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Breaking the Silence, Addressing Youth Suicide: APA Women's Caucus · The Medical Mind

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  Anjali Gupta (00:04) kids, know, teens, brains are still growing, they can still learn skills. They haven't learned the skills yet. So skills-based therapies for kids to help ⁓ work through distressing experiences can be helpful and encouraging community within the schools. Sometimes, you know, life at home can be really stressful, but if you can find refuge within your school or within ⁓
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  trusted mentors or adults that can really be life-changing for some of these teams. ⁓
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  Fatima Reynolds (00:41) Welcome to the APA More Equity in Mental Health series, Breaking the Silence, Addressing Youth Suicide. In this episode, our host, Dr. Anjali Gupta, speaks with Dr. Leika Simeon-Thompson. Dr. Gupta is assistant professor in the Department of Psychiatry at the Georgetown University School of Medicine. She has led a number of wellness and equity initiatives at Georgetown and was selected to be a Gender and Justice Initiative Faculty Fellow for her research on the experiences of women in medicine.
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  She is the president of the Women Psychiatrist Caucus for the American Psychiatric Association, active with an APA's Committee on Women's Mental Health, and chair of the AMWA Literary Committee. So now, let's break the silence with Dr. Gupta and Dr. Simeon Thompson.
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  Laika Rose Simeon-Thompson (01:28) Welcome to our podcast today. I have the pleasure of being here with Dr. Laika Rose Simeon-Thompson. She is an assistant professor in the Department of Psychiatry at the Wake Forest School of Medicine. She is also the assembly representative for the American Psychiatric Association's Black Psychiatrist Caucus. Dr. Simeon-
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  has had a lot of academic work centering around multiple themes that range from biological changes in the brain and provider education around patient-centered language. Dr. Simeon, thanks for being here with us today.
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  Anjali Gupta (02:15) Thank you so much for having me.
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  Laika Rose Simeon-Thompson (02:19) So I'm really looking forward to this conversation. I know that you have ⁓ in your research and your clinical work ⁓ been a part of a number of really interesting and important projects. ⁓ I thought we'd start out with some foundational research that you, I know you've done on neurogenesis and the hippocampus. I thought maybe you could help us.
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  discuss kind of the brain in context of depression and adolescence and how that might be different than adults.
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  Anjali Gupta (02:59) Yes, thank you. So for adults, the difference between adults and kids, ⁓ one of the things that we notice is kids, young adults tend to be a little bit more impulsive. ⁓ And what we see is that ⁓ for adolescents, the prefrontal cortex is still maturing.
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  So this can make adolescents more emotionally reactive and less able to regulate mood compared to adults. But on the other hand, adolescent brains are more plastic, meaning that they're still growing and still changing. They can still adapt and respond to interventions ⁓ more effectively compared to adults. And that's really exciting because it means that even though we
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  ⁓ can see we're seeing some more crises ⁓ in adolescents. We do have opportunity to intervene and change things for that.
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  Laika Rose Simeon-Thompson (04:08) Okay, and again, I know that you also are medical director of emergency psychiatry. So you've had the opportunity to see firsthand as youth arrive in crisis. What patterns have you noticed among young girls and teens?
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  Anjali Gupta (04:30) What I've noticed that seems to be increasing among young girls and teens are crises involving technology. ⁓ from things related to conflict ⁓ on social media and bullying that extends beyond the school day to emotional crises related to electronics being taken away.
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  ⁓ The other thing that we're seeing is these teens and young girls being affected by family distress and generational trauma showing up ⁓ in these young girls and teens.
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  Laika Rose Simeon-Thompson (05:13) So, ⁓ thank you for bringing up social media. It's hard to have a discussion about teens these days without discussing social media. It's a growing influence kind of in their lives. ⁓ Let's talk, let's start with a positive influence. What role do you see social media playing in a positive way?
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  Anjali Gupta (05:37) In terms of positives, social media for a lot of kids can be a great source of community. So for example, ⁓ for some marginalized populations, so for some kids who may be the only one of our particular group ⁓ in their communities, they now have the opportunity to seek out community to others across the country, across the world, seek support from them.
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  ⁓ realize that others are struggling with similar struggles, having similar struggles. ⁓ Increasingly we're noticing people making friends online, which some people can find worrisome, but I have had, I have seen situations in which ⁓ a child came into the emergency department because their online friend alerted their family that there was a crisis that was happening that the family did not realize. ⁓
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  know, teens are able to learn more about what they might be struggling with. I find that ⁓ social media can help break down stigma for diagnoses that were previously very stigmatizing, such as borderline personality disorder. ⁓ So there are some positives.
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  Laika Rose Simeon-Thompson (06:56) Yeah, I imagine also there's access to online mental health resources. And again, all of these things perhaps could have a positive and a negative because you want to make sure that the resources they're getting are vetted and appropriate. But, you know, if those resources are solid, then they have access to them.
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  Anjali Gupta (07:21) Yeah, and exactly. to build off of what you said, that's why it's really important for us to stay knowledgeable about what people, what our patients, what kids are seeing online. Because I see these resources as a starting point, like you said, because we don't know who is saying what, whether or not they're vetted. So it's a starting point for discussion. But then we need to be prepared to continue having the discussion with them.
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  Laika Rose Simeon-Thompson (07:48) Right. So in addition to the positives that we just discussed, what world do you see social media playing in terms of the negative influences?
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  Anjali Gupta (08:00) Yeah, so in terms of negative influences, ⁓ what we're seeing is people are living their lives through a lens that's not realistic. And kids, teens, because their brains are still developing, they may not really fully understand, and even adults may not fully understand that what we're seeing is highly curated and highly edited. So.
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  things, you so we're seeing ⁓ people having unhealthy ideas of what bodies should and should not look like, ⁓ comparisons, and sometimes harmful threats on blocks that may direct teens to engage in maladaptive coping skills, ⁓ traumatizing content as well that can be really stumbled, can be easily stumbled upon. ⁓
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  So definitely there are some harms.
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  Laika Rose Simeon-Thompson (09:01) And let's talk a little bit just about bullying. You know, when we hear that word initially, it's easy to think about that very traditional sense of bullying. But now with social media, there's really cyber bullying is growing. And we know that cyber bullying is linked to some harmful outcomes as well. So given that girls are often more vulnerable to this online harassment.
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  What prevention strategies do you think work?
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  Anjali Gupta (09:34) So I think we start at home. So ⁓ one thing that I always emphasize is fostering an environment where kids feel comfortable discussing their experiences. Sometimes we may not realize ⁓ that we're giving out certain messaging to kids without even saying it. So if you don't seem that you want to discuss what kids are seeing online, they're not gonna discuss it with you.
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  Encouraging regular check-ins about social media use and interactions with peers. ⁓ Privacy settings, so helping kids navigate privacy controls on social media because they may not always understand the implications ⁓ of what the internet is, that it's forever. ⁓ And parental controls are very important. ⁓ We as adults should also ⁓ model respectful behavior online.
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  ⁓ and not engaging in ⁓ harmful communications online. And also schools, schools should implement policies that include cyberbullying and have clear consequences for cyberbullying ⁓ and helping students ⁓ know how to report these incidents safely.
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  Laika Rose Simeon-Thompson (10:52) So.
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  You just mentioned school and you also mentioned family. ⁓ Can we talk a little bit about just school connectedness and supportive adults as factors that can help in so many ways? How can communities and schools help to foster those relationships?
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  Anjali Gupta (11:16) Great. So kids spend so much of their time at school. ⁓ So that gives those opportunities for ⁓ programming within schools, things like sports teams, after school programming ⁓ to help kids feel connected to something beyond themselves, whether it's a team, whether it's an interest group.
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  Those also can be really protective against ⁓ mental illness for kids, helping them have interests and things ⁓ outside of school. ⁓ The other thing is having ⁓ mentorship. Mentorship is so important. So it could be mentorship from teachers, mentorship from older students. All of those can be very helpful and important ⁓ in building community.
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  for these kids.
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  Laika Rose Simeon-Thompson (12:15) Yeah, I think you gave some really great examples. You supportive adults can come in lots of different ways, whether that's parents or family friends, but also teachers and coaches. you know, there are so many different adults that can play that role for a child.
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  Anjali Gupta (12:36) Right, and what we're seeing too is there's opportunities in schools to embed counselors and social workers ⁓ for kids to help increase access for mental health care for the kids who need it.
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  Laika Rose Simeon-Thompson (12:53) Okay, so we know that, you know, 20 % of high school students have reported having seriously considered suicide in the past year, and that female students report having seriously considered suicide at higher rates than their male peers, and they're also more likely to attempt suicide. What explains these gender differences?
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  Anjali Gupta (13:20) Yeah, so what can explain this is we're seeing increased anxiety and depression in teen girls compared with teen boys. The rates of anxiety and depression in teen girls has been increasing. And we ⁓ talk about ⁓ differences in the way ⁓ teen boys and teen girls may express or may experience distress.
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  We found that girls may be more likely to internalize distress ⁓ and this can lead to rumination, persistent sadness, hopelessness, and suicidal thoughts. ⁓ The other is trauma. We're seeing that teen girls have experienced, many teen girls have experienced sexual trauma.
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  ⁓ which can also be linked to suicidal thoughts and suicidal behaviors. And that's something that I've seen in my own practice within the emergency department. And then we've talked about ⁓ bullying ⁓ and also what teen girls are seeing on social media in terms of how they should be and the comparisons that we've mentioned.
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  Laika Rose Simeon-Thompson (14:43) So we know, I know you just mentioned a few of these, that we know that mental illness, domestic violence, substance use are contributing factors driving self-harm and suicide attempts in teen girls. How can we better support at-risk households?
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  Anjali Gupta (15:02) Yeah, so the way that we can help support at-risk households ⁓ is to, so we can refer people to trauma-informed family therapy to help improve communication and reduce conflict within the home. So I mentioned programming within schools. ⁓ And the other thing, as I mentioned earlier, because kids, know, teens, their brains are still growing, ⁓
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  they can still learn skills. They haven't learned the skills yet. So skills-based therapies for kids to help work through distressing experiences can be helpful and ⁓ encouraging community within the schools. Sometimes life at home can be really stressful, but if you can find ⁓ refuge within your school or within... ⁓
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  trusted mentors or adults that can really be ⁓ life-changing for some of these teams. The other piece of it is we need to support the parents, the families themselves. So sometimes when I see kids who come into the emergency department in distress, ⁓ after I speak to the families,
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  I may take some time to talk to the parents themselves and ask them how they're doing. What are they doing to take care of themselves? Because that can really easily be forgotten when you're taking care of a child in distress.
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  Laika Rose Simeon-Thompson (16:39) That's a good point. So more than a third of young adults felt an unmet need for mental health care in 2024. How does this access barrier affect outcomes and particularly for teenage girls?
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  Anjali Gupta (17:01) Yeah, so we, you know, especially in the emergency departments, see the effects of this significantly. There's just not enough providers in the community. And so what we find is, you know, families may be struggling, trying to reach out, trying to look for providers. In the meantime, the child, like, their child is struggling. And then by the time they,
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  ⁓ are able to seek out care that at that time it's in the emergency department. ⁓ And now we're instead of looking at, okay, are we looking at outpatient resources? We're now looking at do we need to hospitalize or not because of how long it takes to find providers in the community.
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  Laika Rose Simeon-Thompson (17:51) So we often hear that teenage girls are more vulnerable to depression and suicidal ideation. What are your thoughts on this from a biological or a neurodevelopmental standpoint?
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  Anjali Gupta (18:05) Yeah, so when we're looking at differences between teen boys and teen girls, estrogen, testosterone surges during puberty and it can affect brain regions that are involved with mood regulation and that can lead to increased vulnerability to stress, increased emotional reactivity and increased risk for depression.
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  especially when we combine the social stressors that we've talked about that teens are facing today. The other thing is girls may show greater activation in the amygdala ⁓ in response to emotional and social stimuli. ⁓ They may be more attuned to peer rejection and relational conflicts, which can impact their risk for depression. So it can be really great for social bonding.
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  ⁓ which can be productive, but it can increase the risk under stress. So those are a few ways in which biological differences can impact what we're seeing.
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  Laika Rose Simeon-Thompson (19:13) Okay, now let's turn to one of your other academic focuses, which is again promoting patient centered language in emergency departments. Why is language so important in moments of psychiatric crisis, especially for these teen girls?
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  Anjali Gupta (19:32) So one thing I always tell my colleagues and the trainees that I work with is that when we're in the emergency department, sometimes we may be the first time that someone is telling their story, someone is seeking out care, and we really want to make sure that that experience is one that is welcoming ⁓ and not full of judgment and rejection. And so we've talked about how
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  this population can be sensitive to rejection. So if you can imagine if somebody's coming in because of bullying or social rejection and the person that they ask for help ⁓ has also engaged in language or behaviors that are also perceived as rejecting, that person is less likely to ask for help in the future. And I believe that our behavior starts with our language.
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  using negative language, biased language about people when they're not around, it's going to come out in the way that we talk to them. The other piece of it is we're in an age where people can read their charts. And kids may or may not be able to see their charts, but their parents can see their charts. And so it's really hard to build trust with folks if we're using language that is ⁓ stigmatizing.
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  It seems that it's especially gaining traction, and I think that that's a good thing. And I think our field will continue to move forward and work on this. So I'm excited.
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  Laika Rose Simeon-Thompson (21:12) So from everything you've seen and studied from brain scans to emergency calls to hospital cases, what gives you hope when it comes to improving mental health outcomes for young women?
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  Anjali Gupta (21:25) I would say reduce stigma. ⁓ I think that it's, really hopeful for both the kids and for the parents coming in. There's less stigma around this idea that they may need help. Those conversations have been a little bit easier. And I think that that is the first step in increasing, it is the first step in increasing access. There are a lot of barriers to access, but
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  but I do think that reducing stigma is the first step.
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  Laika Rose Simeon-Thompson (21:57) And what if you had one message that you wished every parent, educator or first responder knew about helping girls in crisis? What would that message be?
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  Anjali Gupta (22:11) I actually have two. So the first one is not to ignore ⁓ when someone reaches out for help. Don't ignore that outreach. It's really hard to ask for help. And so we need to be ready when someone does ask for help. But in particular, it's important to lead with kindness, but also with authenticity.
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  ⁓ Kids can pick up on a lot that's not said. So we need to be ⁓ as much as possible and as much as appropriate ourselves when we're talking to them about what's happening.
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  Laika Rose Simeon-Thompson (22:53) Well, thank you so much, Dr. Simeon. It was a pleasure to talk to you today about some very important topics. Thanks for being here.
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  Anjali Gupta (23:01) Thank you.
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  Fatima Reynolds (23:03) Thank you for joining us on Breaking the Silence, Addressing Youth Suicide. Please visit the Medical Minds podcast homepage at psychiatry.org for more information and a resource document related to this episode. We also invite you to visit psychiatry.org slash more equity, M-O-O-R-E-E-Q-U-I-T-Y for more information on the APA More Equity in Mental Health Initiative. Take care.
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  The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.