A Computer Test to Catch Boys Headed for the Edge

WITHOUT TeenScreen, there is no telling whether Simon would have been rescued from his depression.

Through TeenScreen, a computerized mental-health test, Simon found out he suffered from the illness and soon stopped cutting himself, and falling further into a mental abyss.

"I knew that somebody understood or was out there," he said, explaining his feelings after taking the test, which was developed by Columbia University. "It was a matter of someone extending help to me instead of my finding it."

Simon was a sophomore at an elite New York City public high school when he took the test many years ago; today, he is a 20-year-old college student studying information systems.

Leslie McGuire, the director of TeenScreen and a social worker, said Simon was just the person, those suicidal or depressed, that TeenScreen is intended to seek out. In 13 years, Ms. McGuire said, the program has screened 43,000 teenagers nationwide, making it possibly the largest screening effort of that age group in the country.

Started by Dr. David Shaffer, the chief of the Child and Adolescent Psychiatry division at Columbia, TeenScreen aims to offer mental-health checkups to all teenagers before they leave high school.

The screening, medical specialists said, is particularly important given the statistics. Suicides among young men from 15 to 19 years old, which TeenScreen primarily focuses on, ranks second among young adults through their early 20's.

Male teenagers in the 15- to 19-year-old group are five times more likely than girls to kill themselves. Girls, who make more suicide attempts, usually rely on pills or cutting their wrists, leaving more time for rescue or a decision to seek help. Boys tend to hang or shoot themselves.

Fortunately, the number of suicides among teenagers has been dropping, while research into the causes has increased, with medical specialists pointing to disorders like depression, a family history of suicide, psychiatric illnesses and stress as some of the causes.

Drug and alcohol use also contributes significantly to suicide attempts, especially with boys, who tend to abuse such substances more than girls.

"Alcohol in certain individuals leads to suicides," Dr. Shaffer said, adding that 40 percent of suicides among boys 17 to 19 years old are related to drinking. Getting drunk several times a month, being arrested while drinking and driving, going to school while drinking or losing relationships because of it are the most telling signs of alcohol misuse. One reason for the link to drinking may be that alcohol reduces serotonin levels, which tend to be lower in males.

Dr. Shaffer said a teenage boy was a high suicide risk if he drinks heavily, is prone to outbursts or impulsive behavior, or is "getting into trouble because of his drinking and usually feeling bad about it."

Laurie Flynn, the director of the Carmel Hill Center for Early Diagnosis and Treatment, which is the umbrella group for TeenScreen at Columbia, noted that impulsiveness in adolescent boys can be more common than with girls. "When they have something happen ? flunking a chemistry test ? they can lose it." Girls, on the other hand, might cry in reaction, she said.

In addition, a subgroup of boys who are vulnerable to suicide are those who experience performance anxiety; they exaggerate the significance of pending tests, for example, and predict the worst (even if they have done well in the past). Difficult to identify, these boys are popular at school because they work hard and do not get into trouble.

The screening test works like this: after parents sign a consent, the students take a 10-minute computerized test during school. The test is usually administered by a mental-health professional and questions assess for eight psychiatric disorders, including anxiety, depression, social phobia, suicide and alcohol and marijuana abuse. The questions are direct. This, for one, addresses social phobia: "In the last three months, have you often felt very nervous when you've had to do things in front of people?"

One incentive for taking the test, some students admit, is a chance to miss class. The test is followed up with a meeting with a parent.

Ms. McGuire said that students generally wanted to take the test.

"No one else is asking them these questions," she said.

For boys, who are known for their unwillingness or inability to open up, a computerized questionnaire can provide a safe, confidential avenue for expression.

Simon was fortunate. After taking TeenScreen, he was able to persuade his parents, immigrants from Hong Kong, to come in and talk with school administrators.

"My parents' impressions of mental health is of people locked up in padded rooms," he said.

Ultimately, Simon saw a counselor during school whenever, he said, he needed to "babble." He feels more self-confident now and comfortable with himself. "It empowered me to have a voice," he said, "to not be afraid to discuss my thoughts and feelings."