# data[].attributes.attachment_link.readable_text
Abstract
Cerebral palsy (CP) is a developmental disorder, characterized by movement disorders that appear in early childhood. Children with CP experience poor motor coordination and have problems with sensation, vision, hearing, swallowing and speaking. A qualitative study was conducted at Mutale Municipality to ascertain the challenges faced by mothers with children who have CP. Unstructured interviews were conducted with 12 participants and data were analysed using interpretative data analysis. The results showed that the challenges faced by mothers, with cerebral palsy children were social and psychological, hence, the study concluded that these specific types of support should be given to these mothers. The findings also indicated that cerebral palsy is condition that requires a lot of care from parents and that there is lack of support and understanding of the condition from family and friends. Parents raising children with cerebral palsy require the support of friends and family members, therefore, the lack of that support leads to psychological problems, such as feelings of isolation, worries and stress. The researchers recommend that campaigns must be undertaken to help the society to understand cerebral palsy, as this might enhance the societal acceptance and motivate support for those with the condition.

1. Introduction

Cerebral palsy is a physical impairment usually appearing in childhood and affecting the development of movement; it is a condition that affects people differently (Rosenbaum, ). According to Stanley et al. () around 2.5 of every 1000 children born in the Western world have cerebral palsy, and it is mostly found in children who are born prematurely. Population-based studies from around the world show that the statistics on cerebral palsy worldwide range from 1.5 to more than 4 per 1,000 live births (Mandal, ).

Cerebral palsy, as a neurological disorder, causes a non-progressive brain injury that occurs when the child's brain is underdeveloped (Dixon, ). Children with cerebral palsy are noticeable by symptoms, such as loss of motor function. This affects body movement, muscles tone, muscles coordinator, posture, body balance; sometimes it may also affect fine motor skills, oral and gross motor functioning (Mayston, ). Children with cerebral palsy find it difficult to walk, sit, grasp objects, and may experience problems from intellectual impairment, seizures and swallowing. These symptoms may appear during infancy or at preschool years (Nelson, ).

Cerebral palsy is divided into three subtypes: spastic, dyskinetic and ataxic; these categories are based upon the predominant motor impairment. The spastic cerebral palsy also has subdivisions based on the number of limbs affected, for example, hemiplegia affects one side of the body, diplegia affects the legs only, while quadriplegia impacts on all four limbs. Dyskinetic cerebral palsy is associated with fluctuating or rigid muscle tone, while the ataxic conditions are associated with problems with co-ordination, muscle tone and balance (Donna, ).

According to the World Health Organisation (WHO), neuro deficits are major global problems in children (World Health Organization, ). The neurodeficits include, head injury, trauma to spinal cord and parasitic infection (Batal, ) and according to Idro et al. (), these deficits commonly cause cerebral palsy. Cerebral palsy is caused by brain damage that may happen before birth, during birth or just immediately after birth. The brain damage may be caused by an accident, abuse or medical malpractice. Medical causes include being born too early (premature birth), not getting enough blood, oxygen or other nutrients before or during birth, a serious head injury or infection during pregnancy that can affect the brain, for example, meningitis.

Raina et al. () indicate that children with cerebral palsy encounter challenges because they experience functional limitations and long-term dependency on their mothers. The Center for Children Development (Center for Child Development, ) further maintained that these challenges do not only affect the child with the condition, but also the entire family. Cerebral palsy affects developmental milestones in speech, vision and learning and causes prolonged dependence on a caregiver, thus, affects psychological and social functioning of the parents (Idro et al., ). Parents of children with cerebral palsy undergo social, psychological and economic exhaustion (Mungo et al., ). Mungo et al. () add that marital relationship may also suffer due to stress, guilt and blame, hence, cerebral palsy affects marriages and family organizations (Vijesh and Sukumaran (). Among the social challenges that the parents experience, is inadequate support from the family, parents and the society (Ambikile & Outwater, ). The condition also causes psychological issues, such as fear of rejection by the extended families and friends (Vijesh & Sukumaran, ). Families of children with the condition also suffer from financial problems since the condition requires special care that is difficult in getting insurance coverage for doctor's medication and treatment, hence, parents have to pay for the child's treatment (Lawal et al., ). Most of the aforementioned were not conducted within the Limpopo Province; therefore, the current study sought to explore the challenges in the context of Mutale Municipality, a rural area in the Limpopo Province.

2. Methodology

2.1. Research design

A qualitative phenomenological design was employed to explore and describe the experiences of mothers with children suffering from cerebral palsy (Burn & Grove, ).

2.2. Population and sampling

The population of this study comprised mothers who have children suffering from cerebral palsy in the Mutale Municipality; 12 participants were selected purposively from three villages-Masisi, Tshenzhelani and Ha-Gumbu. Only participants with children between the ages of 3 and 5 years were included in the study.

2.3. Data collection

Data were collected using semi-structured interviews conducted at the residential places of the participants; these were recorded using a voice recorder and data were transcribed verbatim, later (Brink, ). Interviews were conducted in Tshivenda and lasted between 60 to 70 minutes and a language expert was employed to translate the transcribed data from Tshivenda to English.

2.4. Data analysis

Data were analysed using interpretative phenomenological analysis and the collected data were clustered into themes with similar meanings and tabulated.

2.5. Trustworthiness of the study

Credibility was ensured by prolonging the engagement between the researcher and participants during data collection (Babbie & Mouton, ). Participants were given enough time to express their experiences as the interviews were in-depth and face-to-face sessions. The methodology and results were also discussed with the peers who have knowledge on qualitative research (Guba & Lincoln, ).

2.6. Ethical consideration

The topic is sensitive, therefore, voluntary participation was strictly adhered to. Participants were informed comprehensively about the purpose of the study before they signed informed consent forms. Additionally, ethical issues such as anonymity and confidentiality were explained to the participants and adhered to, by the researcher. Debriefing was done after the study and those affected were referred to a psychologist.

2.7. Findings

This section presents the results obtained from the different participating mothers who outlined their experiences in parenting children with cerebral palsy. The data with same meaning were grouped together into themes and later, these emerged themes are discussed and supported by relevant literature. The table below shows the themes and their sub-themes from the data collected.

The findings are categorized into two themes-social and psychological challenges. Social challenges were further divided into-lack of facilities and services, financial problems, limitation of parents' social life, unsupportive interaction with relatives and conflicts with relatives. The psychological challenges were divided into-being worried, stress, as well as loneliness and isolation.

2.8. Themes and subthemes

The challenges experienced by mothers with children suffering from cerebral palsy: A study conducted at Mutale Municipality, South Africa

2.9. Discussion of the findings

The participants indicated a number of factors that contribute towards the social and psychological challenges that one encounters while raising a child with cerebral palsy. The following are the social and psychological challenges that emerged from the data collected:

3. Theme 1: Social challenges

3.1. Lack of facilities and services

Children who suffer from cerebral palsy need medication in their developmental stages. Those children need to attend clinic on a weekly basis. The participants indicated that there is a lack of facilities and services at the hospital to help those children. "I have to go to Tshilidzini hospital for checkup of my baby every week, but sometimes I return home with the baby not checked because of lack of facilities and medication, sometimes I am forced to buy some medicines" said Participant 2.

The above findings are supported by Alaee et al. (), who observed that there is a shortage of social and therapeutic services to help children with cerebral palsy. These shortages included social services, such as daycare, wheelchairs in public places and a lack of public toilets that are suitable for children with cerebral palsy.

3.2. Financial problem

Parents raising children who suffer from cerebral palsy encounter financial problems. One of the participants indicated that there are times when she buys the medication for her child and some of the medications are expensive, yet she cannot afford not to buy them. "The medication for children with cerebral palsy are expensive, although I try to buy some of the medication some of the medication are so expensive that I am not able to buy them for my child; sometimes I end up using the money that I should use to support my first child with, so that I can buy some medications" Participant 4.

Alaee et al. (), state that lack of financial support and limited access to medical service are some of the problem faced by mothers who are raising children with cerebral palsy. Correspondingly, Ambikile and Outwater () indicate that expensive treatments that exceed most families' income make it difficult to access sanitary facilities such as toilets and other necessary equipment for the child. Sen and Yurtsever () added that there is a load of expensive treatment and care for a child with cerebral palsy. The findings of McNally and Mannan () indicate that lack of money for healthcare is a major financial challenge experienced by families with a child who has this condition.

3.3. Inability of parents to have a social life

The current study shows that parents raising children with cerebral palsy are limited in their social life events. The limitation arises as a result of the child's physical incapacity and difficulties arising from the parents' inability to accept their children's condition. Lack of acceptance of the children's condition by the parents prevents them from engaging in activities and social events as they believe they have to closely monitor the children. "I always put my child at home, if I want to go out I make sure there is a close relative who will be at home looking after the child for me, if there is an event to attend I rather not attend the event because I cannot go to the event with the child" Participant 3. The above statement is supported by Yantzi et al. (), who indicated that lack of trained caregivers who will look after the children in the absence of the mothers results in them seeking help from friends and family members whenever they want to leave the house. The findings of a study done by Alaee et al. () also show that lack of formal temporary day-care facilities for children with cerebral palsy makes it difficult for mothers to perform daily activities.

3.4. Unsupportive environment

The findings indicate that there is lack of support from friends, relatives and in-laws. The participants indicated that the in-laws blame the mother for the condition of the child. The participants also indicated that some friends show sympathy, however they ask lots of questions due to lack of knowledge about the child's condition and this can be irritating. "Ever since people noticed that my child has problems, people start to react differently, some show sympathy for me in such a way that it bothers me, my in-laws are not accepting the child, they think I am the cause of the condition" Participant 1. A previous study revealed that there is a lack of supportive interaction/environment from families, and mothers experience stigma from raising children with cerebral palsy from family and friends (Alaee et al., ). Park et al. () also found that Korean families with children who have chronic illnesses such as cerebral palsy face more negative responses from families and friends as opposed to families in Western countries. The findings of McNally and Mannan () show that spousal or immediate family support was absent because the family blames the mother.

3.5. Social conflicts

Participants in the present study reported that they experience social conflicts with friends and families. Social conflicts emerge when friends and families begin to talk negatively about the child with cerebral palsy. "Sometimes people talk very badly about my child, some blame me, they think that I am the one who is causing my child not to walk or sit, and when they talk to my child in a bad way, I react negatively which is affecting the relationship that I have with many people" Participant 5. The responses show that the parents are subjected to lack of understanding from society that affects social and family relationships (Nimbalkar et al., ).

The participants also reported marital conflicts that may lead to separation. The findings show that fathers find it difficult to accept children with cerebral palsy; therefore, some may separate from the mothers. " After the birth of my child the father of the child was there for us, but as time went on and after we realise that the child was not sitting and talking like other children, he slowly turned his back on us, when the doctor revels to us that our child has cerebral palsy and explained the condition to us, the father of my child broke off with me" Participant 2.

4. Theme 2: Psychological challenges

4.1. Being worried

The findings show that mothers who are raising children with cerebral palsy worry about the condition of their children and have great difficulty in accepting their children. The participants indicated that they sometimes wish their children were like other children. " It is very difficult to accept that the child condition will never change, every time when I go for checkups, I wish the doctor can tell me that my child will be normal and walk like other children, the condition of my child worries me a lot, I want my child to have a better life and be able to sit and walk like others", Participant 4. Ambikile and Outwater (), posit that mothers raising children with cerebral palsy experience inner pain and worry about the future of their children. "I do worry a lot about my child, I always ask myself about the future that my child will have, if I die now who will look after my child, I wish she can learn to do few activities so that she can be able to look after herself" Participant 2.

The above findings are similar to those of Alaee et al. (), who opine that mothers worry a lot about their children's condition, and their worries decrease when their children start to improve. The above statement is supported by Nimbalkar et al. (), when they also maintain that most of the parents are worried about the child's future, wondering who will take care of the child in the mothers' absence.

The findings also show that the mothers sometimes feel guilty about the condition of their children and think is a punishment for their sin and disobedience of the ancestors. "I sometimes feel guilty about my child's condition, I think I contributed by not praying to my ancestors, or maybe it is the punishment for the wrong things that I did in the past" Participant 5.

Fourie (), reports that ancestors are seen as benevolent spirits who preserve the honour and traditions of a tribe, and they usually protect their people against evil and destructive forces, however, they can punish their people by sending illnesses and misfortunes to people who do not listen to ancestors' wise counsel. Alaee et al. () add that parents with children who have cerebral palsy consider themselves as the causes of the child's condition.

4.2. Stress

The findings of this study show that mothers who are raising children with cerebral palsy are stressed by a number of concerns, such as the condition of a child, lack of social support, financial constraints and treatment they get from other people. "The condition of my child stresses me a lot, currently, I am not working and I am not looking for a job because no one accepts to take care of my child, people think my child is a burden " Participant 3.

The study of Nimbalkar et al. () revealed that the parents raising children with cerebral palsy suffer from psychological problems such as stress, anger, tiredness and frustration.

4.3. Loneliness and isolation

The findings also demonstrate that these mothers feel lonely and isolate themselves from other people because of the children's condition. " I usually do not attend social events, even if I attend I will make sure that I stay far from other people so that people do not see my child and notice the child's condition" Participant 2.

Mothers raising children with cerebral palsy isolate themselves from friends and families because of lack of support (Dixon, ). This is inconsistent with the study conducted by Nelson (), where mothers isolate themselves from family members and friends because the latter do not understand and accept the condition of their children. The study of Nimbalkar et al. () indicates that there is a reduction in attending ceremonies such as family gatherings among affected mothers.

5. Conclusion and recommendation

The study investigated the experience of mothers who are raising children with cerebral palsy. The findings show that the mothers encounter challenges, such as financial, social and psychological. Cerebral palsy is a condition that requires lot of care from parents and support from various groups of people; however, the study revealed that there is lack of support and understanding of the condition from family and friends; this leads to psychological problems such as isolation, worries and stress. The researcher recommends that a quantitative study should be done with a large number of participants to provide comprehensive information on the topic. It is also recommended that campaigns must be undertaken to help the society to understand cerebral palsy; this might enhance societal acceptance and support for those with the condition.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding

This work was supported by the University of Venda, Research Publication Committee [RPC].

Mpho Madzhie holds a PhD in Psychology, she is a part-time lecturer at the University of Venda. Her research focus is developmental psychology and indigenous knowledge system.Valeria Baloyi holds a PhD in Psychology; she is a clinical psychologist at private practice and a lecturer at the University of Venda. Research interest is in gender and sexuality, adolescent health, and personalities.Mphephu Khathutshelo holds a master's degree in psychology, she is a Lecturer at the University of Venda. Her research focus is indigenous knowledge systems and youth and Health Education.Maphuti Chueng holds master's in public health, Honours Degree in Psychology, he is a Research Assistant at the University of Venda, School of Health Sciences. Research Interest is in Health education and Promotion, Gender-Based Violence, Adolescent health, and personalities.

References

, Shahboulaghi, F. M. , , & Kermanshahi, S. M. K. (2015). Psychological challenges for parents of children with cerebral palsy: A qualitative study. Journal of Child and Family Studies, 24(7), 2174. https://doi.org/10.1007/s10826-014-0016-3

Ambikile, J. S. , & . (2012). Challenges of caring for children with mental disorders: Experiences and views of caregivers attending the outpatient clinic at Muhimbili National Hospital, Dares Salaam-Tanzania. Child and Adolescent Psychiatry and Mental, 6(1), 16.Health.www.capmh.com/content/6/1/16

(2011). Neurological disorders. [unpublished doctoral dissertation], University of Pittsburgh. www.buzzle.com

,& (2010). The practice of nursing research; Appraisal, synthesis and generation of evidence (6th ed). St.Louis: Sauders.

Center for Child Development. (2007). Children with cerebral palsy. www.childsupport.in.htmt

(2012) A Qualitative Analysis into Children's Experience of Living with Cerebral Palsy [Unpublished thesis]. University of Glasgow. http://theses.gla.ac.uk/3509

, Kakooza- Mwesige, A. , Balyejjussa, S. et al (2010). Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan Children. British Medical Journal Research Notes Journals 3, 104. https://doi.org/10.1186/1756-0500-3-104

, , , & . (2014). Socio-economic challenges of parents of children with neurological disorders: A hospital-based study in North West Nigeria. International Journal of Nursing and Midwifery, 6(4), 58-8. https://doi.org/10.5897/IJNM2014.0122

(92db). Child and Youth experiences and perspectives of cerebral palsy: a qualitative systematic review. Child: care heath development journal. 42(2):153-175. https://onlinelibrary.Wiley.com/toc/13652214/2016/42/2

(2019, february 26). Cerebral Palsy Prevalence. News- Medical. Retrieved on february 22, 2022 from http://www.news-medical.net/health/Cerebral-Palsy-Prevalence.aspx

, (2001). People with cerebral palsy: Effects of and perspectives for Therapy. Neutral Plasticity. 8.51-69. 101155/NP.2001.51.

, & . (2013). Perceptions of Caring for Children with Disabilities: Experiences from Moshi, Tanzania. African Journal of Disability, 2(1), 1-10. https://doi.org/10.4102/ajod.v2i1.21

, , , et al 2007. Impairement of quality of life in parents of children and adolescents with pervasive developmental disorders. Health Quality of Life Otcomes Journal 5, 2. https://doi.org/10.1186/1477-7525-5-22

(2002). The epidemiological of cerebral palsy in term infants. Mental Retardation and Developmental Disability Research Review, 8(3), 146-50. www.onlinelibrary.wiley.com

Nimbalkar, S. , Raithatha, S. , , & . (2014). A qualitative study of psychosocial problems among parents of children with cerebral palsy attending two tertiary care hospitals in Western India. ISRN Family Medicine, 1(1), 1-7. https://doi.org/10.1155/2014/769619

, , , & . (2009). From their own response: experiences of Korean children with chronic illness and their families. Journal of Korean Academic Child Health Nursing, 15(4), 350-358. https://doi.org/10.4094/jkachn.2009.15.4.350

Rosenbaum, P. (2005). Cerebral Palsy: What Parents and Doctors Want to Know. British Medical Journal (Clinical research ed.). https://www.researchgate.net/publication/10776930

, & Yurtsever, S . (2007). Difficulties experienced by families with disabled children. Journal for Specialists in Pediatric Nursing, 12(4), 238-252. https://doi.org/10.1111/j.1744-6155.2007.00119.x

, & Sukumaran, P. S . (2007). Stress among mothers of children with cerebral calsy attending special schools. Asian Pacific Disability Rehabilitation Journal, 18(1), 1-12.

World Health Organization. (2006). International classification of functioning disability and health. World Health Organisation.

, Rosenberg, M. W. , & . (2007). Getting out of the house: The challenges mothers face when their children have long-term care needs. Health & Social Care in the Community, 15(1), 45-55. https://doi.org/10.1111/j.1365-2524.2006.00663.x

# data[].attributes.attachment_link.title
The challenges experienced by mothers with children suffering from cerebral palsy: A study conducted at Mutale Municipality, South Africa

# data[].attributes.attachment_link.description
Abstract Cerebral palsy (CP) is a developmental disorder, characterized by movement disorders that appear in early childhood. Children with CP experience poor motor coordination and have problems with sensation, vision, hearing, swallowing and speaking. A qualitative study was conducted at Mutale Municipality to ascertain the challenges faced by mothers with children who have CP.

# data[].attributes.body
https://www.madinamerica.com/2020/01/no-dr-friedman-solution-teen-suicide-not-simple/

# data[].attributes.attachment_link.readable_text
In the largest newspaper in the world this week, one of the largest problems in the world was proposed as having a very simple solution.

There are few problems more heartbreaking and excruciating than the growing epidemic of youth (and adults) taking their own precious lives. So it's understandable that we all continue putting significant attention towards solutions that can make a difference.

In response to this urgent challenge, psychiatrist Richard A. Friedman asked in a recent New York Times op-ed : "How is it possible that so many of our young people are suffering from depression and killing themselves when we know perfectly well how to treat this illness? "

Do we? That's certainly a widely shared perception among many in the general public today. But are the answers really so crystal clear?

Dr. Friedman certainly thinks so, suggesting that little more needs to be discussed: "The good news is that we don't have to wait for all the answers to know what to do. We know that various psychotherapies and medication are highly effective in treating depression."

While it's true there are different therapies and treatments that have been helpful for many, there are also wide-ranging debates that continue today about inadvertent consequences associated with some of the most commonly used treatments - over both the short and long term. Shouldn't we be weighing those in the balance? And what else could be done to help more people find sustainable healing over time?

Instead of having that important (more complex) conversation, we continue to be invited into a much simpler discussion: How do we get more people to be able to access more treatment?

After noting that rates of youth treatment are significantly below treatment rates for adults, Friedman goes on to suggest that the pathway ahead is obvious: "We just need to do a better job of identifying, reaching out to and providing resources for at-risk youths."

On its face, this seems a clean and compelling solution: just get these kids some more help!

How could we not simply rally around that?

Because that's what we've been rallying around for many years now.

The other day, I sat in a suicide prevention presentation in my home state where the speaker advocated the same solution: "the biggest need is to get more teens access to treatment."

I raised my hand during the Q/A and asked my sincere question: "Haven't we been doing that for quite a while already? If so, are there other questions we should be considering?"

A 2011 report released by the National Center for Health Statistics (NCHS) showed that the rate of antidepressant use in this country among teens and adults (people ages 12 and older) had increased by almost 400% between 1988-1994 and 2005-2008 - with estimates of one in every 10 Americans now taking an antidepressant. (During this same period, rates of psychotherapy usage have not increased in corresponding fashion - with some studies finding these rates decreasing in recent years).

If getting more teens more help was really the answer, wouldn't we have reasonably seen a measurable decrease in suicide, depression and anxiety by now? In striking contrast, the rates of these concerning numbers have increased markedly during this same period.

Indeed, these troubling numbers have reached such historic levels that one would think it was time to reassess and reevaluate a lot of things: from the way we conceptualize these problems, to what we're doing about them (and what we're not doing about them).

Instead of this kind of a pause for reflection, all across America what we see today is a doubling down of the approach we've taken for the last twenty years. Is this a responsible way to respond to the suicide crisis among our youth (and our adults too)?

No, it's not. And it's time for a bigger conversation about not only suicide, but mental health care in America today.

It will likely be the voices of people who are seeking and finding healing in their own lives that lead the way in this conversation. Too often, it's the professionals who orient us back towards something more narrow. As Dr. Friedman himself wrote to his worldwide audience, "Our collective failure to act in the face of this epidemic is all the more puzzling" - even asserting, "Teenagers and young adults in the United States are being ravaged by a mental health crisis - and we are doing nothing about it."

Not true, Dr. Friedman. We have done something about it. And it's just not working.

During this same period of time in which antidepressant rates have soared, depression, anxiety and both suicidal ideation and suicidal completion have continued to increase. I was so troubled by this counterintuitive pattern that I reviewed the research and found seven different lines of evidence that confirm a concerning linkage between antidepressants and suicidality - especially among youth. To provide just one illustration, a 2017 study in Sweden that examined 483 suicides from young women between 1999-2013 (representing 93% of all confirmed suicide for this subgroup) explored treatment they received 6 and 12 months before the suicide.

Not only did antidepressants not "lead to a drastic reduction in suicide rates," the author, Dr. Larsson, noted : "On the contrary, it was found that an increasing tendency of completed suicides follow the increased prescription of antidepressants," adding, "This analysis shows a covariance between increased prescription of antidepressants and an increasing trend in the number of suicides among young women."

This is not an anomaly, but one of many examples in a broader pattern hardly receiving attention in America's mental health conversation today. And perhaps that shouldn't be surprising, since it runs in the face of the conventional wisdom taken for granted not only by psychiatrists like Dr. Friedman, but by many faith and community leaders across the United States today: that the real issue in this crisis is "undertreatment." A great deal of rigorous scientific, epidemiological, clinical and randomized-controlled trial data - not to mention the precious lives of our youth today - call for much greater care in making such a conclusion.

It's not just caution we need, however - it's hope. And it's important to note that the same research literature is remarkably full of solid reasons to hope. Alongside the encouraging understanding that continues to emerge from neuroplasticity and epigenetic studies, there is a vast research literature documenting hundreds of lifestyle adjustments that can make a difference in reducing emotional pain over the long term.

And not just for mild cases. A Pubmed search of "suicide" and "risk factors" reveals well over 15,000 scholarly articles documenting a dizzying array of possible contributors. Factors commonly cited as making a likely contribution to increasing suicide rates among youth include a more pervasive social media and digital presence, widespread sleep deprivation and a nutrient-deficient American diet, growing cyber-bullying and social anxiety, the unsettling influence of compulsive pornography use, and the uniquely painful trauma of sexual abuse or assault.

After examining cases of suicide in our own state, one state suicide research summarized : "Our investigation showed that suicide is complex and youth can experience multiple risk and protective factors. No single behavior or risk factor could explain all the reasons for the increase we've seen."

If that's true, then there are a lot of things we can do in response. And that's the good news hidden in all this: there's so much we can act on and do something about!

Starting with better protecting our youth from early trauma and abuse. Underscoring perhaps the most important theme across studies, a 2014 Utah summary of factors involved in youth suicide notes that "Suicide is also often preceded by a lifetime history of traumatic events."

We can do a better job of protecting our youth - rallying together to help provide them with the kind of lives overall that don't drive them to despair. And we've got a lot of options to do just that: improvements in a nutritious diet, more time outside in nature and away from screens, physical activity, better connection with those who love them the most, discussions that bring them greater meaning and purpose. And yes, in cases of previous abuse, finding ways to increase access to trauma-oriented therapy is crucial.

When asked what the alternative to standard care was for teens for whom the medications weren't working, another leading psychologist responded simply: "all of life!" This is precisely what the research also confirms - with a large wealth of possible adjustments showing up that can make a measurable difference for anyone, especially over time.

So no, Dr. Friedman, the answer to our suicide crisis among youth is not to rally more force of will (and legislative dollars) to encourage more teens to embrace more treatment. It's to have a little - or a lot - more humility about what is facing us. To breathe deep, and to pursue multifaceted answers to a complex, multifaceted problem.

It's time to do just that, uniting around the precious youth who depend on the steps we take next.

# data[].attributes.attachment_link.title
No, Dr. Friedman: The Solution to Teen Suicide is Not So Simple - Mad In America

# data[].attributes.attachment_link.description
In the largest newspaper in the world this week, one of the largest problems in the world was proposed as having a very simple solution. There are few problems more heartbreaking and excruciating than the growing epidemic of youth (and adults) taking their own precious lives.

# data[].attributes.body
https://www.nytimes.com/2020/01/06/opinion/suicide-young-people.html

# data[].attributes.attachment_link.readable_text
Teenagers and young adults in the United States are being ravaged by a mental health crisis - and we are doing nothing about it. As of 2017, statistics show that an alarming number of them are suffering from depression and dying by suicide. In fact, suicide is now the second leading cause of death among young people, surpassed only by accidents.

After declining for nearly two decades, the suicide rate among Americans ages 10 to 24 jumped 56 percent between 2007 and 2017, according to data from the Centers for Disease Control and Prevention. And for the first time the gender gap in suicide has narrowed: Though the numbers of suicides are greater in males, the rates of suicide for female youths increased by 12.7 percent each year, compared with 7.1 percent for male youths.

At the same time, the rate of teen depression shot up 63 percent, an alarming but not surprising trend given the link between suicide and depression: In 2017, 13 percent of teens reported at least one episode of depression in the past year, compared with 8 percent of teens in 2007, according to the National Survey on Drug Use and Health.

How is it possible that so many of our young people are suffering from depression and killing themselves when we know perfectly well how to treat this illness? If thousands of teens were dying from a new infectious disease or a heart ailment, there would be a public outcry and a national call to action.

While young people are generally physically healthy, they are psychiatrically vulnerable. Three-quarters of all the mental illness that we see in adults has already occurred by age 25. Our collective failure to act in the face of this epidemic is all the more puzzling since we are living at a time when people are generally more accepting of mental illness and stigma is on the wane.

You'd think it would be no big deal to see your family doctor or a therapist and get your depression treated like any other medical problem. But the data suggest otherwise: Only 45 percent of teenage girls who had an episode of depression in 2019 received any treatment, and just 33 percent of teenage boys with depression did. In contrast, two-thirds of adults with a recent episode of depression received treatment.

What explains the epidemic of teen depression and suicide? There are lots of theories but few definitive answers.

Some researchers emphasize the potential role of social media exposure and use of smartphones. There is some evidence that girls, who have shown greater rates of increase in depression than boys, experience more cyberbullying because of their greater use of mobile phones and texting. But most studies of digital technology and mental health are correlational and can't prove causation.

Drugs and alcohol are always a popular culprit, but in this case they are an unlikely explanation, as the studies cited above controlled for drug use. In addition, there is no evidence of a significant increase in the use of drugs or alcohol in young people during the study period.

It is legitimate (though controversial) to ask whether the Food and Drug Administration's "black box" warning for antidepressants back in 2004 - which said the drugs could cause suicidal thoughts and actions in some children and teenagers - discouraged the use of these drugs and unwittingly helped fuel the rise in teen depression. Within two years of the F.D.A. advisory, antidepressant use dropped by 31 percent in teens and 24 percent in young adults. Although antidepressant use recovered somewhat after 2008, it has remained below levels that would have been expected based on prescribing patterns before the warnings appeared.

The good news is that we don't have to wait for all the answers to know what to do. We know that various psychotherapies and medication are highly effective in treating depression. We just need to do a better job of identifying, reaching out to and providing resources for at-risk youths.

To start, we need a major public campaign to educate parents and teachers to recognize depression in young people and to learn about the warning signs of suicide - like a sudden change in behavior, talking or writing about suicide, and giving away prized possessions. We should have universal screening of teenagers at school, with parental consent, to identify those who are suffering from depression and who are at risk of suicide. And we have to provide adequate funding and resources to match the mental health needs of our young people.

Every day, 16 young people die from suicide. What are we waiting for?
[If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to The Times is committed to publishing a diversity of letters to the editor. We'd like to hear what you think about this or any of our articles. Here are some . And here's our email: letters@nytimes.com. SpeakingOfSuicide.com/resources for a list of additional resources.]

# data[].attributes.attachment_link.title
Opinion | Why Are Young Americans Killing Themselves?

# data[].attributes.attachment_link.description
Teenagers and young adults in the United States are being ravaged by a mental health crisis - and we are doing nothing about it. As of 2017, statistics show that an alarming number of them are suffering from depression and dying by suicide.

# data[].attributes.body
https://www.nytimes.com/2020/01/12/opinion/letters/suicide-youths-teenagers.html

# data[].attributes.attachment_link.readable_text
Re " Why Are Young Americans Killing Themselves?," by Richard A. Friedman (Op-Ed, nytimes.com, Jan. 6):

While I appreciate Dr. Friedman's effort to call attention to the epidemic of suicide among young people in this country, I can't help but be frustrated by the simplicity of his plan to address it. First, and perhaps most challenging, we need to address some of the underlying causes: a profoundly broken economy that robs young people of opportunities for a healthy and productive life, a constant news cycle full of dire predictions, and, of course, access to lethal means like guns.

But second, Dr. Friedman's assertion that a visit to a family physician or therapist and medication are the first steps to treatment ignores the fact that we face a dire shortage of medical professionals, especially psychiatrists like Dr. Friedman himself, who can properly prescribe medication and provide accompanying therapy - the combination proven most effective in treating both depression and anxiety.

"What are we waiting for?" Dr. Friedman asks. Probably a callback from the one psychiatrist within hundreds of miles who is taking new patients.

Lee Burdette Williams
South Burlington, Vt.
The writer is senior director for mental health initiatives at NASPA: Student Affairs Administrators in Higher Education.
To the Editor:
It seems extraordinary that in a time of relentless school shootings and obvious evidence of climate change that the depression of teenagers is attributed to media and drugs rather than the failure of politicians to care about America's children and their future.

Chandra Mukerji
San Diego
To the Editor:
Richard A. Friedman calls attention to the very disturbing problem of significant increases in youth suicide and depression. His solution - depression screening and better access to pharmacotherapy and psychotherapy - is a good start. However, it does not address the causes of young people's depression and despair: the isolation, cyber-preoccupation and bullying he mentions, and the feelings of inadequacy and uncertainty that fuel and compound them.

What is needed are school programs that teach self-awareness and self-care and offer group support, for teachers and parents as well as all students - programs that create a communitywide culture of wellness.

Teaching kids to use meditation techniques to reduce their stress and teaching them ways to express their feelings and thoughts in words, drawings and movement will give them greater understanding of, and control over, disturbing emotions.

These approaches improve mood, sleep and focus, decrease anxiety, and make kids feel more competent and hopeful. When they share their challenges and their successes in safe, supportive groups, they overcome the terrible loneliness that contributes so significantly to depression.

James S. Gordon
Washington
The writer, a psychiatrist, is the author of "The Transformation: Discovering Wholeness and Healing After Trauma."
To the Editor:
A 2019 University of Michigan study showed that previously suicidal teens were more likely to be alive 11 to 14 years later if the adults caring for them received education about depression and suicide. Parents are the most likely to recognize that their teen is depressed, most motivated to act and most able to harness resources to help their teen get well.

Too many parents feel immobilized because they don't know how to talk to their teen or find treatment and services. Something as accessible as a webinar or workshop on teen depression can get parents on the right track to supporting their teen.

While social stigma and a shortage of mental health professionals for adolescents are potential barriers, having a parent to advocate for their care and provide emotional support can mean the difference between life and death for a teen.

Valerie Cordero
Susan Weinstein
The writers are co-executive directors of Families for Depression Awareness.
[If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources.]

# data[].attributes.attachment_link.title
Opinion | The Soaring Rate of Suicide by Young People (Published 2020)

# data[].attributes.attachment_link.description
Re " Why Are Young Americans Killing Themselves?," by Richard A. Friedman (Op-Ed, nytimes.com, Jan. 6): While I appreciate Dr. Friedman's effort to call attention to the epidemic of suicide among young people in this country, I can't help but be frustrated by the simplicity of his plan to address it.

# data[].attributes.body
• The economy has an impact on young people living a healthy and productive
• Theres a shortage in medical professionals and psychiatrists/limit to accessible psychatrists (distance etc)

Possible Solutions
• Self-care awareness programs especially in schools,
• Supporting communities/groups.
• Meditation techniques
• Teaching them methods on how to get more control over emotions and more understanding & mindfulness

# data[].attributes.body
• Some of the cases the solution is simple
• psychotherapies and medication are useful
•

# data[].attributes.body
•Uses words like 'epidemic'

# data[].attributes.body
The cause of the increased suicide rate among teens.

Point of view: A psychiatrist
Target Audience: teens/ the youth
Style: A report style of writign

# data[].attributes.body
Refined:
- How the Covid 19 Pandemic has impacted unempoloyment rate in Africa

# data[].attributes.body
Refined:
- How the increase in substance abuse is affecting the suicide rate
Or
- suicide rate in teens/young adults/people

# data[].attributes.body
Refined:
- How our future is looking in terms of the environment, natural disasters, weather etc.

# data[].attributes.body
Some causes:
• failure to act on treating mental illnesses and dismissing    them has a negative impact on suicide rate.
• exposure to social media and its 'fake-ness' has an effect
• The use of smartphones, (cyber-bullying & texting etc)
• Drugs and Alcohol also influence some of these mental illnesses or the other way round (mental illness leading to drug use) which leads to suicidal thoughts.
• Antidepressants increase suicidal thoughts.

Some Statistics:
•From 2017, the statistics of suicide have been rising in young adults in the US.
• A number of them have suffered or been suffering from depression.
• suicide is now 2nd most common cause of death in young people.

• After the suicide rate declining for about 2 decades, it then began rising again for the past decade.
• Between 2007 and 2017, the suicide rate increased by 56% in people aged 10 to 24 according to the Center's for Disease Control and Prevention.

• The rate of teen depression increased by about 63%

• Only about 45% of teenage girls who experienced a period of depression got treatments.

Possible Solutions:
• Campaigns to encourage people specifically parents to look out for signs of depression.

# data[].attributes.body
• Uses stats, with in-text citations
• Relates & connects to other global issues
• Includes a story as an example.
• Has a straight to the point introduction
• There are notes to the editor?

# data[].attributes.body
https://nndc.org/nndc-member-dr-richard-friedman-discusses-teenagers-medication-suicide-in-new-york-times-op-ed/

# data[].attributes.attachment_link.readable_text
IS our culture of relentless achievement and success driving our young people to suicide? You would certainly think so, given the prevailing narrative in the media about the recent spate of suicides on college campuses: one high-achieving student after another succumbing to the toxic social pressure for perfection.

It's a plausible but incomplete explanation. No doubt the intense social pressure on young people, especially girls and young women, is daunting, but stress is only part of the story: We should also focus on adolescent mental illness and its treatment.

At least 90 percent of people who commit suicide have a diagnosable and potentially treatable mental illness like depression, or alcohol or other drug abuse problems, often in combination. Suicide is the third leading cause of death among young people and has been rising since 2007. The unidentified killer in this story is untreated psychiatric illness.

In 2013, for example, 8.7 percent of people between the ages of 18 and 25 experienced a major depression episode in the previous year, but only half of them received any psychiatric treatment, according to the National Survey on Drug Use and Health. And in 57 percent of these episodes, patients were seen by a general practitioner or family doctor - neither of whom is typically an expert in the treatment of mental illness.

Worse, antidepressants, which can be lifesaving, are probably being underused in young people. Their use fell significantly after the Food and Drug Administration issued its so-called black-box warning in 2004, stating that all antidepressants were associated with a risk of increased suicidal feeling, thinking and behavior in adolescents. That warning was later extended to young adults.

One very large study, including 1.1 million adolescents and 1.4 million young adults, examined data for automated health care claims for 2000 to 2010 from 11 health plans in the United States Mental Health Research Network. Disturbingly, the study found that antidepressant use plunged 31 percent among adolescents and 24 percent among young adults within two years after the F.D.A. advisory was issued.

It's not hard to understand why. The F.D.A.'s well-intended warning was alarming to the public and most likely discouraged many patients from taking antidepressants. Physicians, too, were anxious about the admittedly small possible risks posed by antidepressants and were probably more reluctant to prescribe them.

What the public and some in the medical community did not understand then - and perhaps still don't know - is that the risk of antidepressant treatment is minuscule: In the F.D.A. meta-analysis of some 372 clinical trials involving nearly 100,000 subjects, the rate of suicidal thinking and behavior was 4 percent in people taking antidepressants, compared with 2 percent in people taking a placebo.

This very small risk of suicidal behavior posed by antidepressant treatment has always been dwarfed by the deadly risk of untreated depression: 2 to 15 percent of depressed people actually commit suicide.

The somewhat good news is that the downward trend in antidepressant use among adolescents following the F.D.A. advisory reversed a bit after 2008. Still, the rates of antidepressant use since the F.D.A. warning was issued have remained below the levels that would have been predicted based on pre-warning use patterns.

This pattern is very disturbing, since in the decade before this downturn in prescribing of antidepressants - 1990 to 2000 - there was a steady decline in adolescent suicide rates that coincided with an increase in the use of antidepressants in this age group.

One study found that a 1 percent increase in adolescent use of antidepressants was associated with a decrease of 0.23 suicides per 100,000 adolescents per year. (Of course, correlation cannot prove causality; other factors, like reduced rates of alcohol and drug use and more stringent gun safety regulations during this period, may have played a role, too.)

Since there is no evidence that the F.D.A. black-box warning has been helpful, and there is a very reasonable possibility that it has discouraged patients from taking antidepressants and physicians from prescribing these medications, the government should rescind the black-box warning on antidepressants altogether.

Parents and teenagers, and their doctors, too, should not be afraid of antidepressants and should know that they can be very helpful. Indeed, with careful use and monitoring, they can be lifesaving. The only thing we should all fear is depression, a natural killer that we can effectively treat.

# data[].attributes.attachment_link.title
NNDC Member, Dr. Richard Friedman Discusses Teenagers, Medication & Suicide in New York Times Op-Ed - National Network of Depression Centers

# data[].attributes.attachment_link.description
The Opinion Pages | CONTRIBUTING OP-ED WRITER Teenagers, Medication and Suicide AUG. 3, 2015 Richard A. Friedman IS our culture of relentless achievement and success driving our young people to suicide? You would certainly think so, given the prevailing narrative in the media about the recent spate of suicides on college campuses: one high-achieving student after another [...]

# data[].attributes.body
Some Causes:
- Social Pressure
- Entreated Mental illness, depression
- Drug & alcohol abuse

Some info:
- It is the 3rd most common cause of death among young people been rising since 2007.
- The use of antidepressants increased by 31% in adolescents.
- 2 to 15 percent of people that live with depression commit suicide.

# data[].attributes.body
A lot of statistics

# data[].attributes.body
• Compares the response of people responding from teens dying from suicide and the response of teens dying from infectious diseases etc.
• Provides possible solutions at the end.
• A lot of statistics used