Each teen suicide is a puzzle with pieces missing. Gone is the only person who might know the exact reasons. But taken together, these deaths reveal much about the social forces contributing to teen suicide. Originally published in the Omaha World-Herald in May, 2005.
Smaller Cities, Bigger Problems
For every teen suicide, there is a story, though it usually goes untold.
There's one for Michael Fisher and one for Lindsay Whitaker. They would have graduated from McCook High School today. Instead their headstones sit near a tall pine in a local cemetery.
There's one for Michael Weber, whose room in North Platte remains unchanged six years after he shot himself. His mother sleeps with his unwashed shirt under her pillow.
There's one for Jason Altstadt. After he shot himself, his father took 20 guns from their home in Fort Calhoun and hurled them into the Missouri River.
There are plenty of stories to tell, considering that every year, 15 to 20 Nebraska teenagers kill themselves. Only accidental deaths take more teenagers in Nebraska, where the teen suicide rate is one-third worse than the nation's.
To find out why, The World-Herald studied federal and state death records dating to 1994, interviewed the nation's leading experts and talked extensively with the parents of 37 Nebraska teens lost to suicide.
Each teen suicide is a puzzle with pieces missing. Gone is the only person who might know the exact reasons. But taken together, these deaths reveal much about the social forces contributing to teen suicide. Consider:
Teen suicide is most common outside metropolitan areas of Nebraska and the nation. It is not necessarily a rural problem, though. The highest rate of teen suicides in Nebraska occurred in counties with small or midsize cities such as McCook, Fremont and Beatrice.
Guns are used in most teen suicides, especially outside metro areas. In fact, the higher rate of gun suicides is key to the higher overall rate of suicides in less populated areas. Most victims in Nebraska had easy access to the guns they used.
Boys commit four of every five teen suicides even though girls are more likely to attempt suicide. Nonfatal attempts usually involve poisoning or cutting. Teens seldom survive attempts with guns.
Teens who kill themselves usually have reasons to feel estranged from parents, peers or both. Common is the stress of divorce. Rare is the daily presence of a stay-at-home mom or dad. The teens often have just endured romantic rejection, bullying or other problems at school or home.
Abuse of alcohol or drugs is common. Separate studies show that teen drinking is a bigger problem in Nebraska than in most states and that, nationwide, teen alcohol and drug abuse is worse outside metropolitan areas.
For every teen suicide, there is a teenager in pain.
Suicide is often called a permanent solution to a temporary problem. The teen isn't necessarily trying to end life, but rather to end his or her pain, whether it is emotional, physical or mental.
Most mental health professionals say teens who die by suicide suffered from depression or had other deep-seated problems. But only a fraction of people diagnosed with depression kill themselves. Among teens especially, the experts say, the actual impulse to attempt suicide does not last long.
"Teen suicides are very impulsive, " said Dr. David Grossman, a Seattle pediatrician whose research links gun safety and lower teen suicide rates. "The suicidal urge tends to be transient, and it dissipates pretty quickly."
Nationwide, the rate of teen suicide was 37 percent higher outside metropolitan areas than within metropolitan areas.
This isn't explained by the high teen suicide rate among American Indians, a problem widely discussed since the murders and suicide in March by a teenager on Minnesota's Red Lake Indian Reservation.
Indian teens do indeed kill themselves at nearly twice the rate of white teens, and they live mainly outside metropolitan areas. But their numbers are too small to account for the disparity.
Eight of 10 teen suicides in the United States involve white adolescents. Nebraska, for example, has recorded only two teen suicides by Indians since 1994.
Overall, 166 Nebraska youths (all but three of them teens) killed themselves in the 10-year period ending in 2003. Most of the 166 (90) had lived outside the state's nine metropolitan counties even though most Nebraska teens live within those counties.
The state's small towns and rural areas suffer more than urban areas across the nation. But the worst problem in Nebraska and Iowa is in midsize communities -- counties called "micropolitan" by the U.S. Census Bureau. Each is centered on a city of 10, 000 to 50, 000 residents.
American teenagers in small and midsize communities face a combination of social pressures that adds to the suicide risk.
First, there are simply fewer outlets for teens if they don't fit in with the popular crowd or meet social expectations. That makes them isolated. Second, there is an expectation in such communities that people handle their own problems.
It's a dangerous combination to feel like an outcast and to believe that you can't talk about it. But Dr. James Fish sees this frequently in the kids coming to him at the Richard Young Hospital in Kearney, Neb. It is one of the state's few mental health centers outside Omaha and Lincoln.
"The value is more 'You're independent, you take care of yourself, you deal with your own problems, '" Fish said. "'And if you can't, there is something terribly wrong with you.'"
Traditionally, strong families have helped teens cope. But that strength is weakening. The divorce rate is highest in Nebraska's midsize communities. And compared with the nation, there are more Nebraska children being raised by a single working parent or by two parents who both work. That means teens have more time alone and less time with parents.
Rebecca Hartford had a long drive to work ahead of her one Thursday morning, and her two boys were fighting over a video game. So Hartford yanked the plug out of the socket and took the game console with her on her 17-mile commute.
Home alone in rural Bladen, her sons were bitter. One of them, 17-year-old Dustin, had reached a breaking point after months of depression, failures at school and frustrations trying to find a job. He wrote a note suggesting that he was a burden to his mom and that it was time he "did something" about it. Dustin shot himself with a handgun his mother had borrowed for security. He died April 7, 2003, at age 17.
For every teen suicide, there is a mystery.
Some families read and reread pages of journals or long suicide notes left by their children. They find no answers. It is likely that some despondent teens themselves don't know why they end their lives.
Among the 37 teens whose families spoke with The World-Herald, nearly half had just broken up with a boyfriend or girlfriend, and one in four had been bullied or teased by classmates. One in four had gotten in legal trouble or been disciplined sternly.
Mental health experts said the key is to see things like breakups -- which are common among teens -- in context with other problems. If such teens are withdrawing from normal activities, abusing drugs or alcohol, or talking about hurting themselves, then the combination of problems suggests a risk for suicide.
"Not everyone who breaks up attempts suicide, " said Fish, the Kearney therapist. "The question is why do" some teens do it? "What's different about them?"
The answer is often depression. While only a fraction of people who suffer depression die by suicide, major depression is widely accepted as a common risk factor.
In 11 of the 37 Nebraska cases, the teens who killed themselves had been clinically diagnosed with depression or some other mental illness. Most were prescribed antidepressants.
In 10 other cases, parents say they now suspect their children were depressed, but at the time they figured they were just moody teenagers.
Consider the deaths of Lindsay Whitaker and Michael Fisher, the two McCook teens who would have graduated from high school today.
Everyone knew Michael struggled. He took antidepressants. He tried to overdose when he lost a girlfriend. School officials made him promise to get help if he was tempted again. But problems persisted. Classmates even teased him about his prior suicide attempt: "How the hell can you not succeed at that?" someone asked him. One Saturday night, Michael overdosed on pills. He died Sept. 21, 2002, at age 15.
Lindsay, 14, had no such history. She stayed home from school on Thursday, March 29, 2001, and hanged herself. Afterward, her parents found a list she had written, with one column of reasons to live and one column of reasons to die. Her father remembered how she lay motionless on the couch one night before her death, how he stroked her hair and tried to comfort her. He also found out Lindsay had told a friend of her plans the day before, but then laughed it off when the friend questioned her.
For every teen suicide, there is a means.
Guns are the means in nearly 60 percent of U.S. teen suicides, and that number jumps to more than 70 percent outside metropolitan areas in Nebraska.
The problem might not be the guns themselves, but how accessible they are to adolescents.
The World-Herald found a close statistical link between states with high suicide rates and states in which a higher number of teenage boys say they handle guns regularly.
In interviews with 28 families of children who killed themselves with guns, the newspaper found that only three of the children had to break into locked gun cabinets. The rest had keys, or had the guns in their rooms, or knew where the guns and ammunition were stored.
If the guns were locked, and the ammunition locked in a separate location, some teens may have found another way. But researchers say at least some deaths wouldn't have happened.
Tammy Weber still wonders why her popular, athletic son killed himself six years ago. Maybe in part he was disappointed over a girl who wouldn't go steady with him. Maybe his uncle's suicide five years earlier influenced him. Many teens who die by suicide have family histories of mental illness.
Michael found a gun his mother forgot was even in the house. The family still owns guns, but every one is locked. Only Tammy and her husband, Robert, know where the key is hidden.
For every teen suicide, there is grief.
Like the rage inside Donald Altstadt when he piled all of the guns he owned into his pickup, drove a dozen miles and dumped them into the river.
He then negotiated for three months with police to get the gun used by his oldest son, Jason. He dumped it in the river as well. It was a shotgun Donald had bought for Jason.
After their children's deaths, at least seven of the interviewed parents started taking antidepressants. Many siblings and friends have needed counseling. Some have attempted suicide themselves or thought seriously about it.
Donald Altstadt is divorced. He lives a nervous existence raising his only other son. He questions every parental decision, weighs every word. His son wants to go hunting, but Donald won't ever go hunting again.
Jason, 19, died more than five years ago.
"It ruined my family, it ruined our life, and it ruined my life, " his father said. "I'm still trying to pick up the pieces, and I don't know how."
Please stop reading now. Ask for help. Talk to a parent, friend, counselor, clergy member or doctor.
Or call the Girls and Boys Town National Hotline, (800) 448-3000. Or the Hopeline Network, (800) 784-2433.
Average annual rate, ages 10-19, per 100, 000
SOURCE: World-Herald study of mortality data from the National Centers for Disease Control and Prevention, 1994-2002.
Midsize areas worst in Nebraska and Iowa
Metropolitan areas are counties containing large urban and suburban areas.
Midsize areas are the counties called "micropolitan" by the U.S. Census Bureau. Each is centered on a city of 10, 000 to 50, 000 residents.
Small town/rural areas are counties without a city of at least 10, 000 residents.
Annual suicides per 100, 000 youths (ages 10-19)
Midsize areas (micropolitan): 6.20
Small town/rural: 7.05
Small town/rural: 6.15
Small town/rural: 6.88
Metro: 76 (40%)
Non-Metro 90 (54%):
Midsize areas: 52
Small town/rural areas: 38
Nebraska youth population: 263, 843
SOURCES: Nebraska state death certificate database 1994-2003; U.S. Census Bureau, National Centers for Disease Control data 1994-2002