PITTSBURGH (AP) — The world changed for Rita McWilliams on Nov. 20, 2012, when her daughter, Karla, committed suicide.
She locked herself in a bathroom in their Trafford home and turned on a portable grill purchased for family picnics.
She died of asphyxiation.
She left a note reassuring her mother she "had done everything possible to help," said McWilliams, 67. "She also warned me in the letter about the toxic fumes and said the family dogs were safe."
Legislation signed in June by Gov. Tom Corbett might save other young people, said Barb Scheinberg of Monroeville, whose daughter, Melanie, 20, committed suicide while at college.
All Pennsylvania schools must immediately adopt age-appropriate youth suicide awareness and prevention policies for students in sixth through 12th grades.
"You warn your kids before they go away to school over the perils associated with drug taking and alcohol. But who educates their children about depression and (tells them) there is help available before doing something drastic?" Scheinberg said.
Karla McWilliams, 29, an aspiring model and the only child of Rita and Sam McWilliams, had been treated for depression for 16 years.
"You go through a period of second-guessing yourself ... thinking and rethinking what you possibly could have done differently," her mother said. "Eventually, if you're fortunate, you come to realize through counseling that suicide is a malfunction of the brain.
"Everything is changed after suicide. ... There will be no grandchildren, no more holidays with the entire family or shopping together. You never really get over it. But gradually, with support, time and God's help, you come to the realization you actually have to start your life over again," McWilliams said.
In 2013, deaths by suicide across the country surpassed the number from vehicle crashes, the Centers for Disease Control and Prevention reported. In 2010, 33,687 deaths resulted from traffic accidents and 38,364 from suicides.
"It has become an epidemic here," said Laurie Barnett-Levine, executive director of Mental Health America of Westmoreland County.
Suicides in the county reached an "all-time high" of 55 in 2013, Coroner Ken Bacha said.
Fayette County recorded an 80 percent increase in suicides, from 15 in 2012 to 27 in 2013. In Allegheny County, suicides rose 24 percent in four years, up to 160 in 2013.
At the same time, other counties reported slight decreases.
"Sometimes you can place a reason on it, such as the person may have a mental health history, or it may be economic reasons, a failed relationship, drug abuse. It's one of the most difficult things we investigate," Bacha said. "We've had some cases where people go shopping, come back with $150 of groceries. ... They set the bags on a counter, go to the garage and shoot themselves."
People contemplating suicide might be dealing with problems related to employment, financial hardship or relationships, said David Brent, a psychiatrist at Western Psychiatric Institute and Clinic in Pittsburgh who co-founded Services for Teens at Risk, a state-funded suicide prevention program.
Various studies, including a CDC analysis of suicides from 1999 to 2010, document increasing rates among middle-age men, who tend to shun medical care, Brent said.
"Clearly, when economics in the region flattened out for a long time, it made people more vulnerable," he said.
Coroner Phillip E. Reilly feared that would be the case in Fayette County.
"We sort of anticipated an increase with the economic pressure in the region ... the lack of jobs and the frustration and financial pressures associated with that," he said.
For nearly 30 years, families have turned to Survivors of Suicide, a support group in Western Psych run by clinical nurse specialist Sue Wesner.
"People believe you can change an outcome. Based on that misconception, guilt becomes a primary emotion ... and can be very destructive," she said.
Participants spend four weeks "addressing the woulda, shoulda, couldas," Wesner said. They then tackle issues such as celebrating holidays and adjusting to an altered life.
'I'm still in shock'
Scheinberg remembers the knock on her door on March 16, 2005.
Melanie, a junior at Kent State, had called her mother that morning about a problem that seemed insurmountable. Still, the honors graduate of Gateway High School was doing well in school, on track to earning a teaching degree the next spring.
"Melanie was upset, and I eventually told her I had to leave for work and that I would call her ... after I got home from work" at Gateway High, Scheinberg said.
Later, a Monroeville police officer came to the door.
"Honestly, I knew why he was there. I had briefly fallen asleep after I got home and had this terrible dream that Melanie had killed herself. ... I was awakened by that knock at the door," Scheinberg said. "Melanie had hanged herself in her dorm room with the string from her laundry bag. She left no note. ... I'm still in shock."
Then there's the lingering, misplaced guilt, said Mike Vernon, 48, a Ligonier Realtor. He struggled for 14 years when his mother, Nancy, hanged herself in her Munhall home in 1995.
"I was in a dark place for a very long time, trying to understand it. I only came to grips with it about four years ago," Vernon said. "At least with cancer or a car accident, you know what happened."
Vernon found solace through L.O.S.S., Loved Ones Stolen by Suicide, a Greensburg support group. "I served in the Navy, and I have to admit, it's tough for guys. Men aren't supposed to cry. But it helped, hearing it from others who have gone through it too," he said.
Vernon now is a grief facilitator for families affected by suicide.
Information from: Pittsburgh Tribune-Review, http://pghtrib.com