Health & Fitness

Teens get moody. But they also get depressed and suicidal. How to spot the difference.


The night before 17-year-old Bailey Leal hanged herself in her bedroom closet with an electrical cord, she had called the police to her home in Parkland. Bailey had just had a verbal and physical fight with her sisters and told the police she was scared.

“I think she was scared of herself,” said Pam Leal, Bailey’s mother. “They talked to her and pointed out how much she had going for her.”

The next morning, the same police officers arrived at Bailey’s suicide scene.

From all appearances, Bailey did have a lot going for her.

“She was beautiful. She could handle the soccer ball better than many boys. She could do hair and makeup. She had just toured Princeton and Dartmouth,” Leal said.

However, in hindsight, Leal, a mother of four girls, recognizes signs she missed, unaware at the time of how seriously her daughter was suffering from depression. “The last six months of her life were miserable but I didn’t know she was suicidal. I was thinking she was just a rebellious teen.”

Looking back, Leal said Bailey made comments that were dark and out of character, calling herself evil and saying she hated herself. “She was sick and didn’t know how to help herself. She couldn’t talk about it because of the stigma of depression.”

Leal said teen suicide often is impulsive. “I believe when a teen is depressed, sometimes they can’t see past it. They know people love them, but can’t see past their own pain.”

In the last decade, the rate of teens reporting a recent bout of clinical depression grew by 37 percent and suicide rates have been increasing dramatically, particularly among adolescent girls and young women, according to Johns Hopkins Bloomberg School of Public Health. In addition, research presented at the 2017 Pediatric Academic Societies Meeting reported a steady increase in teen admissions at 32 children’s hospitals due to suicide attempts or self-harm, from 2008 to 2015.

Yet, even as the teen suicide rate rises, many parents, teachers and teenagers believe the stigma associated with depression prevents communication.

At South Florida hospitals, emergency room doctors are seeing the repercussions, as are psychiatrists and psychologists. “We have seen an increase in adolescent suicidal ideation or suicide attempts,” said Dr. Raul Poulsen, a psychiatric resident at the University of Miami Health System. “They are taking pills, prescription and over-the- counter. They are making suicidal attempts by cutting themselves or engaging in risky behaviors such as running into oncoming traffic.’’

Research by the Center for Suicide Prevention and Research has shown that puberty is associated with the onset of psychological disorders, specifically depression. Depression is a big risk factor for suicidal thoughts and actions.

While the causes of depression vary, recent societal influences are exacerbating the problem, according to medical professionals. Teens now encounter intense pressure to excel in school, are faced with an increase in online and in-person bullying and a plethora of new drugs and pharmaceuticals. Couple those stressors with genetic predispositions to depression and chemical imbalances that surface during adolescence and it makes for a potential crisis.

“What I have seen is a trend toward more kids acting on their depression than in the past,” said Ana Maria Ojeda, a clinical psychologist with Nicklaus Children’s Hospital in Miami.

Ojeda said social media may or may not play a role. For some teens, seeing what others are sharing on the internet gives them ideas. For others, it makes them feel like they are not alone, she said.

Dr. Samantha Saltz, psychiatric resident at the University of Miami Health System, has seen evidence of cyber-bullying among her patients. In a recent study of 50 teenagers in an inpatient psychiatric unit in New York, 20 percent had been victims of cyber-bullying. “Pictures and messages that are posted online can reach thousands of people in seconds. This is a problem that didn’t used to exist.”

Saltz said teen depression (and its sister illness, anxiety) isn't something that can be overcome with willpower — it can have serious consequences and requires ongoing treatment.

Graciela Jimenez, psychotherapist with the Care and Counseling Services for Baptist Health South Florida, said beyond the hormonal changes that cause teen depression, additional triggers are stressful life events like parental divorce, a death, or a breakup of a friendship or romantic relationship. Rejection from a friend, boyfriend or girlfriend can escalate into depression, Jimenez has found. “They may need professional help learning how to deal with that.”

Jimenez said parents, school counselors, coaches, even grandparents should start a conversation if they notice signs of depression. “It’s OK to ask a teen if they have thoughts of killing themselves. It’s a misperception that if you ask, you will cause it. However, it can be the opposite. You may prevent it. When kids are depressed, they usually are open to seeking help.”

Dr. Judith Regan, a child and adolescent psychiatrist at the University of Miami Health System, advises establishing a non-judgmental environment for a teen to talk and a parent to listen. “Just be attentive and let them know you are there for them.”

Once diagnosed, there are a variety of methods to treat depression, including medications and psychotherapy. A mental health professional can help decide if a teen’s behavioral changes are a normal part of adolescence or a sign of depression.

10 signs to watch for with depression in adolescents

1. Changes in sleeping habits. “The key is to know what is normal for your child,” said Regan. Teens with depression may sleep excessively and show apathy. Now, some early research by the National Sleep Foundation has linked less sleep and more internet use with an increase in teen depression.

2. Unusually poor school performance or complaints of headaches or stomachaches to miss school. A sudden drop in grades is worthy of concern.

3. Loss of interest in previously enjoyed activities. If your son or daughter used to play soccer and suddenly has no interest in it, or used to go to friends with malls and now wants to go nowhere, it may be time to ask questions.

4. Isolation from friends and family. Many teens retreat into the privacy of their bedrooms as part of their normal routine. However, if you notice your child chooses to be alone rather than watch television or have dinner with the family, and that behavior is coupled with sleeping more or expressing hopelessness, then it likely is more serious.

5. Irritability, anger outbursts, concentration problems. Many teenagers are moody during puberty. However, a depressed teenager may get angry often, particularly with people to whom they formerly showed affection.

6. Significant weight gain or weight loss. Either of these can be a sign as well as a noticeable new lack of interest in appearance.

7. Critical comments about themselves. Leal said Bailey had been making harsh comments about herself in the month before her suicide, both online and in person.

8. Hopelessness. Watch for comments such as “You would be better off without me” or “I wish I could go to sleep forever.”

9. Attempts at self-injury. Saltz said depressed teens may cut or burn themselves to get relief. While it may start on their forearms, it often spreads to the bra line, abdomen, stomach and upper thighs. “Some teens do it to relieve stress, some to see the blood because it makes them feel better,” she said. Parents should know that self injury is dangerous because it could lead to accidental death.

10. Use of alcohol or drugs and promiscuous sexual activity. These behaviors on their own are worrisome but combined with depression can lead to lack of inhibition and impulsiveness.

How To Get Help

Florida Initiative for Suicide Prevention

13798 NW Fourth St., #309, Sunrise, FL 33325


Jewish Community Services of South Florida/formerly Switchboard of Miami

In Miami: 2-1-1 or 305-631-4211

The National Suicide Prevention Lifeline

1-800-273-TALK (8255)

Psychology Today

Adolescent/Teen psychologist directory