MARIETTA — From a young age, Dr. Avril Beckford said her son Justin Rowley had both a kind heart and a sharp wit.
She recalled in the early ’90s a then 2-year-old Justin making up his own prose in a picture book version of “Peter Rabbit” telling the story to his infant brother.
“He said, ‘And Baby Derek, what did Peter Rabbit say to his Mommy? ‘New babies cry and poopoo entirely too much,’” she said, laughing.
Beckford, a general pediatrician and chief pediatrics officer for WellStar Health System, said she’d shared that story countless times. She told other stories that made her smile as she walked around her medical practice in Smyrna, pointing to pictures of her son hanging on the walls in examination rooms.
As he grew up, Justin’s peers saw him as happy and successful — the life of the party, his mother said, and outwardly, he was. He did well in school, and he was outgoing and friendly.
“He had amazing charisma. He was engaging. ... He loved to do karaoke,” Beckford said, noting that his best attributes, and also his vulnerabilities, were his sensitivity, kindness and love for others.
A Type 1 diabetic, Justin had once organized a two-day bike ride that raised more than $12,000 for children to go to Camp Kudzu, a nonprofit organization serving children with diabetes. He also served as a counselor at the camp.
“He was just the most handsome and incredible child,” his mother said.
But on Aug. 19, 2009, Beckford received a chilling call from her 21-year-old and first-born son while he was away for school at the University of Denver.
“He called me and I always answered his calls, but unfortunately on this particular occasion, I was out of cellphone range. But (I saw the) missed calls, and I called him back instantly,” the Vinings resident said. “He said, ‘Mom, I just want you to know you’re the greatest mom ever, and I love you very much. And I’m calling to say goodbye. It’s just too hard. Goodbye, Mom. I love you.’”
Beckford said Justin hung up and took his own life.
“He had all the resources, all the help — in those days, not as skilled perhaps as what is available today ... but we did our best,” she said.
Beckford said her son’s own story is just one in an increasing number of stories making up what she and other medical experts are calling an alarming trend in suicide rates over the past decade or more.
Youth suicide has nearly tripled nationwide, state data also shows alarming increase
Federal and state data shows rates of suicide for all Americans and Georgians is on the rise. But late last year, a report from the Centers for Disease Control and Prevention found that nationwide, the trend is particularly alarming among the youngest Americans.
The suicide rate among people ages 10 to 24 nearly tripled from 2007 to 2017 after a slight decline in the years prior, the report showed. In 2017, suicide was the tenth leading cause of death in Americans of all ages but the second leading cause for people ages 15 to 24.
In 2017, the latest data available from the CDC, the rate of death by suicide among those ages 10 to 24 increased 56% from the prior decade, according to Dr. Ryan Breshears, clinical health psychologist and chief behavioral health officer for WellStar.
More than 6,700 people in that age range killed themselves between 2007 and 2017, according to the National Institute of Mental Health estimates.
“I think the most striking thing about that was that the rate had stayed pretty flat in the decade leading up to 2007. So it is a marked and significant increase,” he said.
In the Peach State, WellStar Health System leaders say prevention has become their top priority, as recent community health studies have shown suicide is the third leading cause of death for Georgia residents ages 15 to 24.
Health officials observing these increasing trends say they’re learning more every day about the factors associated with youth suicide, and trying to answer the most important question: why?
Breshears said while there are hundreds of contributing factors, a few — ongoing physical or psychological pain, bullying or social isolation and feeling like a burden on their loved ones — are almost always shared in cases of suicide.
Unknown to many, Justin, who would have turned 32 on Jan. 8, had many of those risk factors, she said. He’d struggled with anxiety and depression from a young age, and experienced chronic pain for much of his life.
And while he was a towering, athletically built boy, she said Justin was also an old soul, and didn’t like to participate in many of the same activities as other boys his age. She said he was excluded for that.
“You know, as a pediatrician, you always think, ‘How can this be happening to my child?’” Beckford said.
But, she added, Justin’s death was a result of a combination of factors, including his genetics and biology. She said some people are hard-wired and have the chemical makeup to be more resilient in the face of internal turmoil. Others, like her own son, she said, need more support from their family and friends, as well as the larger community.
“I think the most important thing is that it is a call to action,” she said. “I think we have to recognize that it’s one of the most important health risks that’s facing the nation.”
Social media may amplify risk factors
While it is just one of the many factors associated with the risk of youth suicide, physicians agree that the explosion of social media use over the last decade is significant.
“It used to be that if kids were talking behind your back, you never knew it. So you had a lack of technology that actually buffered you from risk,” Breshears said. “Today, you’ve got all the stuff out on social media, so the exposure to those threats of failed belongingness or isolation are much more prominent than (they used to be).”
Bullies also seem emboldened to say things from behind a keyboard or phone that they wouldn’t in person, Breshears said. And even if they’re not being bullied, he said teens often compare themselves to the images they see on social media and can fall down a rabbit hole, scrolling on their phones.
But while it’s fair to note the positive correlation between the growth of social media and increase in youth deaths by suicide, Breshears said he’d be careful not to paint social media as the boogie man — it can be a powerful tool for good, under careful parent supervision.
“We can’t ignore the parallel tracks of increase (in suicides and social media growth). I just think the question is to what extent are they correlated? ... In some respects, you could argue that social media is actually a method of creating more belongingness, because you’re interacting more with peers,” Breshears said. “Parents just have to be very mindful. ... You don’t just set your kids loose on the world with a phone in their hand. It’s got to be monitored very closely.”
Others take a more hardline stance.
“Even though there are reports to the contrary, I think social media is driving suicide rates in youth,” said Dr. William Mayfield, a WellStar thoracic surgeon who lost his son, Mark Mayfield, to suicide in August 2015.
William Mayfield said social media “magnifies the pain inflicted by tweens and teens against each other.”
Forty years ago, if someone called you names or insulted you, it was between two people and the insult disappeared with time, he said. Now the humiliation is magnified across “tens, hundreds, or thousands of people, and can remain digitally present forever,” he said.
Like Beckford, William Mayfield said his son had struggled with anxiety and depression. While he had a close relationship with his family and his psychologist, Mark Mayfield seemed to struggle with a sense of belonging, his father said.
Social media can be an amplifier for those feelings, and it’s time for society, the media, the courts and social media companies to define what constitutes acceptable behavior, William Mayfield said.
“Families, schools, churches and mentors need to teach children first not to use social media to denigrate others, and second to not allow a simple text on a screen to define how they feel about themselves,” he said.
Beckford agreed, calling social media “brutal.”
Parents can teach their children to ignore or cope with the nasty comments that might be thrown at them in school, but when that same comment is posted on Instagram or Facebook and they have to go to school knowing that “4,000 people saw something that could be vastly untrue,” it’s harder to shake.
“One can say, ‘This is just what people say, it’s not the truth.’ But that’s different when you’re in your 40s compared to when you’re 17. It’s a whole different phase of development and processing and ability to compartmentalize,” Beckford said.
She said social media can have a damaging effect on youth brain development and has also gotten in the way of family connectedness. Parents have to be more proactive in engaging their children in honest conversation to find out how their children are feeling, she said.
What can be done?
While the data is alarming, WellStar leaders have been hard at work on the system’s “zero suicide” initiative since 2017, Breshears said. The initiative has also been adopted by other health systems.
Breshears said the systemwide endeavor includes development of best practices for physicians to identify signs of suicide risk, no matter the medical specialty, as well as using treatments that specifically mitigate suicide risk and ensuring a continuum of care without gaps.
He said WellStar is also focused on hiring a workforce that is confident and caring in the face of what can be a sensitive topic. He said the system hired a suicide prevention coordinator in December 2018 and is searching for more suicide prevention staff.
“If you simply treat this as a behavioral health problem, you’re going to miss a significant number of people,” Breshears said. He added that many who die by suicide paid a visit to a health care provider within four weeks of their death. “Twenty percent have an emergency department visit, and 60% of that 20% are there for a non-behavioral-health-related issue.”
He added that taking responsibility for how suicide is addressed, for example, focusing on the stories of those who have survived their bouts with suicidal thoughts rather than simply shocking statistics, is extremely important.
“We know that suicide contagion in a real thing,” he said. “So I’m not going to support going into a school and giving a talk about the problem of suicide because there’s a responsibility around having these conversations, and you need to offer hope and you need to offer options.”
William Mayfield and Beckford said caring, open communication and more investment in behavioral health are important steps toward solving the problem.
In addition to laying out what behaviors are acceptable on social media, children need to know that suicide is never a resolution to any problem, William Mayfield said. That starts with recognizing that mental wellbeing is very often a precursor to physical wellbeing, he said.
“Behavioral health is underfunded and under-appreciated as a health entity. On the most basic level, behavioral health drives behaviors that contribute to heart disease, obesity, vascular disease, and lung and ENT cancers,” he said. “The recognition of behavioral health as the fundamental driver of downstream medical issues, both physical and emotional, is important.”
For Beckford the answer is open and honest communication, and conversations around suicide are not yet where they need to be. Parents and even many medical professionals shy away from engaging their children or patients about mental health issues, which she said affect between 17% and 27% of Americans.
Mental health should be a common topic of conversation, she said.
“I know as a mom people ask me, ‘How many children do you have?’ And I will say, ‘I have two sons, one late son, Justin, who took his life by suicide at 21, and one surviving son, Derek, who is 29.’ And sometimes people, from the goodness of their hearts will say, ‘Oh my gosh, I’m so sorry I asked.’ And I always say, ‘Please don’t apologize. I appreciate the question,” Beckford said. “I think the moment we break through the taboo, use the words openly and freely — depression, suicide, anxiety, schizophrenia — just like we feel comfortable talking about stroke, heart disease, breast cancer, is the first step in getting on top of it.”
She said Justin lives on through her work and speaking to and helping families.
At her pediatric practice, Beckford said she begins asking children at the age of 12 about whether they’re having dark thoughts.
“(We’re) asking them if they ever feel sad or like just not waking up in the morning or if anyone’s bullying them such that they don’t want to get up, don’t want to go to school or don’t want to come home. I would say at least 8 times a week, at least, in a well child check, the answer is yes. And a good number of those already have a plan,” she said.
Beckford said parents have to be unafraid to ask their children the same questions and show that they are accessible. She said developing a routine of keeping cellphones off in the car or at dinner and asking your child how school is going, whether anyone has made them feel sad or if they’ve had any dark thoughts will at least show you will listen when they need to come to you.
“There may be no signs, so you must talk to your child,” she said. “They may say, ‘Oh, mom please stop.’ ... And they may or may not answer, but it opens the door.”
And Beckford says the most important message for parents comes from her son’s favorite childhood book, “I Love You Forever.”
“Time goes very quickly. Make sure every day you tell this newborn baby and all through adulthood that you love them forever — there’s nothing you can do to take that away — I think that’s really important.”