide.
“It’s hard to know which comes first, but oftentimes, when people feel pain [as with depression], they use drugs and alcohol to numb that pain,” said Mr. Bennett, who also manages Emergency Services, which provides emergency psychiatric interventions. “It magnifies the problem. You’ll see that with adults and kids.”
The Youth Risk Behavior Survey was administered to Island students in seventh through 12th grade in February of this year.
The results show 12 per cent of high school students say they attempted suicide in the previous 12 months, whereas in similar surveys done in 2000, 2002 and 2005, five per cent said they had. This exceeds the 2005 state average of six per cent and the 2005 national average of eight per cent.
Among seventh and eighth graders, 11 per cent this year said they had attempted suicide in the last 12 months — up from two and three per cent in the previous years’ surveys. Past surveys show that girls are much more likely than boys to cite depression, thoughts of suicide, suicide attempts and self-inflicted injuries, but a gender breakdown of this year’s statistics is not yet available.
On the other hand, the survey shows that the rate of clinical depression among high school students — 21 per cent — is not higher than state or national averages and is not higher than in 2005. The rate among middle school students — 14 per cent — was the same as in 2005 and state and national comparisons are not available.
Even if some of the students who said they attempted suicide have a different definition of what would constitute an attempt — or outrightly lied — the number 12 per cent is still worth paying close attention to, according to Martha’s Vineyard Regional High School guidance director Michael McCarthy.
“It’s the perception of the students and the feelings and thoughts that are important,” Mr. McCarthy said. “You can’t make light of any indication like that.”
Mr. McCarthy said he did not find it unbelievable that 12 per cent of regional high school students said they attempted suicide in the last 12 months.
“I was not surprised to see there were a number of kids who had those thoughts, because we do deal with that a lot,” he said. “It’s still a very nervous topic for everyone. But I don’t think something like this should be swept under and not acknowledged. Kids are having thoughts and feelings in that area.”
Last year, the regional high school started a peer outreach program that educates students on depression and suicidal ideation.
“We’re trying to sensitize the teenage population that if someone is sharing these thoughts with them, it’s something to take seriously and not keep secret,” Mr. McCarthy said. “They learn that those are legitimate feelings, but that they’re feelings you need to talk about with someone.”
This is a healthy approach to the issue, according to Tim Lineaweaver, program director of a clinic-based program on Cape Cod called Community Care for Depression.
“What you want to do is create a culture among kids where you really are willing to go out there and get help for your friend if you have concerns,” said Mr. Lineaweaver, who is researching depression across the Cape and Islands. “We also need to create a culture that doesn’t normalize substance abuse, because a lot of attempts happen under the influence.”
Still, the hospital data showing 16 youths in the emergency room for attempted suicide is a far cry from the 97 youths who said they attempted suicide in the last year (12 per cent of 525 high school students, plus 11 per cent of 311 middle school students).
Some medical professionals don’t think the survey numbers are plausible.
“Just based on my sense of how things are in the emergency department, I’m a little bit surprised at that number because I go over the figures for transfers monthly, and I don’t see a lot of transfers to psychiatric facilities,” Dr. Tsai said. “That’s very worrisome if those figures are true,” he added.
That does not mean the numbers are uninteresting, he said.
“Even if there is some error in the design of the question, there is an increase to the number of people who respond to that question. So there is an indication that there is at least an increase in depression or suicidal ideation,” Dr. Tsai said.
There is additional skepticism of the youth survey results because they fail to demonstrate a particular pattern.
Before asking students whether they actually attempted suicide in the last 12 months, the survey first asked if they had seriously considered attempting suicide and whether they had made a plan to attempt suicide in the last 12 months. In previous survey years and in state and national data, the number of students who seriously considered attempting suicide was always greater than the number who made a plan, which was always greater than the number who actually attempted suicide.
But that pattern did not emerge this year among Martha’s Vineyard Regional High School students, drawing more questions about the validity of the results. The percentage of students who said they had seriously considered attempting suicide, the percentage who said they had made a plan and the percentage who said they had actually attempted suicide were all the same — 12 per cent.
“I’m really skeptical that that’s a valid result. One hundred per cent of those who contemplate also attempt? That doesn’t match up with the experience of people in medicine or public health,” Dr. Tsai said.
The middle school students demonstrated the opposite of the typical pattern. While 11 per cent said they had attempted suicide, eight per cent said they had made a plan and five per cent said they had seriously considered attempting suicide.
The Youth Task Force is currently investigating whether it is the same 12 per cent of high school students who answered yes to the each of the three questions.
Mental health professionals say that one reason there would be more suicide attempts in the survey than in the emergency room is that many suicide attempts are not reported on the Island and don’t get as far as the emergency room.
“I think different people define suicide attempts very differently,” Dr. Silberstein said, noting that a person might take too much aspirin in one sitting, knowing it probably would not kill him or her, but still consider it an attempt. “My guess is that most people who make suicide attempts don’t end up in the emergency room.”
People may also not go to the emergency room after attempting suicide because they don’t want others to know, he said.
“Lots of people feel way too ashamed to show up in the emergency room,” Dr. Silberstein said. “I’ve seen many people in my practice over the years who attempted suicide and never told anyone.”
Mr. Bennett said he has also found that to be true, and notes that privacy is more difficult to come by on the Island.
“Some people would rather that people not know they’re receiving mental health help,” said Mr. Bennett. “That may hinder people from getting help, because they feel they will be exposed.”
In terms of the apparent spike in youth suicide attempts from January to May of this year, mental health professionals say that is the most common time of year for Islanders to experience mental health problems.
“Those are definitely the down months on the Island,” said Tisbury psychiatrist Dr. Gretchen Jacobs, who has board certification in adolescent and child psychiatry. “We are probably more affected on this Island by seasonal affective disorder because of the isolation,” she added.
Mr. Bennett said he sees a dramatic increase in patients at Community Services from after the holidays until the spring.
“It’s always the time we see the most folks in crisis and an increase in clients,” Mr. Bennett said. “That’s a tough time for people. January, February, March, April — May, even. People start to come out of their depression in May or June, but it’s a difficult time because they’re starting jobs, the tourists are starting to come, they might be moving . . . .”
Some mental health professionals, including Dr. Silberstein, wonder if suicide attempts on the Island have increased among adults as well.
“I know that our numbers for emergencies have increased in the last few years, but the numbers of Islanders have increased too,” Mr. Bennett said of the caseload at Emergency Services. “Overall, it’s getting more and more difficult for working Island people to live on the Vineyard. The cost of living is going up and up and the availability of land and houses for their children has diminished to the point where most people that are working folks can’t afford any property anymore. So that puts a lot of added stress on Island folks. If you’re a working person, to be able to get ahead is extremely difficult. People get to a point where they’re feeling discouraged, they’re not able to pay their bills. A lot of times, they have to move seasonably to be able to stay here, they have to rent out their home.”
Many patients have told Mr. Bennett that it has become harder to make a living in common Island vocations like landscaping and stonemasonry with the influx of immigrants doing those jobs.
“We know those are the kinds of things that cause people to go into crisis,” Mr. Bennett said. “In my work, I’m seeing a lot of Islanders under these economic pressures. They’re selling their homes and going away. And that’s sad to see.”
Dr. Silberstein had some additional theories as to why adults and young people on Martha’s Vineyard struggle more with depression and ideation of suicide than in other places.
“A lot of people have suggested it’s part of Island life and there’s something that’s desolate and depressing about Island winters. I’m not sure I believe that,” Dr. Silberstein said. “A lot of people move here who find that this is a place that they’re happy and they imagine that if they come here, their problems will go away. So to some extent, it’s a self-selected population that are seeking something, relief from some psychic distress. Having said that, most people on this Island are happy. But there is a significant portion of the population that I think has moved here looking for something, and their problems follow them.
“Another factor that’s been suggested is there was a certain counterculture community in the seventies and eighties that lived here and there was a high rate of drug use in that population, so in that population, certainly alcohol use and marijuana use were normal. If it’s normal for parents, it’s normal for children, so it becomes more embedded in the community. And alcohol is a depressant,” he continued. “Also, it’s the nature of a resort community to party. And party means alcohol and drugs. I’ll bet if you looked at resort communities you’d see higher rates of alcohol and drug use.”
Whatever the cause of the apparent increase in suicide attempts, health professionals on the Island say that continuing to collect and analyze data will help the Island address the problem.
“It is such important information for us to look at as a community,” Dr. Silberstein said. “I think what we really need is to continue doing the kind of study that the Youth Task Force is doing and the survey we did [Island-wide in 2004], focusing on mental health issues. And there is a wealth of information at the hospital.”