Carol Ortez hugs her son, Aaron Ortez, during a memorial service on the anniversary of the mass shooting at Marjory Stoneman Douglas High School. (Joe Raedle/Getty Images)

Americans are increasingly likely to die by their own hand. In 1999, about 29,000 people in the United States killed themselves, and by 2017, the toll had grown to more than 47,000, a significant rise even when adjusted for the growing population. In recent days, three of those deaths have shocked the nation.

Two teenage survivors of the Parkland, Fla., school shooting of 2018 apparently died by suicide , as did the father of one of the children slain at Sandy Hook Elementary School in Newtown, Conn., in 2012. Both communities are in mourning.

Mental-health experts advise caution in moments like these. There is a persistent concern about contagion effects, the risk that people who hear about suicides will be more likely to end their own lives. And experts say it can be difficult to draw specific conclusions from individual deaths in which the contributing factors are not fully understood. Every suicide is a unique tragedy.

But these deaths provide an opportunity to confront a national public health crisis as suicides become more common. Researchers who study suicide say the field is grossly underfunded. They say they have minimal understanding of who, exactly, is most at risk of suicide.

The basic question raised in recent days — what is the link between surviving extreme trauma and the subsequent risk for self-harm — is not readily answered.

“We know that adverse childhood experiences are linked to many ‘bad’ outcomes — suicides, drug fatalities are examples — but we don’t know how much higher that risk is, as no one has studied folks over the course of time comparing diverse outcomes against diverse experiences,” said Eric Caine, a researcher at the University of Rochester Medical Center. “And, indeed, the vast, vast majority of abused, traumatized folks don’t kill themselves.”


In this file photo from Feb. 21, 2018, memorials are seen on a fence surrounding Marjory Stoneman Douglas High School in Parkland, Fla. (Rhona Wise/AFP/Getty Images)

At a more personal level, the news bulletins provide a reminder to everyone that people who are traumatized need continued care — that the trauma doesn’t necessarily recede in a week, or a month, or even a year. People who are suffering should be reminded that they can reach out, that help is available (including at the suicide hotline 800-273-TALK). And support networks — friends, family members, professionals — need to stay vigilant.

“In the second year, friends and family are no longer checking on you as much. The first year, you may have distracted yourself or taken on other things to move forward, but you get fatigued over time. That comes at a price and you can’t always sustain it as well,” said David Schonfeld, director of the National Center for School Crisis and Bereavement at the University of Southern California, who is an expert on mass shootings and has been working as consultant to the Broward County, Fla., school district in the year since the Parkland shooting.

But Schonfeld said that, even though survivors are never quite the same, they often emerge with new coping strategies, a stronger sense of purpose in life, and what he calls a post-traumatic growth effect. The public should not expect survivors to be depressed or suicidal, he said.

“We should be communicating the expectation of recovery,” he said.

The Parkland student body became nationally famous as many Marjory Stoneman Douglas High School students campaigned to end gun violence. That was an experience unique among mass shooting survivors, and the students operated amid great expectations and with many people watching them, noted Jane Pearson, a suicide researcher at the National Institute of Mental Health.

“It’s different than normal grieving, or even grieving that comes after a natural and man-made disaster. This is grieving in the wake of a man-made murder disaster,” she said.

For high-profile events like the massacre in Parkland, survivors often feel a “honeymoon phase” while media attention is intense and resources plentiful, but that can be followed by a longer term “disillusionment phase,” said Stephen Brock, a professor of psychology at California State University at Sacramento and the past president of the National Association for School Psychologists.

Constant connectivity online can also make it impossible for young people who survive school shootings to escape reminders of the trauma they’ve endured, he said. The news is right there on their cellphone, he said.

“Now it’s in your pocket,” Brock said, “and the exposure can be really intense.”

The Parkland students “were already a vulnerable population because they’re going through massive psychological transitions as they move from adolescence to young adulthood,” said Jeffrey A. Lieberman, chair of the Department of Psychiatry at Columbia University. “The fact that they were at ground zero for an event that was so unexpected, so horrific, so unexpectedly ironic — in the sense that it was one of their own peers that perpetrated it — created the potential for massive psychological, emotional shock waves.”

Suicide is the 10th most common cause of death in the United States but the second most common among teenagers and young adults. The death rate from suicide is rising broadly, among almost all demographic groups. Experts cannot easily explain it. There is no single factor driving the phenomenon.

“We grossly underfund suicide research,” said April Foreman, a psychologist and executive board member of the American Association of Suicidology who specializes in treating patients at high risk of suicide. “What we don’t understand very well as scientists is who’s going to be suicidal. . . . We don’t have the blood pressure cuff of mental health. I wish that we did. We don’t have the thermometer of suicide risk.”

One theory for the rise in suicides in the United States is that it has lost some of its cultural stigma.

The rise of social media and always-online lifestyles could also be a factor, said Jean Twenge, a professor of psychology at San Diego State University who has written a book about “iGen,” the generation that has come of age during the iPhone era.

She said research shows that suicidal thoughts among people aged 18 or 19 increased 46 percent from 2008 to 2017, and suicide attempts among people 22 to 23 years old doubled.

“There’s been a fundamental shift in how young people use their time outside of work and school, it’s shifted away from face-to-face interaction and toward more time on the screen,” she said. She said face-to-face interaction provides social support and emotional connections that are not matched by online connections.

A significant factor in the high suicide rate in the United States is the ready availability of guns. “Most of the folks who die by suicide in America die by firearms,” said Michael Anestis, an associate professor of psychology at the University of Southern Mississippi.

Anestis said people need to be sure to lock up firearms if there is someone in a home who might be vulnerable to self-harm. Gun-control advocates are pushing for “red flag” laws and other procedures for keeping firearms from people who may be a danger to themselves or others.

Pearson said the most important message for everyone is that help is out there: “If someone is feeling suicidal, we want them to hold on and stay alive and safe long enough to where we can help them to get better.”

To reach the National Suicide Prevention Lifeline, call 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741. Correction: This article originally stated that guns were reportedly involved in two recent suicides in Parkland, Fla., and one in Newtown, Conn. On March 28, a spokesman for the Newtown Police Department told The Post that the suicide of Jeremy Richman, whose daughter was slain in the 2012 Sandy Hook Elementary School shooting, did not involve a firearm.