Adolescent Suicide, Screens, and Sleep with Abhishek Reddy

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Travis

The number of child and adolescent suicides has been on the rise for a number of years now. It's actually one of the leading causes of death for that age group. So when I learned that Virginia Tech's Abhishek Reddy had recently completed a study to help us better understand the connection between adolescent suicide, screen time, time of day, and access to medication, I absolutely wanted to know more about what he learned and how he can apply it to help people.

And thankfully Abishek has a similar goal in mind and was quick to accept the podcast invitation. Abishek is a faculty member and associate professor in the Virginia Tech Corillian School of Medicine's Department of Psychiatry.

He also works at the Carilion Clinic in Roanoke with specialties in child and adolescent psychiatry and sleep medicine. So, Abhishek broke down his study for me. He told me how they went about doing it, what they found, and then we talked a little about some preventative strategies that parents and guardians can take to really just help mitigate any possible risks to their teens and adolescents. He also just gave me some good advice on sleep hygiene that I think anybody can benefit from. mean, who doesn't want to sleep better? and he stressed the importance of adults modeling good behavior for adolescents in this area. I do have little bit of work to do. I'm Travis Williams and this is Virginia Tech's Curious Conversations.

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Travis

I think it's pretty much a consensus that suicide in adolescents and children is on the rise, sadly. And you recently did this interesting research looking at the intersection of that and screen time and the time of day and even the types of medications that kids use in those situations for overdoses. I'm curious, what got you interested in that intersection of this?

Abhishek

Yeah, so I do majority inpatient child psychiatry. So we take care of kids who come into the hospital with different mental health issues. And I was seeing more and more kind of kids who, adolescents who tried to overdose on pills to hurt themselves or kill themselves. And it was happening more in the evening times and there was a lot of association with screen use. So I was curious, like, because we all know that the numbers kind of are pretty impressive when you look at them, right? It makes you think and understand. And I was curious about the data. So I started, I was wondering if we can look at the data. So we went back and looked at six months of overdose attempts in kids who tried to hurt themselves or kill themselves. And then we looked at the time when they did it and if there was a screen association or a screen time link with it. So that's how my training and also curiosity helped me think about that process.

Travis

Yeah, it sounds like you're observing some things anecdotally and you're like, well, what's the hard data behind what's actually happening? Does it line up with what I'm seeing?

 

Abhishek

Yeah, and there are very few studies too, both in adults and kids, which looked at like the time of overdose or what they were doing before the overdose. So I thought that this would make it more interesting.

Travis

Yeah, it's fascinating that there hasn't been more studies about that, but that makes your study all the more interesting. So you said you looked at six months worth of, I guess, instances of children trying to overdose. And so how many children did you look at? And I guess, what did you find?

Abhishek

So in our study, in the age group of 12 to 17, that's where our kids were. We had 52 kids when we looked at six months data. And then we might look at later future in the day too. But when we looked at the past records, right, for six months, so we had 52 kids. And out of them, two thirds overdosed on pills to kill themselves after 8 p.m. So between 8 p.m. and I think 6 a.m. And then three fourths of the whole group were on the screen right before they overdosed. And so those numbers are pretty impressive when you look at it like that, right? Like majority of them are either on the screen or late in the evening after 8 p.m. when they're trying to kill themselves.

Travis

Do you know what kind of the overlay of that was? Like, I don't know, maybe what percentage of them was both, like late at night and also attached to a screen right before it happened?

Abhishek

Not necessarily that way because I think it is a combination of both.

Travis

When you say they were on a screen, do we know what they were doing on a screen and how that might have impacted it?

Abhishek

Yeah, so we used screen as both for cell phones or social media or tablets or TV or anything. We included all of them in general and it's hard to identify individually or percentage wise what they were doing. But just kind of thinking about it or remembering it, a lot of them are either on social media or chatting with their friends or someone says something to hurt them or it could be bullying like a breakup. So different scenarios and situations, but it's hard to quantify that because you're trying to put the percentages and numbers. So it's hard to put like narratives in there and when you collect data.

Travis

Yeah, so just attached to a screen in some capacity. Yes. Well, what is it about using social media or screens or engaging in content as he gets later in the evening? Does that make us more vulnerable to these types of things and impacts they might have?

 

Abhishek

That's a really good question, Travis. So we do know for sure that poor sleep can impact mental health in adults and kids. The less you sleep, the more depressed, anxious you get. And then when you are more on the screens at night, you don't have distractions. During the daytime, you have a lot of distractions, but at nighttime, you have less distractions.

So when those messages are something that comes across on your screen, which triggers you, it makes you kind of more vulnerable. And then you're also ruminating about things at that time. So it kind of pushes you off the edge. And that's what our study was going to is, if you have poor sleep hygiene, access to screens, and also access to means, different pills, at that time when you're vulnerable, it just pushes you off the edge.

Travis

Yeah, I asked that question because I find myself, even though I try my best not to look at any social media or my phone at all in the middle of the night, it's just, it's a losing battle, if I'm being honest with you. But if I see something and it act of like, if it gets in my brain, I find it really hard to get it out of my mind at night, a lot harder than during the middle of the day. So it sounds like that I'm not abnormal in that situation.

Abhishek

Yes, and in addition to not having distractions, I think the other thing also is in your sleepy state, you're not using your 100 % of your brain. So you're not able to cognitively process things really well. So in the morning, if somebody says something to you, you're like, yeah, well, I don't know if they're getting the complete perspective of it. But at night, if somebody says, then you're like, oh, I really can't process it well.

Just like drowsy driving can cause more accidents because you're cognitively not doing well, very similarly, when you're drowsy, you're not able to process information well.

Travis

Yeah, that makes a lot of sense to me. I'm glad that I'm glad that I'm not, it's not just me in that situation, to be honest with you. Well, what did you learn from your study related to the means of the overdoses?

Abhishek

Yeah, and again, that's a very good question because we were thinking one way, like it could be more or the counter medications for most kids, but our studies shows that like it's almost 50 50 split where overdoses are sometimes mixed with over the counter pills and prescription pills.

50 % of the time it could be from over-the-counter pills and 50 % time it could be because of your or family members prescription pills. So it's kind of all mixed up and it was not like one is more than the other clearly.

Travis

Was that surprising to you?

Abhishek

 

Yes, because I was thinking like it could be more over the counter pills, but it was a mix of both.

Travis

Well, I'm kind of curious what we can do with this information. Specifically when we're talking about younger people, what are some things that maybe parents, guardians, folks that are the adults in the house can do to help mitigate any potential problems?

Abhishek

Yeah, and I think that was one of the biggest goals of our study. When me and Dr. Faribi looked into it, Dr. Faribi is one of the physicians who's training with us. So we both looked at this. And the main thing that we want to talk about or discuss is how to prevent these and raise awareness in the community, right? So the first thing that I would talk about is having a good sleep hygiene.

Having a good daytime routine, good nighttime routine so that kids can, or adolescents and teenagers can go to bed on time. An hour before going to bed, and that's the standard recommendation with different organizations. And at least an hour before going to bed, keep yourself away from the screen. That will help you relax, have a good nighttime routine. And the third is limiting access to over-the-counter pills or prescription medications of the kids or the family members, those three things are pretty important takeaway messages from our study that will help suicide attempts in teenagers down the lane.

Travis

Well, I know you mentioned as we were getting started that you studied a lot about sleep, sleep medicine, sleep hygiene, and that's one of your areas of expertise. How'd you get interested in that?

Abhishek

That's a good question because when I was doing my training in psychiatry and child psychiatry, I noticed a lot of overlap between sleep problems and mental health problems. And it is very commonly known in research and other areas that mental health and sleep are bi-directional. It's like a chicken and egg and they go along hand in hand. And I was like, if I need to treat people optimally, I need to get this sleep training too. And that's why I went ahead and did an extra year of sleep medicine training.

Travis

So from doing your training, how has that impacted you as a sleeper? Because I can't imagine if I studied it that much, I wouldn't be taking home some of that information and trying to apply it.

Abhishek

I think like some of the strategies you learn during the training, you use it on yourself and then you, that's what I try to do, educate families and kids. And I do take the screens pretty seriously. We don't have TVs in the bedroom in our house and try to keep away screens as much as we can and have like a nighttime routine where for like everybody has a relaxation technique or strategy and. We try to use those and I try to advocate that for the kids on the inpatient unit and for my outpatient. And I also have a psychiatry sleep consultation clinic and we try to talk about that in that clinic. using your training to raise awareness in the community.

Travis

Well, I guess as a final question, what would you most like for people to know about sleep, sleep hygiene, and this interesting intersection between that and adolescent mental health and mental health risks?

Abhishek

I think the screens have kind of invaded into our sleep time and this is not only me, it's like research and all the organizations are talking about that. So maybe being cognizant of that and getting back to our study, one of the things that I have seen being helpful for the children and adolescents in having a good sleep hygiene is having a good role model in their family members. So if the whole, like for teenagers especially, right? The whole family having a good sleep hygiene routine really helps the kids. It's very hard for teenagers to understand when their parents are on their TV or phone at night and they're like, go to your bed and sleep, they get confused. But if everyone has a routine, okay, we are all going to have this and this, and then we are all going to go to our rooms and...turn the lights off, relaxation strategies for everyone. I think they learn and understand better from that kind of watch and learn rather than kind of getting lectured. I felt that that was very helpful when I talked to the parents and kids inpatient and outpatient and I learned when the families are successful, it is because everybody has a similar routine.

Travis

Wow, so us parents, we have to not just preach it, but also practice it, is what I'm hearing.

Abhishek

Yes, and obviously understanding that sometimes families have to keep their phone together to take care of either other people or work related and stuff, but explaining it to their kids and role modeling whenever you can, like, hey, we're all going to keep the screens away or we'll have certain time for certain things and then we'll have good bedtime so that everyone can have enough rest and having uniform rules for all the kids in the house. Those kind of things really help.

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Travis

And thanks to Abishek for helping us better understand this important intersection between adolescent suicide, screen time, time of day, and access to medication. If you or someone you know would make for a great curious conversation, email me at traviskw at vt.edu. I'm Travis Williams and this has been Virginia Tech's Curious Conversations.