What Every Teacher Should Know

Helping Oregon's Youth

Youth suicide in Oregon is reaching epidemic proportions. Oregon's youth suicide rate has increased 400 percent over the last four decades. Today we have a suicide rate 30 to 40 percent higher than the U.S. national rate.

These alarming increases have made suicide Oregon's second leading cause of death in youth. Even children as young as seven years old have killed themselves.

Download brochure: What Every Teacher Should Know about Preventing Youth Suicide (pdf) or view information in En Español.

It is more important than ever that teachers help prevent youth suicide. Adolescents who die by suicide are most likely to be clinically depressed when they complete suicide. By knowing how to spot the early warning signs and understanding what to do if you identify a student at risk, you could literally save the life of a child.

Seeing the signs

Depression is a biochemical imbalance in the brain that affects how students think, how their bodies function and how they behave. That means that sometimes behavior problems aren't just problems - they are surface signs of a deeper cause. Depression in adolescents is common: more than 1 in 5 youths will experience clinical depression by adulthood.

As a teacher, you will see some of your students with one or more of the following surface signs, which may indicate depression:

Low self-esteem
Anger management problems or preoccupation with violence
Irritating, fighting with or withdrawing from students, teachers and parents
Refusing to go to school
Behaving to get negative attention
Doing poorly or dropping out of school
Getting into trouble with the law
Becoming pregnant early in life
Increased physical health problems
Becoming a smoker
Abusing alcohol or drugs
Threatening suicide or homicide

Taking a closer look

Teachers working with young people are usually the first to notice when a student begins show signs of depression. But too often these changes aren't recognized as warning signs until it's too late.

Parents and teachers can sometimes mistake a youth's change in mood as a case of "the blues" when in fact the youth has a medical illness called depression. "The blues" will only affect the student's mood briefly and will improve after talking with a good listener. Depression will only improve with psychiatric treatment.

The most severe form of depression is a major depressive episode. This is marked by a change in your student lasting at least two weeks, during which time your student has become either depressed, irritable or uninterested in most activities, most of the day - nearly every day. Your student will also experience five or more of the following symptoms nearly every day:

Depressed or irritable mood

"I hate my life"
Rebellious behavior
Easily irritated
Rarely looks happy
Listens to depressive or violent music
Starts hanging around other depressed or irritable kids
Wears somber or dark-colored clothing
Frequent crying spells

Loss of interest in activities

"I'm bored"
Withdraws - spends majority of time alone
Decline in hygiene
Changes to a "more troubled" peer group

Significant change in appetite or weight

Becomes a picky eater
Snacks frequently and eats when stressed
Quite thin or overweight compared to peers

Psychomotor agitation or slowing

Agitated, always moving around
Moping around

Feelings of worthlessness or excess guilt

Describes self as "bad" or "stupid"
Has no hope for the future
Always trying to please others
Blames self for causing a divorce or death, when not to blame

Decreased concentration or indecisiveness

Often responds "I don't know"
Takes much longer to get work done
Drop in grades or skips school
Headaches, stomachaches
Poor eye contact

Significant changes in sleeping habits

Takes more than one hour to fall asleep
Wakes up in early morning hours
Sleeps too much

Fatigue or loss of energy

Too tired to work or play
Leaves school exhausted
Too tired to cope with conflict

Recurrent thoughts of death or suicide

"I'm going to kill myself"
Gives away personal possessions
Asks if something might cause a person to die
Wants to join a person in heaven
Actual suicide attempts

The next step: Talking to the family

After you have identified a student as being at risk for depression or suicide, the next step is to talk to the student's family.

If you've noticed warning signs of a major depressive episode, the one thing you should never do is ignore these and hope your student will "get over it." Instead, here are some of the ways you can step in and help prevent youth suicide:

Be available. Connect with your student. Set limits when needed.
Always take suicidal and homicidal talk seriously. Share these statements with appropriate school officials.

In talking with the family:

Share your care and concerns about their child.
Discuss specific suicidal or homicidal statements and indicate that these statements need to be taken seriously.
Review similarities between their child's problems and what is discussed in this brochure. Provide a copy of this brochure to the family.
Recommend their child have an immediate evaluation by a mental health professional trained in recognizing/treating depression in youth. The family's school counselor or primary care physician can be consulted to find an appropriate professional for their child. As part of this process, families should be made aware that depressed youth should not have access to firearms; two thirds of youth suicides in Oregon occur with guns.
If parents are ambivalent, ask why. Review this brochure with the family again, making sure to point out the warning signs you've noticed.

Some parents may hesitate about having their child referred for an evaluation. Their reasons can include:

A belief their child is experiencing "normal" adolescence. Clinical depression is not normal and causes ongoing problems until their child receives sufficient treatment.
A concern that their child might be viewed as "crazy." It is important to help the family recognize depression as a medical illness with physical causes, similar to diabetes or asthma.
Hope that their child will "get over it." Unfortunately, depression persists until treated.

The earlier depression is evaluated and treated, the easier it is to treat and the less likely it is for further complications to develop (e.g., death by suicide or homicide). Getting treatment for the student is critical.

Treatment options that should be considered include:

Taking immediate and sufficient steps to ensure safety, including eliminating access to firearms
Individual/family/group therapy
Good role models
School and community support
Developing interests in their child
Good nutrition and exercise
A complete physical exam by the child's primary care physician
Antidepressant medication
Eliminating any abuse or domestic violence
Taking steps to relieve or improve parental ability to deal with stress
Eliminating alcohol and drug use

Where there's help, there's hope.

Depression causes problems for the student, the school, the family and the community. But with the right treatment, you could see dramatic improvements in a child's life in just a very short time. As a teacher, you play a crucial role in the early recognition and referral of students who may be depressed. Knowing what to look for and what to do could mean the difference between life and death for a student close to you. For more information, contact your school's child development specialist or school counselor.

Information in this brochure is based on "Recognizing Depression in Youth: A Key to Suicide Prevention and Good Health in Oregon," by Kirk D. Wolfe, M.D.

Dr. Wolfe is a child and adolescent psychiatrist practicing in Portland, Oregon. He has been an active part of Oregon's youth suicide prevention efforts.

Download brochure: What Every Teacher Should Know about Preventing Youth Suicide (pdf)