Weary World View Leads Teens to Risky Behavior

Some who use alcohol, drugs, weapons expect to die young, study finds

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HealthDay Reporter

TUESDAY, July 5, 2005 (HealthDay News) -- Many teens who engage in risky behavior -- such as drug, alcohol and weapons use -- are up to five times likelier to believe they're going to die within two years, a new study suggests.

The survey of nearly 2,700 urban African-Americans aged 12 to 21 runs counter to the notion that teens engage in high-risk pursuits because they think they're immortal.

"Some of them know what a mess they're getting into and think, 'Since I'll be dead anyhow, I might as well go ahead,' " said study co-author Dr. Tomas Silber, director of the adolescent medicine fellowship program at Children's National Medical Center in Washington, D.C.

Silber and his colleagues had noted that many of the teens they treat at the clinic seemed to have fatalistic attitudes, a belief that living in dangerous surroundings would lead to a shortened life.

"When life around them is hard, they see the glass as half empty and truly believe that their lives will be short," he said.

The findings appear in the July issue of the journal Pediatrics.

Silber and his colleague Dr. Adela Valadez-Meltzer conducted a three-year study of 2,694 adolescents who came to the clinic for various health reasons. They were then asked to fill out a standard questionnaire, called the Youth Risk Behavior Surveillance System (YRBSS) survey, which was designed by the U.S. Centers for Disease Control and Prevention. The researchers added a question asking how likely a teen thought he or she would be dead in two years.

One hundred sixty respondents -- 7.1 percent of the boys and 5.4 percent of the girls -- said they thought they would die within two years.

The researchers found that those teens who abused drugs and alcohol were twice as likely to believe they would die early, compared to those who did not use drugs or alcohol. Those who used and sold drugs were three times more likely to believe they would die within two years than those who did not. And teens who carried guns and had been injured by a weapon were more than five times likelier to think they'd be dead in two years, compared to those who did not use weapons.

"This is a small number of adolescents, but they are the ones involved in a large number of social problems, and the implications are huge for them and the people around them," Silber said.

Nadine Kaslow is a professor of psychiatry and behavioral sciences and chief psychologist at Emory University School of Medicine in Atlanta. She called the new research "a very thoughtful study. We rarely routinely ask adolescents their own thoughts about dying and mortality," she said.

"Kids do engage in risky behavior because they think they're invulnerable. But the other side of it is that kids do it because they think they're totally vulnerable, so 'why not?'" Kaslow said, adding that such teens often are frightened and risky behavior offers them a sense of empowerment.

Silber said the study shows that health-care providers must address this fatalistic world view when they sense their young patients are troubled.

First, he said, doctors must determine if a patient's worry about death is based on an imminent and specific threat. In that case, the doctor should recommend immediate action, like urging the teen to move out of his or her living situation -- immediately, if necessary.

But beyond that, the doctor must try to tease out the teen's feelings, Silber said.

"You can say, 'I have a sense that you're worried. Let me ask you a strange question -- do you think you have a long life in front of you, or a short one?' " he said.

"If they say, 'I think my life is going to be short,' then it's time to ask a few more questions," Silber said, and schedule a follow-up appointment much sooner than might otherwise be warranted.

More information

For more on teens and depression, visit the Nemours Foundation.

SOURCES: Tomas J. Silber, M.D., director, adolescent medicine fellowship program, Children's National Medical Center, Washington, D.C.; Nadine Kaslow, Ph.D., professor of psychiatry and behavioral sciences, and chief psychologist, Emory University School of Medicine, Atlanta; July 2005, Pediatrics

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