Do you ever find yourself jumping to the worst possible conclusions in everyday situations? When you’re facing an upsetting scenario, do you find yourself preparing for negative outcomes as if they’ll inevitably come true? If so, you’re “catastrophizing” — and you’re not alone. Catastrophizing is a distorted way of thinking that causes people to assume the most destructive outcomes, typically without much justification, sending them spiraling into a loop of fearful thoughts. It’s a behavior that can be easy to fall into and hard to overcome.
Clinical Licensed Psychologist, Patrick Moran, PhD explains, “Catastrophizing takes an often-minor true experience and projects the probability of it being a reality in the future without sufficient and reliable evidence, usually in larger proportions than the original experience. It’s often comprised of ‘Fortune Teller Error,’ and ‘Mind Reading’ where people believe in their accuracy in predicting future outcomes and/or what others are thinking. It can make people very anxious when catastrophic thinking habits are not balanced by contradictory facts, or if the facts are dismissed or minimized.”
The mind-body connection of catastrophizing
Beyond the effects on your mental health, this kind of fearful thinking can trigger strong physical reactions in your body. The amygdala, located in the center of the brain, is activated by fear and alerts the nervous system. This causes a release of adrenaline and the stress hormone, cortisol, which can trigger your “fight or flight” instinct. This instinct results in elevated heart rate, blood pressure, and respiration as well as increased blood flow to your limbs to help you “fight” or “run for your life”.
While this “fight or flight” response is meant to prepare us for danger, the increased adrenaline affects our cerebral cortex, the area of the brain that controls judgment and reasoning, cognitive functioning, and ability to think clearly — ultimately coloring our decision making.
How can I stop catastrophizing?
If this is a common experience for you, you may want to try cognitive reframing, a psychological method that involves identifying and changing the way you view experiences, events, or emotions in order to stop yourself from “making a mountain out of a molehill”. The technique allows you to shift your mindset so you're able to look at a situation, person, or relationship from a slightly different perspective and replace your negative thoughts.
For example, if you find yourself catastrophizing frequently at work, consider some of the situations that may trigger those thoughts. Is it conversations with specific people or working on specific projects? If you identify those potential triggers, you can practice reframing your thinking in advance of the situation to help avoid fearful thoughts. Before facing the triggers you’ve identified, envision positive scenarios and ideal outcomes. Expect the best instead of preparing yourself for negative results or failure. Be specific and walk yourself through an ideal experience. Include details like positive conversations and outcomes. Envisioning these scenarios with a positive mindset can help you avoid fearful thinking and the effects that come with it.
What strategies or tips do you find helpful to promote positive thinking?
Mental health concerns are not a new topic by any stretch of the imagination, but what is new is the validation and support that has been desperately needed by so many... for so long. Throughout history, people with mental illness have been ostracized, lobotomized, institutionalized, and demonized, but as our understanding of many of these common conditions has grown, so has our capacity for compassion and treatment.
If recent events have taught us anything, it’s that we are all facing private battles, often waged internally. In the United States, an estimated 15% of kids and 20% of adults are living with a mental health condition at any one time. While many feel comfortable talking about mental health, others are still lacking support to find the resources they need.
Culturally, there is still a wide range of thinking when it comes to conditions such as depression and anxiety. While some communities still prefer to encourage their members to internalize their struggles or share them only with leaders, many others have adopted a broader mindset on mental health resources by setting up support groups and treatment centers and speaking openly on topics that were once considered “sensitive”. This mindset shift has led to a more global normalization of mental health concerns — and not a minute too soon.
Here are a few ways you can reduce stigma and bring more awareness to mental health concerns in your community.
Speak openly about mental health. Stigma is rooted in ignorance, so educating yourself and those around you helps counteract lingering negativity. If you feel comfortable speaking about your own mental health with a trusted person in your life, it may help that person feel safe to do the same.
Utilize local support groups. Open dialogue often leads to discovery, so having available resources at the ready could be a game-changer for the next person you talk to!
Share relevant articles. Social media’s influence stretches way past the bounds of what we’re eating for dinner, so if you find an article with a positive spin on mental health, share, share, share!
Reach out to the experts. If you're looking for someone to talk to about your mental health, we’ve gathered some additional mental health resources to help you find support and information.
How many times have you gotten into your car after a particularly challenging day, turned on the radio, and suddenly felt your mood improving? Believe it or not, there’s actual science behind this phenomenon. Music’s rhythm and repetition engage the neocortex of your brain, and research supports the use of music therapy for various mental health conditions, including depression, trauma, and anxiety. Creating a “rainy-day” playlist can be a lot of fun and might just save the day tomorrow! Here are a few of our favorites...
Five foot-tapping fan favorites
I Can See Clearly Now by Jimmy Cliff — This transcendent, joy-inspiring song perfectly encapsulates the jubilance that comes from a bad day that’s suddenly turned itself around. Look straight ahead; there’s nothing but blue skies!
I Got You (I Feel Good) by James Brown — From the iconic “Whoa!” that sets the tone for James’ buoyant lyrics, this ultimate “feel good” song will have you singing along in no time (and you knew that it would now).
Happy by Pharrell Williams — Seems as if Pharrell knows a thing or two about turning lemons into lemonade when he sings, “Well give me all you’ve got, don't hold back. Well, I should probably warn you — I'll be just fine.” Clap along if you know what happiness is to you!
Young Folks by Peter Bjorn and John — Sometimes we just need to feel accepted, imperfections and all. Young Folks tells the tale of two friends who turn a blind eye to one another’s pasts and choose to live in the moment. If the whistling doesn’t turn your frown upside down, the message certainly will!
What a Feeling by Irene Cara — If you grew up in the 80’s, three things are true: You used waaaaay too much hairspray (yes... you did), you got up early every Saturday to watch cartoons, and you kicked and stomped your way through this song like a champ. Your hairstyle may have (drastically) changed and cartoons are now available on-demand, but this song will ALWAYS inspire you to dance right through your life.
You may be feeling the added pressure at work these days, and most days it probably feels like everyone wants some of your time. Here are a few easy tips for maintaining your positive attitude and protecting your headspace in your professional life. After all, you can’t pour from an empty cup!
Set manageable boundaries. Blocking your calendar for lunch or focus time and not responding to emails after hours are great ways to protect your “downtime”. Last-minute meetings, impossible deadlines, and covering staffing shortages are all common occurrences in today’s world but reducing as many of them as you can and setting clear boundaries for your valuable time can help give you some sense of control over your day.
Take regular “brain breaks”. While our smartphones are often dubbed “tools of mass distraction”, they can be an invaluable means of temporary escape. Taking short, regular breaks can help reset your brain, increasing your overall productivity. Download a few quick games that interest you or keep a light read loaded on an e-reader app and allow yourself a few minutes to decompress when the opportunity strikes.
Tackle one thing at a time. If your to-do list should be relabeled as a “must-do-NOW" list, remember that the best way to eat an elephant is one bite at a time. Prioritizing your tasks, writing them down, and crossing them off in order of importance can give you some sense of control over your day and keep you focused.
Help your neighbor. While this advice may seem counterintuitive to #1, taking some time to voluntarily help a coworker — instead of being “voluntold” to do so — feels good! If you see someone struggling under the weight of their obligations, ask if there’s anything you can do to help them. Even if you simply shine a little light on a task that seems overwhelming to them, the resulting sense of community will brighten the day for both of you!
Keep your visual spaces clear. Much like the chair full of clean laundry mocking us from the corner of our bedroom, we’ve all got “that pile” of paperwork on our desk that’s begging to be dealt with. Just looking at it probably makes you stressed! Schedule 15 to 30 minutes every day to tackle that pesky pile, and (if possible) keep it out of sight.
If you find these tips to be helpful, check out our previous Five tips for improving your mental health post!
[Editor's note: This article was published on April 4, 2022]
Stella, 10, attends a private school in Atlanta, Georgia, and explains to friends that she has four moms. Two of them are the lesbian couple that adopted her. The other two are her birth parents, one of whom recently came out as a transgender woman.
“I’m so grateful that [Stella] is somewhere that sees” the family “as what it is: her moms just love her”, said Kelsey Hanley, Stella’s birth mother, who lives in Kissimmee, Florida.
But Hanley, 30, worries that children who have multiple moms or dads or are LGBTQ+ themselves won’t get the same acceptance in Florida.
That’s because the state recently approved legislation that bans classroom instruction on sexual orientation or gender identity from kindergarten through third grade and prohibits such lessons for older students unless they are “age-appropriate or developmentally appropriate”.
Hanley and some pediatric psychologists say the law stigmatizes being gay or transgender and could harm the mental health of LGBTQ+ youth, who are already more likely to face bullying and attempt suicide than children who are cisgender and straight.
“We all have processes around clarifying who we know in our heads and hearts we are and who we are drawn to or attracted to,” said Laura Anderson, a child and family psychologist in Hawaii whose focus is LGBTQ+ youth and their families. “To make an increasingly large percentage of the population’s experience invisible and taboo is just so harmful and unsafe for all kids.”
The Parental Rights in Education legislation, which opponents labeled the “don’t say gay” bill, is part of a flurry of measures introduced by Republican lawmakers around the country. The Human Rights Campaign, the nation’s largest LGBTQ+ advocacy organization, reports that lawmakers have introduced 300 anti-LGBTQ+ bills this year.
The wave not only includes laws similar to Florida restricting instruction on gender identity and sexual orientation but also ones that criminalize gender-affirming medical care for transgender youth.
Child psychologists say that such laws create an unsafe environment for LGBTQ+ children.
Two-thirds of LGBTQ+ youth said debates concerning the state laws have had a negative impact on their mental health, according to a poll from the Trevor Project, an intervention and suicide prevention organization for LGBTQ+ youth.
And transgender people, in particular, already often face greater psychological distress than the US general population. The National Center for Transgender Equality’s 2015 US Transgender Survey found that 40% of transgender respondents had attempted suicide, which is nine times the rate of the general population.
“We have governors – that have no education or basis or expertise in child mental health – that impose such laws that are going to have horrendous impacts on kids,” said Natasha Poulopoulos, a pediatric psychologist in Miami.
Supporters of the Florida law claim it’s necessary because children are being exposed to “radical concepts regarding sexual orientation and gender identity”.
“What’s even more concerning about this is that parents are not just not being included but are being treated as the enemy here,” said Terry Schilling, president of the American Principles Project, which supported the legislation in Florida and similar bills in other states. “This legislation is not only good, it’s necessary to protect children and their innocence.”
But groups such as the Florida Education Association, the state’s teachers union, say that elementary school teachers do not teach curriculum regarding sexuality and that Republicans are just using it as a cynical political wedge issue.
Rather than protect children, the Florida law stigmatizes gender exploration, which is a normal part of child development, Poulopoulos said.
“It’s healthy and normal for kids to go out of specific gender roles that have been extremely outdated. Even if a child was assigned female at birth and identifies as female, it’s OK for a child to explore things that may be considered more gender-stereotypical for boys,” said Poulopoulos.
The legislation puts negative rhetoric “around aspects of gender identity and sexual orientation that are not heteronormative, so for example, if you are not cisgender and heterosexual, you are to be shamed”, said Poulopoulos.
To prevent that shame, child psychologists say that it’s important for children to see themselves and their families represented in stories.
For elementary school students, this could mean “using very simple language like: families can look diverse. Some families only have one parent. Some families have a grandparent and a mom. Some have two moms. Some have a mom and a dad,” said Poulopoulos. “That simple language is by no means sexualizing children. It is simply explaining the concepts of family structure, of sexual orientation and gender identity in a very developmentally appropriate way.”
A 2019 report from GLSEN, an LGBTQ+ advocacy organization, found that two-thirds of LGBTQ+ youth respondents had not been exposed to representations of LGBTQ+ people, history or events in lessons at school. At schools that did have an LGBTQ+ inclusive curriculum, 59% of respondents said they often or frequently heard the word “gay” used in a negative way, compared with almost 80% of students at schools that did not have inclusive curriculum.
“If you are a family or a child that is figuring this stuff out about your identity and don’t see yourself anywhere, in curriculum, in stories,” that absence means they must “undo the harm of their child having felt othered forever”, said Anderson, the psychologist in Hawaii.
If that’s something that can’t be discussed in school, they are going to feel like they can’t talk about it at home Kelsey Hanley
Two LGBTQ+ advocacy organizations shared the child psychologists’ concern and filed a lawsuit last week challenging the Florida law, describing it as an “unlawful attempt to stigmatize, silence and erase LGBTQ people in Florida’s public schools”.
A spokeswoman for DeSantis said of the lawsuit: “This calculated, politically motivated, virtue-signaling lawsuit is meritless, and we will defend the legality of parents to protect their young children from sexual content in Florida public schools.”
But Hanley, the Florida mom, said the law tries to shield students from something they are going to encounter anyways. Hanley, who works in customer service, said she was attracted to women before she was attracted to men and realized she was bisexual in middle school.
“They are going to go grocery shopping, and they are going to see two women holding hands. They are going to see two men holding hands, and if that’s something that can’t be discussed in school, they are going to feel like they can’t talk about it at home,” said Hanley. "And if their parents think it’s not appropriate to talk about, then their response is going to be: ‘If I have to hide this part of myself, do I have to hide that I’m on substances? Do I have to hide that I have a crush on somebody?’ They are not going to have any kind of openness.”
Hanley also worries about what rhetoric from advocates for the Florida law – about the need to “protect our children” – will mean for children like Stella.
“Stella would think that people want to protect children from her,” said Hanley. “And she would think: what do you need to protect yourself from?”
After decades of battling the stigma associated with mental health and anxiety, we are finally seeing a change in the tide. Every day, more people than ever are seeking help and support for these concerns, and those who once suffered in silence are finding their voice and advocating for themselves and their loved ones. Many others are experiencing “situational anxiety” due to increased stressors at home and work. It can be difficult to eliminate these stressors completely, but there are some ways to reduce their effects, beginning with our daily habits. Here are five tried-and-true daily habits that can help.
Dream on. An agile, resilient mind needs its rest. Creating a bedtime ritual (e.g., turn off devices, have a cup of herbal tea, journal, and read a book) can help you “power down” and relax before your head ever hits the pillow. Not everyone requires the same amount of sleep — you might need slightly more or less than eight hours — but ensuring you’re getting enough sleep helps your brain “reset” and prepare for a new day.
Gonna get physical! Well, now that you’ll be singing that song all day, let it inspire you! An exercise routine you can stick to will not only help maintain your physical health, it will also prompt your body to increase endorphins, your brain's feel-good neurotransmitters.
I feel the Earth move... under my feet. If you work at a desk, get up and move as often as you can. If you’re already on your feet, a quick walk is a great way to take a brain break, even if it’s to the parking lot and back. Sometimes a change of scenery is all you need to gain a fresh perspective!
All I can do is write about it. Journaling is a great way to process the events of your day. Find one with some inspirational quotes and prompts to help you get started and keep it on your nightstand and at the ready! Getting your thoughts and feelings out on paper helps to purge the negative and reinforce the positive.
On the radio... According to the National Alliance on Mental Illness (NAMI), music’s rhythmic and repetitive aspects engage the neocortex of your brain, calming you and reducing impulsivity. Lyrics can also affect your mood, so choosing familiar songs with a positive angle can help propel you to a more positive frame of mind. Create a positive mindset playlist and press “Play” whenever you need to change your perspective. Singing along is optional, but definitely adds to the fun!
We hope this musically inspired list helps you find and maintain your positive headspace. If you find yourself in need of mental health support, please contact a provider in your area. We wish you all the best!
Mar. 31—High school students experienced challenges with mental health during the COVID-19 pandemic including hopelessness, substance abuse, and suicidal thoughts or intentions. But those who felt close to people at school or who reported strong virtual connections with family and peers were less likely to report such concerns.
Those are among the key findings of a special national survey of high school students administered by the Centers for Disease Control and Prevention in 2021. The results, released by the agency Thursday, are one of the largest sets of data about student experiences during the national health crisis.
The survey also captured students' experiences with racism and disruptions to their home and school life, important factors for educators to address as they chart a course for recovery after the pandemic, public health officials said. That's especially true because students who reported racism at school and LGBTQ students were more likely to report poor outcomes during the pandemic than their peers, said Kathleen Ethier, director of the CDC's division of adolescent and school health.
"Although all students were impacted by the pandemic, it did not impact all students equally," she told Education Week in an interview.
A broad picture of high school students' lives during the pandemic
Thirty-seven percent of the survey's 7,700 respondents said they had experienced poor mental health during the pandemic, and 31 percent said they had experienced poor mental health in the 30 days before the questionnaire, which was administered to waves of students between January and June 2021.
Forty-four percent of students said they had experienced "persistent feelings of sadness or hopelessness" within the previous year, 20 percent had considered attempting suicide, and 9 percent of respondents said they had attempted suicide.
Because the questionnaire, called the Adolescent Behaviors and Experiences Survey, was created specifically to be administered online to both in-person and remote students during the pandemic, researchers cautioned that it can't be directly compared to other pre-pandemic surveys of high school students, which were administered by paper and pencil to a broader set of the student population.
But in a supplement, the report's authors cited pre-COVID student mental health concerns tracked by the agency's annual Youth Risk Behavior survey. Between 2009 and 2019, for example, the portion of respondents reporting persistent feelings of sadness or hopelessness increased from 26 percent to 37 percent.
While it's difficult to draw firm conclusions about "causality or directionality of the findings," the authors said, the data is still valuable for school administrators and educators, who are spending an influx of federal COVID-19 aid on academic, social, and emotional recovery efforts.
Confronting racism and building belonging
While schools have reported difficulty with hiring counselors and tutors, the data suggest broader efforts aimed at building a sense of belonging in school may be useful ways to help students flourish.
Twenty-eight percent of survey respondents who reported that they felt close to people at school reported poor mental health, compared to 45 percent who did not report such close relationships. Students who reported feeling connected to others virtually were also less likely to report poor mental health—36 percent of respondents compared to 42 percent of their peers.
"We see how important schools are in mitigating the effects of the pandemic," Ethier said.
In addition to targeted services, like counseling, schoolwide efforts that build community may be helpful in recovery from COVID-19 disruptions, she said. Research has found that mentoring, volunteering, and effective classroom management can help increase school connectedness.
But a sense of discrimination or unfair treatment correlates with a lack of connectedness, the survey suggests, confirming previous findings by researchers who've said giving students a feeling of belonging helps them overcome academic and emotional challenges at school.
Thirty-six percent of survey respondents reported that they had at some point been "treated badly or unfairly in school" because of their race or ethnicity, with their answers ranging on a frequency scale from having "ever" experienced such treatment to having "always" experienced it. Among racial groups, Black and Asian students were most likely to report experiences with racism at school.
And students who reported such discrimination were more likely to report poor mental health during the pandemic than those who hadn't—38 percent compared to 24 percent. Similarly, students who reported any experience with racism at school were less likely to say they felt close to people at school and more likely to report difficulty with concentration.
That's why schools' efforts must center on meeting the needs of all students, including those from all racial backgrounds, genders, and sexual orientations, Ethier said. That could include targeted professional development for teachers and policies that specifically address bullying of LGBTQ students.
Young lives disrupted
The survey also provides a large data set that captures students' life disruptions and adverse experiences in 2021, findings that could help guide immediate and long-term efforts to address the pandemic's fallout, researchers wrote.
Among the findings:
— Twenty-nine percent of respondents reported short-term or long-term parental job loss during the pandemic.
— Twenty-two percent of students reported their own job loss.
— Two percent of respondents reported some form of homelessness, including sleeping in the home of a family or friend, in the 30 days before the survey.
— Over half of respondents, 55 percent, said their parent had sworn at them, insulted them, or put them down during the pandemic. Eleven percent reported that a parent had physically abused them at some point during the pandemic.
— Sixty-seven percent of respondents agreed or strongly agreed that doing schoolwork "was more difficult during the COVID-19 pandemic than before the pandemic started."
Responses showed differences among demographic groups. Asian and Latino students experienced parental job loss at a higher rate. Black students were most likely to report physical abuse by a parent. And students who identified as gay, lesbian, or bisexual were more likely than their heterosexual peers to report emotional abuse by a parent and difficulty with school work.
Those findings may have implications for schools' ongoing equity work and for cooperative efforts with community groups to address family concerns—like hunger and homelessness—that can be barriers to success in school, researchers wrote.
"Many student disruptions and adverse experiences in this report are interconnected with the social determinants of health," the CDC report said. "Previous research shows that disparities based on race and ethnicity and sex existed among persons who experienced economic, food and nutrition, or housing insecurity before the pandemic, and these persons had a greater likelihood of experiencing these insecurities during the pandemic."
Student drug and alcohol use during COVID-19
Thirty-two percent of high school students responding to the survey reported current use of a tobacco product, alcohol, or marijuana or current misuse of prescription opioids.
Among the 43 percent who said they had ever drunk alcohol, 30 percent agreed or strongly agreed they drank more alcohol during the pandemic.
Students who learned remotely at the time of the survey were less likely to report current use of alcohol, marijuana, and opioids than those learning in-person or in hybrid mode. That may be because they had less access to peers who helped them obtain those substances, researchers suggested.
TUESDAY, March 15, 2022 (HealthDay News) -- In the past two decades, a growing number of preteens have taken medicines or other chemicals as a way to end their lives, new research warns.
The mental health of children has become a big talking point in light of the pandemic, but the study data showed the problem has been percolating for years: There has been a 4.5-fold increase in suicidal ingestion cases among children between the ages of 10 and 12 since 2000.
Study co-author Dr. David Sheridan, a pediatric emergency room doctor at Oregon Health and Science University, said mental health concerns are a growing issue in emergency department patients.
"We've just seen rapidly escalating numbers of adolescents coming in with suicidal thoughts. And it seems like we've been seeing younger patients as well," Sheridan said.
To verify this anecdotal information, the researchers turned to data collected in the National Poison Data System for children aged 6 to 18. The cases were coded to show whether it was a suspected suicide attempt or recreational misuse or abuse of a drug or chemical, as well as the final outcome in each case.
During the study period, there were more than 1.2 million cases, about two-thirds in girls. Nearly 29% of the cases resulted in serious outcomes, including just over 1,000 deaths.
While recreational ingestion stayed constant, suicidal ingestions increased dramatically. In adolescents, the increase was 2.4-fold higher, compared to a 4.5-fold increase in those aged 10 to 12.
"It's a good thing that recreational use is not increasing, but it's just a very concerning thing that the suicidal ones are significantly increasing," Sheridan noted.
Despite the dramatic increase, the actual number of teens with suicidal ingestion continues to be much higher than preteens, Sheridan said.
He added that it's important for parents to know that the drugs these children are taking are sometimes those that are the most commonplace in households, including acetaminophen (Tylenol), ibuprofen (Motrin, Advil) and allergy medications like Benadryl.
"Unfortunately, there are kids who are suicidal and they're impulsive, and so they just take whatever is at home," said Sheridan, who suggested locking up even these common medications if you have kids in this age range.
Though the study authors noted that suicidal thinking can be fueled by many factors and is not well understood, they also said that many social media platforms were launched around 2013, which happened to dovetail with the rise in cases. Sheridan, however, urged caution about connecting the two.
"This study was not designed to look at what is causing this rise or what the factors are," Sheridan said. "I think the goal is to highlight this is happening, to fuel more research to hopefully get to the bottom of what you're asking, which I think is a really important thing."
The researchers would also like to see what happened with suicidal ingestion cases during the full course of the pandemic and are waiting for the data to catch up; only one pandemic year was included in the study.
Susan Tellone, clinical director for the Society for the Prevention of Teen Suicide, said it's important to open the conversation about mental health so that people are able to talk about it as openly as they talk about their physical health. A positive side effect of the pandemic is that is happening more.
"I'm very hopeful that we can reduce the stigma and shame attached to mental health and have it start to look like we talk about our physical health, because our brain is an organ, just like our heart, our lungs and every other part of our body," Tellone said.
Parents can do that with their own children by asking, "Are you OK?" Tellone said.
"And if you're not OK, what's going on in your life right now that's making you feel sad," Tellone suggested. "And to ask the question, 'Has it gotten so bad that you're actually thinking about not wanting to live?'"
It's important to be able to have that conversation with your kids, Tellone said, and to help them when they're just starting to feel out of sorts. Three important words to keep the conversation going are, "Tell me more," she said.
"And just listen without advice or judgment, just 'I'm here for you. Tell me more,'" Tellone said.
During the pandemic, children have experienced isolation and uncertainty along with everyone else, and they've had an enormous amount of loss, Tellone noted. Many kids are being raised by parents who are under a lot of pressure and stress.
"For our children, there's many factors that come into the rise in suicidal ideation, but I think the pandemic and the chronic level of uncertainty has taken its toll and it's taken its toll on families," Tellone said.
SOURCES: David Sheridan, MD, MCR, emergency department physician and associate professor, emergency medicine, Oregon Health and Science University, Portland, Ore.; Susan Tellone, RN, MSN, clinical director, Society for the Prevention of Teen Suicide, Freehold, N.J.; JAMA Pediatrics, March 14, 2022, online