When silence can be fatal

"Just raising general awareness can be dangerous because it tends to normalize the idea of suicide," says Ms. Davidson. "Awareness tends to disproportionately impact the population most at risk. It makes troubled youth aware of [suicide] as an option."

The volatile disposition of suicidal teens calls for education on the subject to be far more nuanced than efforts to raise awareness of health issues, such as smoking or pregnancy, according to Davidson. She believes educators have inherited a delicate task. They must reinforce the cultural taboo on suicide; that is, to say it's never OK. At the same time, though, they must remove the imbedded cultural stigma associated with getting help for mental illness.

In regions plagued by high rates of youth suicide, however, leaders on the prevention front are doing all they can to spark fresh public discussion. Virginia and Maine, for instance - two rural states where scant counseling resources have been connected to higher-than-average youth suicide rates - are concentrating new prevention efforts on training a cross-section of people to recognize warning signs and to persuade youth to seek help.

With help from a three-year, $900,000 grant from the Centers for Disease Control, Maine is developing one of the nation's most comprehensive approaches. School staff are trained to spot suicidal behavior, students in a series of health classes learn how to cope with depression, and counselors take calls to a 24-hour crisis hotline.

Adults in Maine are also encouraged to broach the subject with students who show warning signs.

But adults everywhere are apt to bristle at being nudged to raise a topic they fear might be harmful, say experts. Those delivering prevention programs to rural Virginia, where youth suicide rates are nearly three times the national average, say the group most opposed to discussing suicide are parents.

"A lot of parents, when you bring [a child's risk factors] to their attention, say, 'Oh, that's nothing. They've always been like that,' " says Calvin Nunnally, suicide prevention training coordinator at the Virginia Department of Health. "Most think kids are going through a phase when these things could be warning signs of suicide. Parents are pretty much in denial."

"Most parents tell me, 'Don't talk about it,' " says Kathleen Wakefield, a Virginia Beach mother who lost a 21-year-old son to suicide in 2001 and now talks to schools and parents about prevention. "It's that same backward idea that if you try to educate kids about drugs or sex then they'll start using drugs and having sex."

To date, most prevention efforts developed since the crisis peaked in the mid-1990s are too new or too unstudied for any consensus to have developed as to what works. Nevertheless, early studies have their tentative supporters.

Flynn at TeenScreen, for instance, finds encouragement in a 2003 Columbia University study suggesting that access to antidepressant medication might account for declining suicide rates since the mid-1990s.

Conversely, she says, surveys suggest hotlines don't work because suicidal teens seldom obtain help or treatment on their own.

Studies are currently being done of the programs in place in Maine and Virginia to determine if either is demonstrably effective or worthy of replication in other states.

But prevention leaders say the potential for more suicides looms too large to sit back and wait for conclusive results.

"People still have a hesitancy to call it suicide when that's exactly what it is," said Mr. Nunnally, noting that many local newspapers don't report suicides as such. "It's better to put it on the table and deal with it than to push it under the rug and keep losing lives."

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