Sarah Ouellette, M.D., Psychiatry Resident
Steven Lippmann, M.D. Emeritus Professor
University of Louisville School of Medicine

Suicide is the second highest cause of death among young people in The United States. The rates of adolescent suicide were stable from 2000 to 2007; yet, they have steadily increased between 2007 and 2018. It got worse during the recent coronavirus pandemic.¹ Compared to pre-COVID-19 times, in 2021, emergency department contacts for suspected suicide attempts by adolescents, increased by 51% among girls and 4% for boys. Depression and anxiety symptoms doubled, with 25% of youth experiencing evidence for depression and 20% suffering anxiety.²While the pandemic negatively impacted mental health for all age groups, youth appear to have been the most affected.³ Family-related problems and disrupted social relationships are precipitants for suicide attempts among adolescents.⁴

Loneliness, depression, and suicide are intertwined. Many adolescents suffering from depression described loneliness as the “hallmark experience” that defined their emotions.⁵ Loneliness independently increases the risk for depression.⁶ It often is the prompting factor for suicide attempts and contributes to suicide completions.⁷ Knowing the level of connectedness, or lack thereof, is a means for gauging suicide risk in this population. Behaviors like diminished extracurricular activities, isolation in one’s room, problems at school, and withdrawing from family or other social interactions, are frequent signs of depression with an increased risk for suicide. Interpersonal connectedness is alternatively protective; examples include good bonds with parents, other adults, or friends, and participation in sports or engagement in religious practices.¹

Psychosocial theory emphasizes the significance of human relationships. Adolescent development is defined by the formation of identity and degree of socialization, impacting self-concept.  Youngsters seek to gain independence from parents and establish their own individuality amidst many physiologic, emotional, and intellectual changes. With abstract thought, they think of themselves in a complex manner and consolidate different aspects of themselves into their identity. Increasingly dependent on interactions with peers, they begin relationships based on intimacy, loyalty, and shared values. 

Quality relationships aid the formation of identity and self-worth. However, this also leaves them more susceptible to loneliness, with the potential to experience negative effects on their self-concept. Prolonged isolation during adolescence may result in maladaptive concepts, such as considering themselves “unlovable”, and subsequently challenges future intimate relationships and may contribute to developing mental illness.⁷

The pandemic lockdown yielded social isolation that was unnatural for adolescents; separated – many of them may not have developed appropriate social skills during this period. Long-term effects of this deficiency may have negative individual and cultural consequences. Intense loneliness from forced isolation might be sustained later by chronic loneliness in a culture that has become accustomed to physical separation. 

Despite less COVID severity, the world has become increasingly separated and digitally screen-dependent compared to pre-pandemic times. This is detrimental to interpersonal contacts. While these developments have benefits, such as convenience and cost reduction, it has now become a public health concern at society’s peril; the opportunities to form relationships are now less accessible. 

Humans intrinsically yearn for love, acceptance, and understanding, worldwide throughout diverse cultures and backgrounds. People need intimacy to maintain self-worth and purpose. Good personal relationships are necessary for emotional and physical health and for acceptable social functioning.⁷

 Let us clinicians be mindful of this and emphasize socialization as part of our therapies and in our practices. This focus is currently more important in the aftermath of our recent global health crisis. 

References

1. Kurtz B, Levins B. Youth Suicide. Focus. April 2022; 20:191-196. doi:10.1176/appi.focus.202220039. Date last accessed 12/28/2023
2. Office of the Surgeon General (OSG). Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory [https://www.hhs.gov/surgeongeneral/priorities/youth-mental-health/index.html]. Washington (DC): US Department of Health and Human Services; 2021. Date last accessed 1/28/2024
3. Meherali S, Punjani N, Louie-Poon S, et al. Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. International Journal of Environmental Research and Public Health. March 2021;18(7):3432. doi:10.3390/ijerph18073432. Date last accessed 1/28/2024
4. Goto R, Okubo Y, Skokauskas N. Reasons and trends in youth’s suicide rates during the COVID-19 pandemic. The Lancet Regional Health – Western Pacific. October 2022; 27:100567. doi:10.1016/j.lanwpc.2022.100567. Date last accessed 12/28/2023
5. Wahid SS, Ottman K, Bohara J, et al. Adolescent perspectives on depression as a disease of loneliness: a qualitative study with youth and other stakeholders in urban Nepal. Child and Adolescent Psychiatry and Mental Health. June 2022; 16(1):51. doi:10.1186/s13034-022-00481-y. Date last accessed 1/28/2024
6. Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. Journal of the American Academy of Child and Adolescent Psychiatry. November 2020; 59(11):1218-1239.e3. doi:10.1016/j.jaac.2020.05.009. Date last accessed 01/28/2024.
7. Heinrich LM, Gullone E. The clinical significance of loneliness: a literature review. Clinical Psychology Review.October 2006; 26(6):695-718. doi:10.1016/j.cpr.2006.04.002. Date last accessed 01/28/2024