As COVID rose, so did teen suicide attempts. Girls are most at risk.

Editor’s note: This story includes discussion of suicide. If you or someone you know is considering suicide, resources are available to help. Please see the box below.

Catherine Zorn had suffered from suicidal thoughts and panic attacks since middle school. But nothing else mattered when she entered the dance studio. In between jumps, kicks and pliés, the 17-year-old ballerina felt at peace.

Then the pandemic ripped away her lifeline. In March 2020, her dance school shut down. By the summer, Catherine felt anxiety and depression take over. She burned her wrist with a hair iron and stabbed makeup brushes into her thighs. She considered ending her life. Maybe she would overdose on Tylenol or drive into a tree.

“I didn’t see a way out of the feelings and thoughts I was having,” she said.

In October, Catherine asked for help. Her doctor sent her to the emergency room, and the staff there had her committed.

Catherine’s personal crisis is illustrative of a larger one across the country. The national average of weekly visits to emergency rooms for suspected suicide attempts among ages 12 to 17 jumped nearly 40 percent in February and March compared to two years before, according to the Centers for Disease Control and Prevention.

The CDC says emergency room visits for suspected suicide attempts by boys rose 3.7 percent — but jumped nearly 51 percent for girls. In Tampa Bay, BayCare Health Systems said four out of five of its emergency psychiatric patients this past winter were teen girls.

BayCare said pediatric patients making psychiatric emergency room visits to its 15 Florida hospitals jumped 31 percent in the first five months of this year compared to the same period last year. Pediatric admissions increased by 26 percent.

”The increase has been noticeable and very sharp,” said Gail Ryder, vice president of BayCare Behavioral Health Services.

• • •

The pandemic stripped teens of important mental health anchors: sports practices, peer hangouts and interactions with trusted teachers, coaches and counselors.

That’s according to Dr. Kristopher Kaliebe, child and adolescent psychiatrist at the University of South Florida. Adjusting to virtual learning also was a challenge.

Many families likely dealt with other COVID-19 stressors, such as job loss, illness or even death.

That meant teenagers spent even more time on social media, Kaliebe said.

The negative effects of social media, he said, are particularly acute among girls, who tend to spend more time comparing themselves with friends and strangers online.

Catherine said she spent nearly 10 hours a day on TikTok, Instagram and Snapchat during that pandemic summer. She said constantly seeing others highlight their lives made her feel worse.

“You’ll see people happy and I’m like, why can’t I be happy like them?” Catherine said.

She also started having unhealthy body image issues, she said, in part from not being able to work out at the dance studio. “I would constantly beat myself up about it.”

Managing emotions can be particularly difficult during puberty, when hormonal changes intensify self-loathing and other social anxieties, said Dr. Leigh Ruth, another child and adolescent psychiatrist at USF.

The limbic system, or “emotion center,” of teens’ brains activates during puberty, Ruth said. But the prefrontal lobe, responsible for mood regulation and impulse control, does not fully develop until someone is in their early 20s.

“If you have more emotions but your brakes aren’t on from the prefrontal lobe, then you get more impulsive behaviors,” Ruth said, “which you could see with suicide attempts.”

• • •

In October, after Catherine sought help, she ended up at St. Joseph’s Hospital in Tampa, where the staff invoked the Baker Act. That state law is used to involuntarily commit people deemed to be a danger to themselves or others for mental health evaluation.

An ambulance took her to Morton Plant North Bay Hospital Recovery Center in Pasco County.

Catherine was admitted and diagnosed with depression and anxiety. She was prescribed the antidepressant Celexa and Atarax, an antihistamine used as a short-term treatment for anxiety. Catherine said the medication made her constantly drowsy.

Her four days in the hospital were scary and traumatic, she said.

She was placed in a strange facility. She knew no one. She lost access to her belongings and her phone. Hospital staff told her not to share any personal information with other patients except her first name. She was only allowed to talk to her mom for 10 minutes every night, under staff supervision. She had no idea when she would be freed.

“The nurses were so strict. They were like, ‘This is what you’re doing. Don’t move, don’t do anything,’” she said. “I was terrified I would make them upset because I didn’t know what would happen.”

Catherine said she had nightmares for a month after she was discharged.

The 17-year-old and her parents disagreed with the decision to commit her under the Baker Act.

Health experts have long questioned the extensive use of the Baker Act in Florida, particularly with children, and suggested that other options are more effective.

Ryder, who oversees BayCare’s mental health and addiction programs, said being hospitalized can traumatize teens.

“So are we going to see years and years of post-traumatic stress from this event?” she said. “We think we will, but we’re hoping the research tells us that and how to prepare for treatment for these kids.”

• • •

The immediate solution for many kids struggling during the pandemic is a “return to normal and stability,” Ryder said.

Kids need to go back to school, hang out with friends and see mentors outside of the home. Seeing their parents relieved of pandemic stressors such as unemployment and illness will help, too.

Kaliebe, the USF psychiatrist, recommends that parents restrict the amount of time teens spend on their phones and encourage healthy sleep and eating habits, which have a direct impact on mental health.

Catherine’s mom, Michelle Zorn, said that her daughter would often go days last summer without eating anything but junk food. She also stayed up all night and slept well into the next afternoon.

Zorn, 46, wishes she had known that these habits could have both contributed to, and signaled, larger mental health issues.

“Parents need to be aware of what the signs and symptoms of a worsening problem are so we can help our kids,” she said.

Teens also need more robust services to identify their mental health problems before they reach a breaking point, Ryder said.

“If we were dealing with their issues in the community and wrapping services around them,” she said, “they wouldn’t need to come into the hospital.”

Studies show the sooner children are treated, the better. Early treatment is important because half of all lifetime mental illnesses develop by the age of 14, according to the National Alliance on Mental Health.

But in Florida, Ryder’s solution is aspirational. The Sunshine State spends the least money per capita on mental health than any other state. Mental Health America ranked Florida 38th in its annual state ranking of its spending on youths. The ranking is based on the prevalence of mental illness and access to care for those ages 12 to 17.

A key issue is sustainable funding, said BayCare community engagement coordinator Sam Picard. While Medicaid provides most of the country’s funding for behavioral health services, he said many providers refuse to accept Medicaid patients due to the program’s low reimbursement rates.

Picard said the state also can improve access to care by pushing insurance companies to cover mental healthcare at the same rate as other services and making the reimbursement process easier for providers.

“There’s not enough providers in behavioral health to begin with,” he said.

Zorn said her daughter needed to talk to a mental health professional last year instead of being “locked down for four days.” But Zorn ran into a supply-and-demand problem when Catherine told her she wanted to see a therapist several months before the October emergency room visit.

The mother said she called four providers near the family in Wesley Chapel. Two weren’t taking new clients. One had stopped taking the family’s insurance. The last one didn’t answer her calls.

“Mental health care is very difficult to crack into in Florida,” Zorn said. “You almost need to have a crisis to get help.”

• • •

Zorn knew that Catherine was prone to worrying and sadness. But it didn’t hit home how much her daughter was suffering until they landed in the emergency room.

“I felt like a failure as a parent,” Zorn said.

Since then, she has beaten herself up about what she could have done differently.

Looking back, she said she would have made sure Catherine had a therapist many years ago. And spent more time talking to her kids.

“I would strengthen my relationship with all my children, so they could know mom is a safe place,” Zorn said. “They can come to me with crazy thoughts or bizarre ideas … that I’m not going to judge them based on what they’re dealing with.”

Zorn believes growing up in a military family also affected her daughter. Catherine is one of five children, and the family moved around while the Army sent their father to serve three deployments in Iraq. He retired in 2015 and now works as a warehouse manager in Ybor City.

Catherine has lived in five different homes in three countries and three states.

“Military families go through an awful lot of trauma that we don’t even recognize as trauma until we’re removed from it,” Zorn said.

• • •

Catherine says she’s doing much better now. She takes medication for anxiety and depression and meets with a therapist every two weeks. She said connecting with a mental health professional has allowed her to process negative thoughts in a healthier way.

She also is back in the dance studio doing what she loves. Last month, she performed in two recitals — The Nutcracker’s Waltz of the Flowers and a Western-themed jazz number choreographed to Hank Williams Jr. ‘s Born to Boogie.

She graduated in June after being home schooled and plans to spend the next year auditioning as a dancer for entertainment venues such as Busch Gardens and Walt Disney World.

And Catherine and her mom are talking more.

“There is no surface-level ‘how are you doing’ anymore,” Zorn said. “I make sure she knows on the hard days that it’s okay to have hard days. It’s just not okay to give up.”

Catherine said she’s learned how to persevere through her darkest moments.

She said she just wishes she had learned then what she knows now.

Need help?

If you or someone you know is contemplating suicide, reach out to the 24–hour National Suicide Prevention Lifeline at 1-800-273-8255; contact the Crisis Text Line by texting TALK to 741741; or chat with someone online at suicidepreventionlifeline.org. The Crisis Center of Tampa Bay can be reached by dialing 211 or by visiting crisiscenter.com.

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