Amelia Ryerse (AR): National Suicide Prevention Week kicks off today and runs through September 16th. In the US we have lost half a million people since 2010. This does not include the numbers of individuals who may have attempted to end their lives. The fastest increase in deaths are among people of color, younger individuals, and people who live in rural areas. The annual campaign was founded to raise awareness, remove the stigma, and encourage people who may have had suicidal thoughts to seek mental health treatment. Medical Director of the Kennedy Krieger Psychiatric Mental Health Program, Dr. Carmen Lopez-Arvizu, joins me to talk about warning signs, treatment, and places to go for help if you need it. Good morning, doctor. Welcome to Maryland Perspectives.

Carmen Lopez-Arvizu (CL): Good morning. Thank you for having me.

AR: The number of adolescents who have suicidal thoughts has been increasing. Can you give us some of the reasons that are causing this?

CL: One of the reasons that we have identified more is because we are more aware. We are able to identify it more, and we feel more comfortable asking when we noticed changes in individuals presentation or personality.

AR: What are some of those presentations that you see?

CL: The most common issue reported especially by parents and teachers, is when they notice a change in what we call personality or affect in an individual. Somebody that used to be talkative or more interactive, they start to being withdrawn. They start to seem enjoying less of the things that they used to. In academics, we see school absences. We see lack of participation or a decrease on academic performance.

AR: Now, there is a difference between clinical depression and actual just sadness or, you know, maybe something went on, they lost their best friend, or got into a fight. What are some of the things that might clue a parent in that it's more than just getting into a fight with a friend, besides just withdrawing. Because kids, especially preteens and teenagers, their brains are growing again, the hormones are kicking in and they might overreact?

CL: Correct. I think one of the important things that we forget to do as the kids grow up, is having a constant check in of what's happening in their lives and what's happening in academics and the social interactions. The change in that kind of feedback or the change in that kind of interaction with their family it's an important change that we need to be able to identify. If they, for whatever reason, are spending more time with their friends or more time in the room, that is a common behavior in a teenager. The issue is what happens when they are actually interacting with the family? Is there also a change? Have they changed in the way they are communicating, connecting, participating in daily life, or just seeming to enjoy life in a different way? Those are the differences. We can be sad for many things that happen in our lives. A friendship, might be breaking up with a girlfriend or boyfriend, or having a bad grade. However, those episodes are short and they're not intense necessarily. When you see a persistence of low mood or changes in sleep, appetite, changes in other measurable outcomes like academics, or even losing interest in other activities that they used to enjoy, playing basketball and now I drop out of the team, things that are big, that are noticeable to others outside of the individual, those are the things that are flags, to be more in attention to intervention.

AR: Now, just so everybody knows, you do work primarily with children and teenagers. But for adults, is there a difference between that and maybe even anxiety issues between adults and children?

CL: I see kids, adolescents and some adults in transitional age, meaning early college. Yes, there's definitely a difference in the presentation of anxiety, depression, and even just grief and the younger population versus the oldest. In younger kids, you very often will see what we call externalizing behaviors, meaning meltdowns or crying or showing their frustration in a way that is visible from the outside. As you grow up in teenage years and early college, you might often see people being withdrawn or maybe having a verbal outburst that then moves on, and you see more of what we call internalizing behaviors. Same as in boys and girls. In girls, you would see more internalizing behaviors than externalizing behaviors. The presentation that you see might not necessarily match the feeling inside. That is why it's so important to ask those questions of an individual that you are seeing changes evident.

AR: It seems like communication is key between a parent and the child, between adults and adults, your significant other, you can look for these things. It just seems it's almost an epidemic at this point where depression and anxiety ever since the pandemic especially, and also when you get into finances and the economic downturn and all of that. It's interesting because people are really stressed out and everybody presents differently. Like you put it. They show their frustrations or they show their anger. We see a lot more road rage now. What are some treatment options, not only if they're having suicidal thoughts, but for all of these other various things that are coming up to the forefront?

CL: There are certain difficulties that do not require necessarily what we call mental health treatment. Just having a conversation or being able to share your emotions with somebody else can be a relief. That's why we're seeing so much people sharing in social media, what they're feeling, the way they're feeling and processing their thoughts out loud for others to see. That's why communication with the people that are close to you, it might be a family member, a significant other it can be your pastor, it can be a coach. It can be somebody that is there just to hear you. That is the first step to put your thoughts outside of you and be able to process your feelings better. Now then there's the next step. There might be that this is more than somebody else can handle, just sharing your emotions or you're having more difficulties that are interfering with your quality of life and the others that surround you. That's when you have to pursue mental health treatment. That comes in different places. You can access counseling, you can access a psychotherapist to be able to process these feelings. One of the things that is very important is that whenever you look for mental health treatment, you need to ask, what is that? What does it involve? I think the lack of awareness or really knowledge for most of the general public, what does psychotherapy mean or what does it entitle, becomes a barrier for people. It's not that you are going to be changed, nobody's going to be brainwashing of you. It's going to be a conversation and a process with evidence based psychotherapy, meaning that it has been researched to work for treatment of symptoms that you are presenting with. It should be done in an organized manner by the licensed professional. That is very important to be an informed consumer of health care.

AR: Then we live in such a great state too. There are so many avenues of accessing it, whether you have really good health insurance or you don't. I'm going to throw the number 988 out there right now, that is a crisis hotline in our state that if you are in a moment of crisis and you don't have anybody to really talk to, and throwing it up on your Facebook page isn't really helping, 988 not only can help talk you out of whatever crisis you're having, but can also point you in different places where you can find some professional help, if that is indeed what you need. For adults or parents of children to access this treatment, I know that Kennedy Krieger, you guys are in the forefront for all kinds of issues and one of them is mental health? Yes?

CL: Yes. We address brain disorders that affect emotion and behavior. Yes, a lot of difficulties in mental health will fall into that category and we can offer those services.

AR: I love that you're bringing up some things that are slowly but surely changing. That's the stigma of asking for help, and it's associated with these types of situations. Language does have a lot to do with it. Can you give some examples of how we can talk about suicide, depression, anxiety, without using negative phrases?

CL: Absolutely. Words matter. They absolutely matter. Because it can be a huge barrier for you to be able to acknowledge your difficulties and to reach our full help. People make jokes about people being crazy, or you're insane, you're nuts. It is very funny until somebody you love is the one that is needing this kind of help. There's really nothing funny about it. We need to be able to remind people, make sure that we are educated, that mental health, it's brain health and it's a physical thing, it's not imaginary. Just because you do not see it, it does not mean it's not real. It hurts. It can have a very severe impact in your quality of life and sometimes even turns into somebody dying by it. It is very important that we change the way we describe and we talk about mental health.

AR: It can be very debilitating. I've had family members that have succumbed to their depression and it's really hard. A lot of the family members are left scratching their heads, going, what did I do wrong? They blame themselves. It's not anybody's fault. It's not the person and it's not your family member. But it is something that you have to take seriously and, like you said, not to joke around about it. If somebody says, I need help, give them the help that they need. There's, like I said, so many great resources in Maryland including Kennedy Krieger. Where can people go to learn more about warning signs or get the treatment that they need for themselves or for others?

CL: You just mentioned 988, that is a very good resource, has a lot of details about things to look for. In these kind of cases, you can also check the website and you can also check the Johns Hopkins Psychiatry Department website. Those are three great resources to look for more details on symptoms that you need to be aware for.

AR: Dr. Carmen Lopez-Arvizu is an adolescent psychiatrist and medical director at Kennedy Krieger Psychiatric Mental Health Program and I'll be sure to get all of those links up that we talked about including the 988 number that is open 24 hours a day for emergency mental health help. Thanks to you and your staff for helping young people overcome their mental health issues and for your time today in raising awareness for the National Suicide Prevention Week.

CL: Thank you. It's a pleasure to be here.

Learn more about the Psychiatric Mental Health Program at Kennedy Krieger Institute.
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