Depression common among teens; some turn to cutting or attempt suicide

Nearly everyone remembers being moody as a teenager, but for some, it can be dangerous.

In Jamie Smith's case, she was 17 when the depression she'd been battling took a turn for the worse.

It wasn't until a friend accidentally caught Smith attempting suicide in her bedroom that it became clear the young woman was having a problem.

"My mom didn't realize it was that bad. We really didn't talk about mental illness in our family," she said.

Although Smith had complained of feeling unwell and hearing voices that encouraged her to hurt herself, no one listened.

Eventually, her mother relented and took her to a medical doctor who prescribed an antidepressant, but the medication didn't help.

Two weeks into the new prescription, the teen was hospitalized for swallowing a bottle of Tylenol and trying to cut her wrist when the over-the-counter pills didn't kill her.

Although initially diagnosed with depression, Smith, 33, since has been found to suffer from bipolar disorder.

After many issues and hospitalizations, she considers herself stable and is working to wean herself off all medicine while she serves part time as a peer-support specialist at the Community Counseling Center in Cape Girardeau.

Her ultimate goal is to work full time and possibly earn a degree in psychology. On March 15, Smith also will celebrate two years of being sober after overcoming a yearslong drug addiction she said she used as a crutch to self-medicate.

Smith's lifelong problem with mental illness began as a teenager. The Centers for Disease Control and Prevention's national health and nutrition survey reports 13 percent of children between ages 8 and 15 had a diagnosable mental disorder in the past year. The most common disorder is ADHD, which affects 8.5 percent of this population.

Smith's story is one Victoria Dormeyer, the CCC's director of outpatient and emergency services, considers an example of how patients can overcome.

It also illustrates a classic cry for help.

Anytime a young person threatens or tries to hurt himself or herself, Dormeyer said it's something that has to be taken seriously. Self-harm is a sure sign of a big problem that must be addressed immediately.

"When children start harming themselves, you know there's something deep down going on," Dormeyer said.

While threatening suicide is one issue, another has cropped up in recent years that also is a signal something is wrong: Children and teens who begin cutting themselves. This is a coping mechanism that dulls depression symptoms temporarily.

"They're just using it to release the pain," Dormeyer said.

To hide the problem, some youngsters find less-visible places on their bodies to cut, such as between their toes or near underwear lines. Others cut themselves high on their thighs so the cuts don't show while wearing shorts during warmer weather.

"It's become kind of socially acceptable among youths," she said.

Many parents think their child is cutting for attention, "but they're doing it because they need help," she said.

The first line of treatment for cutting is cognitive behavioral therapy.

It teaches teens other, less destructive ways of coping with mental-health issues, such as those most commonly seen at the CCC.

Dormeyer said the more prevalent ones are depression, attention deficit hyperactivity disorder (ADHD), oppositional defiance disorder (ODD), bipolar disorder and generalized anxiety -- all of which usually result from exposure to traumatic events.

At the CCC and elsewhere, mental-health professionals often use a 10-question assessment called the Adverse Childhood Experiences Study, which calculates a person's ACE score.

Five of the questions deal with types of abuse inflicted in the home, and the rest look at problems with family members, such as battered mothers, alcoholics or broken marriages.

Each question marked with a "yes" counts for one point, and anyone with a score higher than five has a greater likelihood of health problems.

"It's pretty interesting how trauma does affect things later on in life, not only mentally, but physically as well," Dormeyer said.

In Smith's case, her parents were divorced, and until he left the household, her father was severely abusive to her and her brother and sister, she said.

"Anything and everything he could pick up, he would hit you with," she said. "He's used tent poles before."

Smith's father would beat the siblings with a belt until they were covered in bruises, throw cigarette lighters at their heads and fling them across the room, she said.

"He never looked at what he did to us as abuse. To him, it was discipline. That's the way his dad did him," Smith said.

When she mentioned her struggle with depression, Smith's father, like his ex-wife, refused to acknowledge she might be ill. Then, when she was hospitalized after her suicide attempt, her father would add to the problem until she asked the administrators not to allow him to visit, she said.

"He would say, 'You're an Armstrong. You shouldn't be like this; you shouldn't feel like this,'" Smith said. "He thought mental illness was some kind of cop-out."

The CCC, which Smith said she considers a godsend, is contracted by the Cape Girardeau School District to provide school-based therapies and more intensive interventions for students.

"We also provide individual therapy and crisis services here in our office," Dormeyer said.

Two staff therapists are trained to work with children. One circulates among certain schools in Cape Girardeau (the high school, junior high, middle school and Jefferson and Franklin elementaries) and Jackson (the high school, junior high, middle school and North and East elementaries), while the other helps in Ste. Genevieve, Missouri.

A Cape Girardeau School District spokeswoman declined to discuss mental-health services in the district.

Brian Lee, superintendent of Scott City schools, said teachers and administrators there have a list of things to look for in students and will let school counselors know whether they suspect a student isn't well.

If a child becomes noticeably withdrawn or isolates himself or herself, or if attendance becomes a problem, those are signs of a potential issue. Another is when a student has a big change in behavior.

"Those are the kinds of things you notice as an educator," Lee said.

Sometimes, mental-health issues can be wrapped into the kinds of individual education plans students who are learning-impaired may have to help them achieve consistently with peers. At other times, sessions with school counselors can help defuse issues.

"We do everything that's best for the kid. We try to connect them with outside resources if our resources or accommodations aren't enough," Lee said.

It's impossible to know how many mentally ill students are in the district, because some students don't show obvious symptoms, and teachers have no way of knowing whether a child is being treated outside of school. Plus, everyone is different.

"The problem is, how do you define a mental illness?" Lee said. "Each kid is different, and it just kind of depends."

For students whose illnesses have caused them to miss school, the Scott City system has homebound services in which teachers will help students keep up with their schoolwork while they are in treatment.

Ultimately, Lee said he wishes more state and federal money was available to help prevent tragedies and treat the mentally ill.

For her part, Smith said she wishes more people would seek help.

"Mental illness is a big thing in our community, and a lot of people aren't getting help here," she said.

ljones@semissourian.com

(573) 388-3652

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Risk factors

An ACE (Adverse Childhood Experiences) Study score is used by mental health professionals to determine how much trauma a child has been exposed to and how that will affect them now and in the future. Ten questions are asked, with five measuring personal trauma and five measuring trauma related to other family members. Each *"yes*" answered is worth a point, so the more yeses a person marks, the higher his or her score up to 10. The ACE model also helps gauge a person*'s resilience to adversity and trauma. A score of 5 or higher increases the likelihood a person will experience medical problems.

Personal trauma:

Physical abuse

Verbal abuse

Sexual abuse

Physical neglect

Emotional neglect

Other traumas:

An alcoholic parent

Mother who is a victim of domestic violence

A family member in jail

Mentally ill family member

Disappearance of a parent through divorce, death/suicide or abandonment