Bullying has always been a problem for kids — and something adults have had to deal with as well. But the increasing role of online bullying in teen suicides has alarmed health officials to the point that they’ve now issued new guidelines for pediatricians to help identify the kids most at risk.

Participation in online forums is associated with increases in suicidal ideation.

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The American Academy of Pediatrics on Monday announced three areas for which pediatricians need to better screen their young patients: being a victim or perpetrator of bullying; pathologic internet use and related online issues; and lack of treatment with antidepressant medication when indicated.

The new guidelines better outline emerging online influences, including a warning of the risk that pro-suicide websites and online suicide pacts can pose to vulnerable teens. The last time the guidelines were updated was in 2007, STAT reported.

Benjamin Shain, M.D., Ph.D., the lead author of the clinical report, is the former liaison from the American Academy of Child and Adolescent Psychiatry to the AAP Committee on Adolescence. Shain wrote that there are at least four internet-related factors that may increase suicide risk in susceptible youths:

1.) Pathological internet use. Self-reported daily use of video games and internet exceeding five hours is strongly associated with higher levels of depression and suicidality (ideation and attempts) in adolescents.

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2.) Searches for suicide-related topics. Suicide-related searches are associated with completed suicides among young adults. Pro-suicide websites and online suicide pacts facilitate suicidal behavior, with adolescents and young adults at particular risk.

3.) Learning of another’s suicide online. Such information is available through online news sites (44 percent), social networking sites (25 percent), online discussion forums (15 percent), and video websites (15 percent). Social networking sites, in particular, may reveal information on others’ suicidality that would not otherwise be available.

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Fortunately, exposure to information from social networking sites does not appear related to changes in suicidal ideation — likely because increased exposure is mitigated by greater social support. Participation in online forums, however, is associated with increases in suicidal ideation. Discussions in these forums may be anonymous and not particularly supportive, at times even encouraging suicide attempts by susceptible individuals.

4.) Cyberbullying. Similar increases in suicide attempts are found when comparing face-to-face bullying with cyberbullying, both for victims and bullies.

[lz_bulleted_list title=”Suicidal Thoughts?” source=”http://www.suicidepreventionlifeline.org”]National Suicide Prevention Lifeline|Help available 24/7|1-800-273-8255[/lz_bulleted_list]

The awareness of these situations reaches far beyond today’s pediatricians — the new guidelines might also serve as an important reminder for parents regarding signs they should watch for if they believe their child is in trouble. Shain noted in his report that females are at a higher risk of suicidal thoughts and attempts — regardless of frequency of bullying — whereas males are at higher risk only with frequent bullying.

What can be done to help teens who might be at risk of depression or suicide as a result of bullying?

In October 2004, the Food and Drug Administration, amid heavy media coverage, directed pharmaceutical companies to label all antidepressant medications distributed in the United States with a black-box warning of an increased risk of suicidal thoughts and behavior in children and adolescents treated with these agents. Their use was not prohibited, but the FDA called on clinicians to balance increased risk of suicidality with clinical need and to monitor kids closely “for clinical worsening, suicidality, or unusual changes in behavior.”

The need for close monitoring during the first few months of treatment and after dose changes was particularly stressed.

The new recommendations state, “Results of subsequent studies suggest that, for appropriate youths, the risk of not prescribing antidepressant medication is significantly higher than the risk of prescribing: The 2 percent increased risk of suicidality cited by the FDA may be an overestimate; there is a negative correlation between antidepressant prescribing and completed adolescent suicide; very few adolescent suicide victims were found to have recent exposure to antidepressant medications; and the increase in adolescent suicides following the warning appears to correlate to a documented reduction of antidepressant prescribing.”

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Shain reminded pediatricians that when prescribing antidepressant medications, the warning should be discussed with parents or guardians. Furthermore, depression is a significant suicide risk factor and careful monitoring of emotional and behavioral status is important, particularly when initiating or changing treatment.

The report Suicide and Suicide Attempts in Adolescents, from the AAP Committee on Adolescence, will be published in the July issue of Pediatrics.