How “13 Reasons Why” Can Be a Lesson for All Ages

Lonely-Man-FBThe controversial Netflix series about a teenage girl’s suicide, “13 Reasons Why,” has kids and parents everywhere talking. In our previous blog, Five Opportunities and Insights from “13 Reasons Why,” a Medical City Green Oaks adolescent psychiatrist discussed the show’s potential impact on teenagers. But there are other populations that are at even higher risk for suicide: older adults.

Medical experts at the Geriatric Behavioral Unit at Medical City North Hills are hoping the Selena Gomez-produced series, which has just been renewed for season two, will also bring attention to the disturbing rates of senior suicide.

The American Foundation for Suicide Prevention reports that from 1999 to 2011, suicide rates among adults 45 to 64 years of age jumped 40 percent. Statistics show that this trend is continuing.

Suicide rates by age (per 100,000 individuals) from 2000 through 2015

  • 19.6 (45-64)
  • 19.4 (85 and older)
  • 17.1 (35-44)
  • 16.1 (65-84)
  • 15.5 (20-34)
  • 3 (Under 20)

“The sense of loss of control over one’s life, from financial circumstances or the pain and physical disability associated with chronic health problems, can contribute to depression, a key factor for suicidal thoughts in older adults,” said Paul Schneider, DO, medical director of the Geriatric Behavioral Unit at Medical City North Hills.

Texas ranks near the bottom — No. 41 — in number of deaths by suicide but even so, on average, one person dies by suicide every three hours in the state.

Other factors that influence senior suicide rates include:

  • Gender and age: Middle-aged white males have the highest suicide rate and accounted for 7 of 10 suicides in 2015 (men of all ages die by suicide 3.5 times more often than women)
  • A previous diagnosis of mental illness: This accounts for more than 90% of suicide deaths, regardless of age
  • Social isolation: Including from death of a spouse or divorce
  • Substance abuse
  • Poor sleep quality and having trouble falling asleep: These factors increased seniors’ risk of suicide by 1.2 times, according to a JAMA Psychiatry study

It’s vitally important for family members to take note of changes in sleeping or eating habits in elderly loved ones. Verbal remarks about ending a life should also be taken as a sign for intervention or assistance.

“Those comments should be taken seriously and professional mental health help should be sought immediately,” Dr. Schneider said.

The good news is, depression is not a normal part of aging, but a true and treatable medical condition. According to the CDC, the majority of older adults aren’t depressed and most who are can get relief from their symptoms with treatment.

Warning signs of suicide in the elderly.

If you see any of these warning signs in a spouse or loved one, seek immediate medical help.

  • Loss of interest in hobbies or activities previously enjoyed
  • Decreased social interaction, self-care and grooming
  • Breaking medical regimens, including going off diets, refusing medications
  • Significant personal loss, such as the death or impending death of a loved one
  • Feelings of hopelessness or worthlessness
  • Putting affairs in order, giving away possessions, making changes to a will
  • Stockpiling medications or obtaining other lethal means (remove access to firearms; about half of all suicides are attributed to the use of firearms, according to the CDC)
  • Preoccupation with death or loss of regard for personal safety
  • Comments indicating finality, including “This is the last time you’ll see me,” or “I won’t be needing any more appointments”
  • Talking about or attempting suicide

The National Suicide Prevention Lifeline (800-273-8255) provides free and confidential resources and support for people of all ages in distress or crisis.

For fast, emergency help in a crisis, look to one of our many Medical City ER locations across North Texas. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you.

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Five Opportunities and Insights from “13 Reasons Why”

Sad-Girl-FB“13 Reasons Why” is a Netflix series produced by Selena Gomez, a celebrity artist who has struggled with depression and anxiety for several years. Based on Jay Asher’s 2007 novel “Thirteen Reasons Why,” it tells the story of 17-year-old Hannah, who takes her own life and leaves behind a suicide note in the form of 13 cassette tapes. All 13 episodes became available March 31 and the controversial show is so popular that a second season has already been renewed by Netflix.

The show deals with some heavy topics in addition to suicide, including bullying, rape and other mature subjects. It has prompted schools to send warning letters home to parents with recommendations from the National Association of School Psychologists.

Suicide by the numbers.


  • Is the second leading cause of death for ages 10 to 34
  • Is attempted every day by an average of more than 5,240 children in grades 7 through 12
  • Is the cause of death for more teens and young adults than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease, combined
  • Was the reason for an average of 420,000 emergency room visits every year during the 16 years of an NCBI study (1993-2008)
    • ER attempts more than doubled from 244,000 in 1993-1996 to 538,000 in 2005-2008

Studies show that 90 percent of those who died by suicide had an underlying mental illness, so we asked Dr. Elizabeth Ucheoma-Cofield, a psychiatrist and the medical director for the adolescent unit at Medical City Green Oaks Hospital, for her thoughts on the show. As both a parent and an adolescent psychiatrist, she feels there are five pivotal points highlighted by “13 Reasons Why.”

Five opportunities and insights provided by the Netflix show “13 Reasons Why.”

Platform for Discussion: Mental illness is still taboo, especially in children and adolescents. “13 Reasons Why” provides the opportunity for parents, teachers, mental health providers and other adults to begin discussions involving depression, suicide and a variety of other topics that are pertinent to teens, including sexual assault and cyberbullying.

Asking for Help/Paying Attention: “13 Reasons Why” highlights the fact that teens in distress need to reach out for help sooner. There were many people in Hannah’s life who could have been very helpful resources for her in her time of distress, but she didn’t utilize them when needed. Conversely, the show is also a cautionary tale for parents regarding the slippery slope of depression and may serve as a catalyst for parents to start researching and paying attention to the warning signs of depression and suicidal thoughts in their children and providing them with professional help sooner.

Perception of Invincibility: Children and adolescents can be impulsive. Many completed suicide attempts in children and adolescents are actually the result of impulsive behavior. Children and teens sometimes do not have the perspective to be able to realize that present crises are temporary. Sometimes children and teens don’t really digest the fact that suicide is permanent and that they will no longer see their friends and family and will no longer have a future.

The main character in the series, Hannah, makes multiple cameo appearances (usually as flashbacks from one of the other characters who are the subjects of her tapes) almost as if she is not really dead. She also controls the actions of the people that she left behind through instructions that she has left on the tapes. This is a very dangerous representation of suicide that alludes to the fact that people who have completed suicide aren’t really gone but exist in some other form that enables them to interact in some way with the people they left behind. This perception of invincibility and lack of finality is actually a soft suggestion to children that suicide is merely an alternate life path and this is not the case.

Attention Seeking Through Suicide: “13 Reasons Why” highlights the fact that Hannah achieved the attention and validation that she didn’t get in life through her death. Many children and teens with depression already feel isolated and invisible. Arguably, the show could give impressionable kids the idea that suicide might be an option to get the same results that Hannah did.

Need to Process: Although “13 Reasons Why” does have a discussion panel at the end of the series to talk about the heavy subject matter presented, it would be much more beneficial for children and teens to have a panel discussion built in after every episode to process the topics discussed more pointedly and frequently.

Clearly, there are a variety of reasons that “13 Reasons Why” can be both adverse and beneficial. At the end of the day, it does help kids understand how important it is to be kind and respectful to others. It also might help them feel empowered to reach out to educators, counselors and other adults when they think that someone (child or adult) is struggling.

If you’d like to talk to your kids about the subjects highlighted in “13 Reasons Why” but aren’t sure where to begin, here are some resources:

The JED Foundation, a nonprofit that aims to prevent suicide in teens and young adults, has developed a series of talking points for children and adults.

The Society for the Prevention of Teen Suicide offers helpful information on how to know if suicide is a risk for your family.

The National Suicide Prevention Lifeline (800-273-8255) provides free and confidential resources and support for people of all ages in distress or crisis.

For fast, emergency help in a crisis, look to one of our many Medical City ER locations across North Texas. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you.

About Elizabeth Ucheoma-Cofield, MD dr-ucheoma-cofield-bio

Elizabeth Ucheoma-Cofield, MD (lovingly known as “Liz” by friends and family), is an avid reader and writer who enjoys spending time with her family, catching up on her fair share of reality TV and engaging in clothes and shoe shopping at frequent intervals. She loves to travel and visiting multiple countries on every continent is on her bucket list. Exercise is her passion and she is very much interested in holistic health (mind, body, and soul) for all of her patients. She truly believes that working with children is her calling and life’s work.

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When You Can’t Sleep, Blame the Elections and the Time Change

insomnia-fbGot rhythm? Even if you can’t sing a note, dance a step or play an instrument, you do have rhythm — circadian rhythm. But the presidential election, the “fall back” time change and even your bathroom night light could cause it to go completely out of whack. Circadian rhythms are the physical, mental and behavioral changes we experience daily, and they’ve been linked to sleep disorders such as insomnia, as well as obesity, diabetes, depression, bipolar disorder and seasonal affective disorder (SAD).

The National Institutes of Health estimates that 50-70 million American adults have sleep or wakefulness disorders and a third get fewer than seven hours of sleep a night and are sleepy every day. This deprivation causes a host of health, safety and economic concerns, including:

  • Increased stress on the heart, insulin resistance and diabetes risk
  • Reduced response to the flu vaccine
  • Increased risk of fatal car accidents, with 5,000-6,000 fatalities that could be attributed to drowsy drivers every year
  • Loss of business productivity estimated at $50 billion annually

Young adults aren’t faring much better: 70% of high school students don’t get enough sleep on school nights.

To sleep, perchance to dream.
Our sleep patterns are influenced by our internal circadian rhythms, but they can be affected by signals from the environment; in particular, light and darkness. When the signals change or are misinterpreted, circadian rhythms become disrupted, turning some of us into hot, sleepy messes.

Time can change me, but I can’t change time. Oh wait … yes I can.
Twice each year, we manipulate time when we “spring ahead” and “fall back.” While no one seems to know why we still do it today, one thing’s for sure: Turning the clock forward and backward — even just an hour — does a serious number on our circadian rhythms. The time changes are linked to:

  • A 25% increase in heart attacks the Monday after springing ahead
  • A significant increase in fatal traffic accidents the Sunday of the fall shift and the Monday following the spring shift
  • An average 8% rise in stroke risk over the two days following both shifts, with a 25% increase for cancer patients and a 20% increase for people 65 and up

It’s easy to understand the effects of the spring time change. Take an hour of sleep away from an already sleep-deprived nation and you’ve got stressed out, grumpy, groggy drivers wondering if they changed every clock in the house (don’t forget the car) before stumbling out the door in the dark.

But why the problems with the fall shift? Researchers say that the health consequences from changes in our circadian rhythms caused by the time changes are not just in response to physiological adjustments (losing an hour of sleep), but from our behavioral responses to those forced changes as well. The spike in traffic accidents in the fall are attributed to an increase in the number of late Saturday night/early Sunday morning drivers, suggesting people aren’t using their extra hour to sleep but to party.

You think I don’t know the presidential election is making me lose sleep?
It’s not what you think. Aside from the obvious stressors of being bombarded 24/7 by digital coverage of modern presidential elections, it’s really the blue light emitted by TVs, computers, tablets, smartphones and even lamps and night lights that’s to blame. Blue light is found in natural sunlight and helps us stay alert during the day, but literally bathing our eyeballs in it at night confuses our brains and prevents or slows melatonin production, the hormone that signals bedtime.

However, orange light (also called amber) is the only color that contains no blue light. Experts recommend that you:

  • Unplug from all blue-screen electronics 90 minutes before bedtime – or –
    • Invest in an orange monitor cover for your computer
    • Download a screen adapter program such as f.lux
    • Turn on Night Shift mode in your Apple device with iOS 9.3
    • Wear glasses with amber lenses; often sold as safety goggles, they have the added benefit of blocking blue light from all sources
  • Use orange lightbulbs in your evening light sources and in night lights, so those late-night trips to the bathroom won’t keep you from getting back to sleep

Wake me up before you go. On second thought, don’t.
Sleep is not a luxury; it’s fuel for our bodies and as necessary as food and water. For peak health, follow these guidelines for nightly hours of sleep:

  • 12-14 years old / 9-11 hours
  • 15-17 years old / 8-10 hours
  • 18-64 years old / 7-9 hours
  • 65 years old and up / 7-8 hours

If you’re expecting, check out our tips for sleeping better during pregnancy.

We hope you and your family have restful nights and sweet dreams, but if things don’t go as planned, one of our many
Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Visit to find a fast Medical City Healthcare ER near you.

When Cyberbullies Attack: Know How to Fight Back


If you caught the all-female remake of “Ghostbusters” this past summer, you may have recognized its breakout star, Leslie Jones, from her work on “Saturday Night Live.” What you may not know is that the comedienne has been a victim of vicious cyberbully attacks since the movie’s debut, to the point that she closed her Twitter account. And she’s not alone; Chrissy Teigen, Amy Schumer, Kesha, J.K. Rowling and Blake Shelton have all been targeted by cyberbullies and online haters.

It’s bad enough when cyberbullying happens to celebrities and adults, but what about our vulnerable teens and tweens? Data collected by TeenSafe shows that of today’s youth:

  • 87% have witnessed cyberbullying
  • 34% acknowledge being the victim of cyberbullying
  • 24% don’t know what to do if they are cyberbullied
  • 39% don’t enable their privacy settings on social media
  • 33% feel more accepted online than in real life

As medical director of a very busy adolescent psychiatric emergency room and inpatient unit at Medical City Green Oaks Hospital , I am witness to the fact that teens feel more isolated than ever. By the time these children knock on my door, they are already thinking about harming themselves or others, and parents are both oblivious and blindsided. In the moment of crisis, almost universally, these parents talk about missing the signs that their children were faltering, including:

  • Increased isolation
  • Worsening mood swings
  • Physical complaints
  • Self-harming behaviors (such as cutting or burning themselves)
  • Declining grades
  • Obsessive investment in checking social media and texts
  • Over-indulgence in depressive recreational activities (such as reading dark books, watching gory movies and playing sad music)

As parents, our children come first — at least we tell ourselves that they do. But it’s often difficult to ensure that our kids are our first priority amidst the myriad of other things that fill up our lives. These days, it’s likely that both parents work in some capacity, and as a result, parents have less emotional reserve and physical energy to keep up with their kids. As families, we spend less time around the dinner table engaged in dialogue about the important or trivial aspects of our day. Instead, we are overly absorbed in texts, television and tweets.

Herein lies the key to intervention: The more engaged and invested parents are in the lives of their children, the more willing children will be to talk about difficult topics (like cyberbullying) and the more confident they will be in reaching out for help.

Meet your children where they are.
Investment and engagement ultimately means meeting your children where they are developmentally, emotionally, socially and spiritually.

  • Connect on their level. If you have a child who loves to play Xbox Live, connect through gaming using this platform. In doing so, you will gain intimate knowledge of the cyber personalities with whom he is interacting.
  • Insist on being “friends.” Friending your children on social media, having their usernames and passwords in case of emergencies and frequently monitoring their cyber activities are crucial in keeping them safe from cyber predators.
  • Teach them about bad people. Helping children understand and identify cyber predators while equipping them with the tools and knowledge of what to do if they are targeted is also crucial. Have discussions with your children about what bullying (in general) and cyberbullying (in particular) look like.
  • Listen objectively. Have an open door policy that allows children to talk to you honestly about difficult subjects. Help them identify adults in their lives that are there for their protection. Monitor their texts and emails frequently and use parental electronic controls as much as necessary to ensure their safety.

You’ve got the power to fight cyberbullying.
If your child becomes the victim of cyberbullying, do you know what to do? Believe it or not, you both have more power than you know to control what flows in and out of your cyberspace.

  • DO NOT RESPOND TO or forward threatening messages — you want to preserve the evidence in as pristine a manner as possible.
  • Save, screenshot, print and file all of the threatening and derogatory messages to present to law enforcement, school staff and web administrators. In most cases, parents can press charges or file for protective orders to limit the contact children have with bullies. In several states, schools are required to address cyberbullying in their anti-bullying policy, including when it occurs off campus. If school administrators take action, parents should insist that their child’s school routine be preserved and instead, the bully’s is altered. This will prevent your child from having to endure further victimization by being forced to change his or her school routine.
  • Record dates, times and descriptions of what occurred and when. This hard copy information will be crucial in allowing you to take definitive action.
  • Highlight those aspects of the printed information that may be threatening in nature, including sexually explicit materials or photos (which might be evidence of sexual abuse), contain evidence of stalking or extortion or specifically target children who are considered particularly vulnerable (such as children with disabilities and LGBT kids).
  • BLOCK THE BULLY from your child’s social media or restrict the phone number being used by the bully to text your child.
  • Have your child take a break from social media and internet activity to decrease the likelihood that the bully will re-victimize her under a different screen alias. Here’s how 17-year-old Nicole Edgington did it — and turned her cyberbullying nightmare into an opportunity to help others.
  • Use the time off from social media to further connect with your child or encourage her to try a new activity. Kids who engage in sports or other extracurricular activities have more chances to form social networks with their peers and gain confidence from activities in which they both enjoy and excel.

Getting children out of the house and off the screen is actually good for their brains.  The American Academy of Pediatrics recommends limiting screen time for children and teens to two hours per day, and this should really be more high quality, educational content. Excessive media use by children and adolescents has been linked to obesity, attention problems and decreased academic performance.

If you have a child who is struggling with depression, anxiety or other emotional problems, do not hesitate to ask for help. Enlist your child’s school counselor or find a community-based therapist or psychiatrist near you. Make sure your child’s teachers and school staff are informed about what is occurring, as they can be an infinite resource in keeping your child safe at school. If your child is suicidal, call 911 or the National Suicide Prevention Lifeline to ask for help. Together, we can all do our part to keep our children safe.

For fast, expert emergency help in a crisis, Medical City Healthcare has a number of emergency locations across the Metroplex. Visit to find a Medical City Healthcare ER near you.

dr-ucheoma-cofield-bioAbout Elizabeth Ucheoma-Cofield, MD

Elizabeth Ucheoma-Cofield, MD (lovingly known as “Liz” by friends and family), is an avid reader and writer who enjoys spending time with her family, catching up on her fair share of reality TV and engaging in clothes and shoe shopping at frequent intervals. She loves to travel and going to multiple countries on every continent is on her bucket list. Exercise is her passion and she is very much interested in holistic health (mind, body, and soul) for all of her patients. She truly believes that working with children is her calling and life’s work.

Can’t Find the Reason for the Season? You Might Be SAD or Anxious.

Your friends are busy hall decking, tree trimming, gift giving and merrymaking, but you can’t seem to find the holiday spirit. Is it just the winter blahs or something more serious? The truth is, you may be one of millions of Americans suffering from the sometimes debilitating effects of seasonal affective disorder (SAD) or social anxiety disorder.

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