Suicide, especially among children and adolescents is a growing phenomenon of concern and the numbers tell a shocking story. Every 40 seconds someone takes their own life according to the World Health Organization (WHO). Bringing awareness on this critical issue, September 10th is being observed each year as World Suicide Prevention Day across the world.
Observing World Suicide Prevention Day, American Association of Physicians of Indian Origin (AAPI) organized a live online seminar on “Treating Depression in Children and Adolescents in Primary Care” on September 10th, 2022. Attended by a record number of physicians from around the nation, the online seminar was led by Dr. Ravi Kolli, President of AAPI and a Board-Certified Psychiatrist from Pittsburgh, PA.
Dr. Kolli set the context for the Webinar, by drawing the attention of the AAPI members to the prevalence of suicidality among people of all walks across the United States. “Nationally in 2020, there was approximately one death by suicide every 11 minutes. In the same year, for people aged 10–14 and 25–34 years, suicide was the second leading cause of death. From April 2020 to 2021 over 100,000 people died of drug overdose alone,” Dr. Kolli said. “Over 44,000 people die by suicide annually. As many as 123 people die by suicide every day. Over 1.3 million people attempt suicide each year, and suicide is the 10th leading cause of death for all age groups,” Dr. Kolli pointed out.
Mental health issues like depression are known to be the leading cause for attempting suicide. Suicide often occurs in a moment of unbearable pain or deep despair. Millions of Americans consider suicide, make a suicide plan, or attempt suicide every year – especially young Americans for whom suicide is the second leading cause of death.
“By drawing attention to the problem of suicide in the United States, the suicide prevention campaign also strives to reduce the stigma surrounding the topic, as well as encourage the pursuit of mental health assistance and support people who have attempted suicide,” Dr. Kolli, a board-certified psychiatrist told the AAPI members. “With the objective of strengthening and expanding the Lifeline infrastructure to respond to crisis calls, texts, and chats anytime and establishing a system that provides more opportunities for crisis service, the Federal Government has initiated the soft launch of Emergency Suicide Prevention Number, 988, transitioning from 1-800-273-TALK to 988,” Dr. Kolli pointed out. Dr. Kolli educated the participants on ways to respond to crisis and talked about the impact from “Reaction vs. Response.”
Dr. Malti Mehta, a member of AAPI BOD and a moderator of the session, stressed the importance of understanding how from inception onwards, the family dynamics contributes to depression and suicidality among children, especially among children of Indian heritage. “Let us work together with our family, friends, healthcare workers, religious and political leaders to prevent suicide through active counseling and support. It is time we empowered others to be in charge of their lives and value the one life they have.”
In her eloquent and comprehensive presentation on “Treating Depression in Children and Adolescents in Primary Care” Dr. Aparna Vuppala, Medical Director, SPEAK project of HHF -Huntsville Hospital Foundation and a Psychiatrist from Huntsville, AL educated the audience on: the prevalence of suicide in children; Criteria for depressive disorders in children; Etiology and stressors worsening depression; Screening u Differential Diagnosis and comorbidity; Suicide prevention measures; Non-pharmacologic Treatment and Pharmacologic Treatment available today.
“In 2011, for the first time in 20 years in the US, more teens died from suicide than homicide,” Dr. Vuppala pointed out. “In 2017, the suicide rate was more than twice the homicide rate. In 2018, Suicide has become the second leading cause of death in 10–24-year-old children.” Dr. Vuppala shared with the audience her own experiences in efforts to prevent suicide among school-going kids in Alabama. “The mayor’s office has recognized our efforts, providing funds for the program,” she said. She offered her team’s services to other parts of the nation.
Addressing the challenges of Pediatric Depression, Dr. Vuppala said, “Most depression research has been done on adults. Childhood depression is not necessarily the same illness as adult depression. We use the same DSM-V criteria as for adults. Childhood emotional instability is a challenge to understand and treat. AAP Guidelines recommend screening all youth 12 years and older for depression.”
Educating the parents about the consequences of untreated depression with the need for treatment compliance, she said. It is possible that 9 out of 10 kids are likely to share their issues with someone close to them or express their views on social media. Identifying them and recognizing them in advance is a sure way to prevent suicidality, Dr. Vuppala said.
She recommended that “parents must ask directly and matter-of-factly about suicide with children. Do not underestimate the threat of suicide or invalidate feelings. Do not be judgmental. Do not argue or debate if suicide is right or wrong. Do not say that their pain/stressor is not a serious enough reason. Do not lecture on the value of life. DO NOT be sworn to secrecy.” Among other things, she stressed the need for a minimum of 8.5 hours of sleep at night and limiting screen time with less than 2 hrs./day of recreational screen time for school-age children, and less than 1 hr./day for 2-5 yrs. old children.
Referring to treatment modalities to address depression and suicidality, Dr. Vuppala highlighted the importance of individual psychotherapy and Cognitive Behavioral Therapy (CBT), which helps increase awareness of thoughts-emotions-behaviors and change thinking pattern. In addition to Parent-child interaction therapy (PCIT) and medications to treat depression, she referred to Dialectical Behavior therapy (DBT) which has been found to be helpful in preventing SI/self-harm by offering techniques to cope healthily with stress, regulate emotions, and improve relationships with others. Mindfulness has been found to a way for compassion and being grateful, while pet therapy and nature therapy are found to be useful.
During the interactive session, Dr. Kolli and Dr. Vuppala shared their insights on how “mindfulness and meditation” have contributed to stress reduction and prevent suicidality. Research on meditation and mindfulness has been shown to improve holistic person. Spirituality is found to be a valuable resource in combating loneliness and depression, Dr. Vuppala said.
American Association of Physicians of Indian Origin (AAPI,) the largest ethnic organization in the United States, representing nearly 120,000 physicians and Fellows of Indian origin in the United States. For more details on AAPI and its programs, please visit: www.aapiusa.org