The voices at the other end of the line often crack in pain, spilling out a bottled-up stream of anger, loneliness and despair.
They are the voices of those teetering on the brink of suicide. And they are heard nearly once a week at Anne Arundel's crisis hot line.
Some of the callers pick up the phone in panic after swallowing a bottle of sleeping pills or trying to slit their wrists. Others call to talk about the despair driving them to the edge of death, said Karen Goldman Lyon, executive director of the Anne Arundel Hot Line and Sexual Assault Crisis Center.
More than a few wind up in the emergency room at one of the county's hospitals.
North Arundel Hospital treats more than 300 youths and adults who attempt suicide each year, said Marshall Belaga, director of psychiatry.
Anne Arundel Medical Center easily matches that rate. Emergency room nurses and doctors sometimes see two or three people a day who have threatened or tried to kill themselves, said Dolores DeOrsey, a clinical specialist in psychiatric nursing with AAMC.
"We treat it very seriously," she said. "I do think it's an increasing problem. We've had more incidents with alcohol abuse this summer than in years, and a lot of (patients) are suffering from the helplessness and hopelessness that goes along with suicide."
Children as young as 12 have been rushed to county hospitals after swallowing pills or reaching for a gun. They are among the growing number of depressed youths who see suicide as the only escape from their pain.
Suicide now is the third-leading cause of death among the nation's youth, following accidents and homicides. The suicide rate among 15- to 24-year-olds nearly tripled in the past three decades, rising from 4.5 per 100,000 in 1950 to 12 per 100,000 in the 1980s.
Maryland's youth suicide rate still is rising, reaching 14.9 deaths per 100,000 in 1988, when 104 youths killed themselves. Anne Arundel County mirrors the national picture with hundreds of attempts each year and nine reported suicides among 10- to 24-year-olds in 1986, according to the latest available figures from the state Mental Hygiene Administration.
The grim statistics touched a nerve with more than 50 people who gathered at a seminar on suicide Monday night at North Arundel Hospital.
One mother mentioned that her son nearly died in a suicide attempt.
Another woman wanted information on counseling and support for relatives.
"The biggest mistake would be not to listen," said Thomas J. Oglesby, director of psychiatry at Mercy Medical Center in Baltimore. "Keep the communication lines open. You may not say the right thing or the wrong thing; you just need to say something."
He opened the talk with a history of medical research on suicide dating back to 1892, when Emil Durkheim studied the varying suicide rates in different provinces in France. Oglesby then offered tips on psychological risk factors and discussed preventive steps.
Adolescents are at a greater risk if they are severely depressed, have a family history of suicide, suffer from a psychological disorder or are abusing alcohol and drugs, he said.
Warning signals indicating a youth could be considering suicide include: * Depression, complaints of feeling hopeless, lonely and despair.
* Sudden behavior changes -- withdrawal, loss of sleep, loss of appetite, mood swings, little interest in school, work or friends.
* Rebellion, family conflict and problems in school or with police.
* Drug and alcohol use.
* Talk of suicide, death and dying, or preparing for death by making a will and giving away personal possessions.
Although women attempt suicide more often, men usually choose more definitive methods, such as shooting themselves, and therefore have a higher death rate, Oglesby said. The suicide rate has increased most rapidly among white males between the ages of 15 and 24.
But both Oglesby and Belaga said they believe the soaring youth suicide rate can be stemmed by talking more to troubled teens.
"It's important that you listen to the communication and try to respond," Oglesby said.
Help is only a phone call away for those who have reached the bleak moment when death becomes seductive. Trained counselors staff the phones 24 hours a day at both Anne Arundel's crisis hot line at 222-7273 and Maryland's new statewide hot line at (800) 422-0009.