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Parents like to think that they know what is going on with their children — and that they would know if their teen was suicidal. However, research shows that this is not always the case.

Teens may consider suicide more often than parents realize

In a study published a few years ago in the journal Pediatrics, researchers interviewed more than 5,000 adolescents ages 11 to 17. In those interviews, they asked them if they had ever thought about killing themselves — or if they had ever thought a lot about death or dying. The teens' parents were asked if they believed that their teens had ever thought about killing themselves, or had thought a lot about death or dying.

There wasn’t a whole lot of match-up. Half of the parents of the adolescents who thought of killing themselves were unaware — as were three-quarters of the parents of adolescents who thought often about death.

This disconnect looms larger as research shows mental health problems are on the rise in youth. According to the 2021 Youth Risk Behavioral Survey, 42% of high school students reported persistent feelings of sadness and hopelessness; 22% seriously considered suicide, and 10% attempted it.

The numbers were higher for girls and youth who identify as LGBTQ+:

• Almost 60% of girls experienced persistent sadness and hopelessness; 30% seriously considered attempting suicide, and 13% attempted it.
• Among LGBTQ+ youth, 70% experienced persistent sadness and hopelessness; 45% seriously considered attempting suicide, and 22% attempted it.

Many factors contribute to this. Stress and isolation caused by the pandemic clearly played a role. While teens are back in school, re-entry has been difficult for many. Social media clearly plays a role, inviting unrealistic comparisons, reinforcing negative thoughts and ideas, and encouraging doomscrolling. It is also a source of bullying: in the report, 16% of high school students reported being bullied electronically, including 20% of girls and 27% of those who identify as LGBTQ+.

Why the disconnect between teens and parents?

It’s not that surprising that parents don’t always know that their teens are considering suicide. Teens may not always realize how bad they are feeling, and may not want to tell their parents when they do — both for fear of worrying them, and also because of uncertainty about how their parents might react.

Parents may miss signs of depression in their teens, or quite genuinely misinterpret them or attribute them to something innocent; after all, it’s natural to want to believe that your child is fine, rather than thinking that they might be suicidal. And given how much drama can be intrinsic to the life of a teen, it’s understandable that parents could misinterpret statements about death or dying as, well, just teen drama.

What can parents do?

• Be aware of signs of depression in teens, and never ignore them. Acting sad is one of them, but there are many others:
  • dropping grades
  • being irritable or angry often
  • acting bored all the time, and/or dropping out of activities
  • difficulty with relationships, including changing peer groups or becoming more isolated
  • dangerous or risky behavior
  • persistent physical complaints such as headaches or stomachaches
  • fatigue.
• Listen to your teen, and never assume that statements like “nobody cares if I live or die” are just drama. Instead of saying, “You don’t mean that,” ask them if they do mean it. Often parents worry that asking about suicide might “give them ideas,” but asking may be the only way to know — and the best way to show your teen that you are taking them seriously.
• Learn how to have tough conversations about mental health and suicide. The American Academy of Pediatrics has many tips and resources for parents.
• Get help. Call your doctor, call a mental health professional, call the new nationwide number 988 that can link you to local help like a suicide hotline, or take your child to a local emergency room. This is crucial. If counseling is recommended, do your best to schedule it, letting your doctor know if you are having trouble finding a provider. Make sure your teen sticks with it.
• If you suspect your teen may be depressed or suicidal, take precautions. If you have a gun in your house, make sure it is locked up with the ammunition locked separately. Take stock of prescription medications and alcohol in your house that could be used for self-harm, and either get rid of them or be sure they are stored safely.

Sometimes it is just drama — or short-term blues after a breakup or another one of life’s inevitable disappointments. And in the study, half of the teens whose parents thought they were suicidal, and two-thirds of those whose parents believed their teens thought about death, said they were fine. But when it comes to suicide, it’s always better to be safe than sorry. So ask the questions — and ask for help.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Feeling rooted in community and socializing with neighbors may strongly contribute to better cardiovascular health by improving diet, exercise habits, and weight control, new research among Black adults in Georgia suggests. And better cardiovascular health may add up to fewer heart attacks and strokes, two leading causes of disability and death.

“There’s a range of interactions within the community that can improve one’s cardiovascular health, not to mention the effect on mental health — the sense of belonging, of being seen — which is tightly related to cardiovascular outcomes in the long run,” says Dr. Dhruv Kazi, director of the cardiac critical care unit at Beth Israel Deaconess Medical Center (BIDMC) and associate director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.

“Another way to put it is that these unique sources of resilience in communities may directly affect diet, exercise, weight, and mental well-being, all of which lead to improved cardiovascular health,” he adds.

A positive perspective on health within Black communities

The new analysis is part of the ongoing Morehouse-Emory Cardiovascular Center for Health Equity (MECA) study in Atlanta. MECA builds on prior research indicating that living in disadvantaged areas is associated with higher rates of having heart disease or dying from it. But unlike much of that research — which focused on negative aspects of Black neighborhoods that may contribute to poor cardiovascular health — the new study fills a gap. It zeroes in on positive neighborhood features, especially social interactions, that can promote ideal cardiovascular health despite higher risks related to race or socioeconomic status.

“Typically, researchers are identifying factors that result in health disparities on the negative side, such as deaths or co-existing diseases, or that cause increased rates of a particular disease,” explains Dr. Fidencio Saldana, dean for students at Harvard Medical School and an attending physician in medicine and cardiology at Brigham and Women’s Hospital (BWH), whose research interests include racial disparities and outcomes in cardiovascular disease. “It’s quite unique to be able to look for solutions, or to look at these positive attributes of communities and think about how to replicate them.”

Measuring social environment and heart health

The study included 392 Black men and women between the ages of 30 and 70 living in the Atlanta area. None had existing cardiovascular disease. About four in 10 participants were men.

Social environment includes perceptions of neighbors and any support system, as well as how often neighbors interact. Participants answered questions about seven neighborhood features: aesthetics, walking environment, availability of healthy foods, safety, social cohesion, activity with neighbors, and violence.

Heart health was measured using Life’s Simple 7 (LS7) scores, developed by the American Heart Association to determine ideal cardiovascular health. LS7 calculates seven elements that influence cardiovascular health: self-reported exercise, diet, and smoking history, as well as measured blood pressure, sugar level, cholesterol level, and body mass index (BMI). Researchers also gathered information about annual income, education, and marital and employment status, and physical exams that included blood tests.

What did the researchers learn?

After controlling for factors that could skew results, researchers found participants who reported more social connection and activity with neighbors were about twice as likely to record ideal LS7 scores. The association was even stronger among Black women than men.

“Our health is more closely related to these social networks than we appreciate,” Dr. Kazi says, noting that individual efforts to combat obesity and smoking, for instance, are more likely to gain steam “when shared by neighbors.”

“The more we’re able to engage with our neighbors and the communities we live in, the better it probably is for our cardiovascular health,” he says.

The study was observational, so it cannot prove cause and effect. It’s also possible that those who are already healthier are more likely to engage with their neighbors, Dr. Kazi notes. Other limitations are the location of all participants in a single metropolitan area, and the self-reported nature of neighborhood characteristics. Another key area that went unexamined, Dr. Kazi says, involves a “missing piece” in LS7 scores: mental health.

“Living in a community where you feel safe and know your neighbors — where you feel part of the social fabric — is critically important to mental health, and therefore cardiovascular health,” he explains. “If anything, this study underestimates the health benefits of feeling part of a cohesive neighborhood.”

What are a few takeaways from this study?

Social environment and feeling rooted within a community matter to health, and may even help counter negative risk factors. However, long-term lack of investment and the effects of gentrification threaten many Black neighborhoods in cities throughout the US.

“When a neighborhood gets gentrified and longstanding residents are forced to leave, the community is gone forever,” Dr. Kazi adds. “Simply offering the departing residents housing elsewhere doesn’t make up for what is lost. Going forward, we need to be cognizant of the value of community, and invest in our neighborhoods that allow people to safely engage in physical and community activities.”

Dr. Saldana agrees. “Our system is not set up for some communities to have those advantages. It’s important to look to the positive aspects of our communities, and as a system encourage those positive traits in other communities.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

A positive outlook has been linked to better heart health and a longer life. But is that true for Black Americans, whose average lifespan is about 72 years, compared with an average lifespan of 77 years for all Americans?

Recent findings from the nation’s largest and longest-running study of cardiovascular risk factors in Black Americans, the Jackson Heart Study, suggest that the answer is a qualified yes. Cardiovascular diseases, which give rise to heart attack and stroke, are the leading cause of death and disability worldwide. Perhaps not surprisingly, the association between optimism and longevity in Black Americans appears to be strongest among people with higher education or income levels, and those ages 55 and younger. It also proved stronger among men than among women.

Is optimism the only key to longevity in this study?

Probably not. There’s another possible explanation for the findings, says Dr. Rishi Wadhera, a cardiologist at Harvard-affiliated Beth Israel Deaconess Medical Center (BIDMC).

“Instead of optimism leading to better health, it’s possible that healthier individuals are simply more optimistic, or less healthy individuals are less optimistic,” he says. This so-called reverse causality — when cause and effect are the opposite of what one assumes — is always a possibility in observational studies, even when scientists take pains to control for possible confounding factors such as health conditions and behaviors, as they did in this study.

“Nonetheless, these findings contribute to a body of evidence that suggests that psychosocial resources, mood, and mental health are all associated with health,” says Dr. Wadhera, who is section head of health policy and equity research at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at BIDMC.

Measuring optimism in the study

Led by researchers at the Harvard T.H. Chan School of Public Health, the study included 2,652 women and 1,444 men who were part of the Jackson Heart Study. Researchers measured optimism using the Life Orientation Test-Revised, which includes questions such as “In uncertain times, I usually expect the best.” Responses are scored on a scale of 0 (strongly disagree) to 4 (strongly agree). The researchers administered this test and others between 2000 and 2004, and tracked mortality among the study participants until 2018.

Optimism — the general belief that good things will happen — may be partly inherited, although genetic factors are thought to explain only about 20% to 30% of this trait. Some research suggests that people can enhance their feelings of optimism either through cognitive behavioral therapy or writing exercises that focus on imagining their “best possible future self.”

Looking forward

Still, optimism is but one of many intertwined social factors that influence how long people live. A better understanding of biological pathways that could potentially explain the outcomes observed in this study may help, says Dr. Wadhera.

“But to meaningfully address the alarming and ubiquitous health inequities that exist in our country, we need to tackle the unacceptable gaps in care and resources that exist between different racial and ethnic groups,” he adds. This includes disparities in health insurance coverage, access to health care, neighborhood factors such as access to green space and healthy foods, and environmental stressors such as pollution exposure. “Doing so may help people and communities from all backgrounds live happier and longer lives,” Dr. Wadhera says.

 

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

We can feel groggy when our sleep schedule is thrown off even just a little. So what happens when shift work requires people to regularly stay awake through the night and sleep during the day — and how can they protect their health and well-being?

What is shift work disorder?

Mounting evidence, including several new studies, paints a worrisome picture of the potential health fallout of nontraditional shift work schedules that affect 15% to 30% of workers in the US and Europe, including factory and warehouse workers, police officers, nurses, and other first responders.

So-called shift work disorder mainly strikes people who work the overnight or early morning shift, or who rotate their shifts, says Eric Zhou, an assistant professor in the Division of Sleep Medicine at Harvard Medical School. It is characterized by significant problems falling and staying asleep, or sleeping when desired. That’s because shift work disrupts the body’s normal alignment with the 24-hour sleep-wake cycle called the circadian rhythm.

“People who work 9-to-5 shifts are typically awake when the sun is up, which is aligned with their body’s internal circadian clock. But for shift workers, their work hours and sleep hours are misaligned with the natural cues to be awake or asleep,” Zhou says. “They’re working against the universe’s natural inclinations — not just their body’s.”

What’s the connection between shift work and health?

A 2022 research review in the Journal of Clinical Sleep Medicine links shift work to higher risks for serious health problems, such as heart attack and diabetes. This research suggests adverse effects can include metabolic syndrome (a cluster of conditions that raises the risks for heart disease, diabetes, and stroke), accidents, and certain types of cancer.

“The research is consistent and powerful,” Zhou says. “Working and sleeping during hours misaligned with natural light for extended periods of time is not likely to be healthy for you.”

How do new studies on shift work boost our understanding?

New research continues to add to and strengthen earlier findings, teasing out specific health effects that could stem from shift work.

• Shift workers on rotating schedules eat more erratically and frequently than day workers, snack more at night, and consume fewer healthier foods with potentially more calories, a study published online in Advances in Nutrition suggests. This analysis reviewed 31 prior studies involving more than 18,000 participants, comparing workers’ average food intake over 24 hours.
• Disrupting the circadian rhythm through shift work appears to increase the odds of colorectal cancer, a malignancy with strong ties to lifestyle factors, according to a 2023 review of multiple studies published online in the Journal of Investigative Medicine. Contributors to this higher risk may include exposure to artificial light at night, along with complex genetic and hormonal interactions, study authors said.

“Cancer understandably scares people, and the World Health Organization recognizes that shift work is a probable carcinogen,” Zhou says. “The combination of chronically insufficient and poor-quality sleep is likely to get under the skin. That said, we don’t fully understand how this happens.”

How can you protect your sleep — and your health?

If you work overnight or early morning shifts, how can you ensure you sleep more soundly and restfully? Zhou offers these evidence-based tips.

Time your exposure to bright and dim light. Graveyard shift workers whose work schedule runs from midnight through 8 a.m., for example, should reduce their light exposure as much as possible after leaving work if they intend to go right to sleep once they return home. “These measures could take the form of wearing blue light–blocking glasses or using blackout shades in your bedroom,” he says.

Make enough time for sleep on days off. “This is often harder than it sounds, because you’ll want to see your family and friends during nonwork hours,” Zhou says. “You need to truly protect your opportunity for sleep.”

Maintain a consistent shift work schedule. “Also, try to minimize the consecutive number of days you spend working challenging shifts,” he says.

Talk to your employer. Perhaps your boss can schedule you for fewer overnight shifts. “You can also ask your doctor to make a case for you to be moved off these shifts or have more flexibility,” Zhou says.

Look for practical solutions that allow you to get more restful sleep. “People engaged in shift work usually have responsibilities to their job as well as their family members, who often operate under a more typical 9-to-5 schedule,” he notes. “The goal is to preserve as strong a circadian rhythm as possible under the abnormal schedule shift work requires.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon