Depression, self-injury focus of panel presentation
Camden — A group of mental health experts put teen and young adult depression and self-injury in a local context in a presentation at Camden Opera House Thursday, Feb. 27.
The event featured Dr. Frederick Goggans, chairman of Pen Bay Medical Center's psychiatry department, Dr. Aniruddh P. Behere, a child and adolescent psychiatrist at Midcoast Mental Health Center, Dr. Michael Hollander, of Harvard Medical School's McLean Hospital, and Greg Marley, LCSW, clinical director of NAMI Maine. It was co-sponsored by Pen Bay Healthcare’s Picker Family Resource Center, McLean Hospital and NAMI Maine. The talks were followed by a panel discussion moderated by Picker Center Co-Director Wendelanne Augunas.
Signs of self-injury
Some possible signs someone is injuring themselves include:
-covering the body, even in hot weather;
-insisting on complete privacy when dressing or changing clothes;
-refusing to go to the beach, where a bathing suit would expose scars;
-hiding knives, razor blades, pins or other sharp objects in their bedroom, backpack or on their person;
-cuts that are parallel, in a shape, design, pattern or words;
-finding blood on linens or bloody tissues in the trash.
Anyone who is concerned about someone who may be injuring themselves should call the statewide crisis hotline at 888-568-1112.
Depression and suicide
Following an introduction by Goggans, Behere presented facts about suicide and self-injury, including statistics for Maine. He noted that since 1940, each succeeding generation has had a higher risk for major depressive disorder, or depression. He attributed the increased risk to a combination of genetic and environmental factors, including changes in family structure, a growing divorce rate and more stress at work.
Depression is the leading cause of disability among Americans aged 15 to 44. It affects 2 percent of children and 4 to 8 percent of adolescents; teen girls are affected at twice the rate of their male peers, according to the World Health Organization, dHowever, while girls are more likely to attempt suicide, boys are more likely to die from an attempt, he said.
In Maine, suicide is the second leading cause of death among young people (behind unintentional injury), and suicides outnumber homicides by seven to one, Behere said. By contrast, in the country as a whole, there are just twice as many suicides as homicides.
Maine's suicide rate per 100,000 population between 2001 and 2010 trended significantly higher than the rate for either the United States as a whole or the Northeast. In 2010, the rate was just under 10 per 100,000 for the Northeast, slightly above 12 for the U.S. and 14 for Maine.
Having lived here only about six months, Behere was reluctant to suggest a reason Maine's suicide rate is so much higher than the Northeast overall. However, he said substance abuse was one likely factor. He noted that youth, and even parents, here are more accepting of marijuana use than in other parts of the country.
Behere also showed a breakdown of youth who considered suicide, who made a plan or who attempted to end their lives, by gender, sexuality and race, showing that girls, Hispanics and bisexuals are among higher-risk populations. This information was from the 2013 Maine Integrated Youth Health Survey conducted by the state Center for Disease Control, the Department of Health and the Department of Education.
The survey also showed that many of the same groups that were more likely to consider suicide were at higher risk for self-injurious behaviors such as cutting, scratching or burning themselves or breaking bones as a way to reduce emotional pain.
A slide that showed the percentage of Maine high school students who considered, planned or attempted suicide in the previous 12 months between 1997 and 2011 indicated that the percentage considering or planning suicide decreased appreciably — from around 25 percent to roughly 12 percent for those who considered it, and from slightly more than 20 percent to slightly less than 10 percent for those making a plan. However, the percentage who attempted suicide stayed relatively stable around 7 or 8 percent, except for a dip in 2007.
He also related feelings associated with depression to considering suicide with a slide comparing percentages of Maine teens who said they had considered suicide in the Youth Health Surveys of 2011 and 2013 with those who said they had felt sad or hopeless in the previous 12 months. In 2011, about 23 percent had felt sad or hopeless, and roughly 13 percent had considered suicide; in 2013, nearly 25 percent had felt sad or hopeless, while more than 14 percent had considered suicide.
While there are a number of local resources for young people struggling with depression and their families, Behere said more early intervention is needed. He said pediatricians' offices are increasingly including a mental health provider on their staffs, to make it easier for families to seek help.
“Psychiatry still has that stigma,” he said.
Within the next month, Behere himself will start seeing patients one day a week at Pen Bay Pediatrics.
Behere was followed by Hollander, a co-founder of the 3East dialectical behavior therapy program at McLean Hospital, which treats teenage girls who self-injure. His portion of the presentation was about understanding and ending self-injury.
Between 10 percent and 20 percent of adolescents in the United States engage in non-suicidal self-injury — injuring their bodies without intending to die, Hollander said, citing studies. Typically, he said, the behavior starts between the ages of 11 and 14, and boys probably engage it about as often as girls, though girls are “over-represented” among those seen in clinics.
Cutting or otherwise injuring yourself, Hollander explained, is a “short-term solution to a long-term problem.” That is, in the short term it makes the person who does it feel better, in part by releasing the body's natural pain-killers, called endorphins. It also allows the individual to assert some control when their emotions seem to be out of control, he said.
Finally, self-injury can be a way of relieving feelings of low self-esteem. If a person believes they are bad or worthless, hurting themselves can be a sort of self-inflicted punishment that takes away the badness, restoring the balance for a while.
While the behavior usually works to calm the person who does it, sometimes people self-injure to jolt themselves out of an emotional void where they are unable to feel anything, Hollander said.
He cautioned that such things as piercings, tattoos, eating disorders and substance abuse do not usually meet the criteria for self-injury. However, eating disorders and some forms of substance abuse can have a similar function to self-injury.
Self-injurers typically have high emotional sensitivity, Hollander said. They may express emotions very strongly, or they may mask their emotional experience. They tend to be perfectionists, and may find it difficult to get to what most people would call a “normal” emotional state. Their behavior is mood-dependent, they may appear depressed and are often anxious, he said. They frequently engage in other high-risk behaviors, such as eating disorders, substance abuse or unprotected sex. They commonly think about suicide.
Hollander said parents and others trying to help someone who self-injures must let the sufferer know that they understand their feelings, and also that they expect the self-injurious person to find a way to stop hurting themselves. He advised seeking professional help for anyone who self-injures.
Differences in behavior
The last presenter was Marley, who talked about the differences between self-injury and suicidal behavior.
Paradoxically, young people who self-injure often see their behavior as a way to avoid suicide, Marley said, because it reduces their internal distress and help them cope with negative emotions in a non-lethal way.
However, those who self-injure often think about suicide, are nine times more likely to report suicide attempts, six times more likely to report making a plan and seven times more likely to make a low-lethality suicide attempt, he said.
Marley summarized some of the differences between self-injury and suicidal behavior: where the intent of self-injury is to seek a temporary escape from distress and make a change in oneself or others, the intent of a suicide attempt is to permanently escape unbearable pain or distress by ending one's life.
Where self-injurers usually use a variety of less lethal methods across episodes, those attempting suicide often use a single, more highly lethal means. While self-injury results in an internal sense of relief coupled with rejection or criticism from others, a suicide attempt typically makes the attempter feel increased stress and disappointment in themselves, even as they receive concern and care from others.
He stressed that parents and school officials should know how to respond to self-injury: be direct and calm, treat any wounds as needed, ask about when it started, how often it has taken place, what are the triggers, what happens as a result and what the person is seeking, and get professional help.
Marley also said it is important not to accede to requests to keep the self-injury a secret. To do so is to tell the person it is OK to keep injuring themselves.