How To Help A Teenager With Suicidal Thoughts

Suicide is a growing concern among adolescents and young adults. It is currently the second leading cause of death of individuals between the ages of 15-24 years-old in the United States. Additionally, the rate of hospitalizations for suicidal ideation or attempts has nearly doubled between the years of 2008-2015, and this increase has been highest for individuals who are between the ages of 12-17 years-old.

Why do some individuals think about suicide?

According to the interpersonal theory of suicide described by Dr. Thomas Joiner (2005) thoughts about suicide, or suicidal ideation, are related to two areas of social functioning.

• The first area includes the feeling of not belonging or being accepted by others. This perception may be related to a real sense of exclusion by others or through a perceived sense of not belonging. This can be seen through higher rates of suicidal ideation and behaviors among those who have a history of peer victimization, or bullying. Higher rates of suicidal ideation are also found for individuals from historically marginalized groups, such as those in the LGBT community, and this has been related to challenges with feeling accepted by those around them. As noted above, this perception may also be present without any clear indicators of exclusion or lack of acceptance from others. This sense of exclusion may therefore be related to the negative cognitions that accompany depression and other psychological concerns.
• The second area of interpersonal functioning includes the feeling as though one’s life is a burden to others. This perception is defined by the belief by the individual that his or her death is of more worth more than his or her life. Again, this perception may be associated with depressive cognitions and interpretations of situations in one’s environment and may or may not be an actual message that is being sent to the individual by others.

What are risk factors for suicide?

Suicidal ideation is most commonly associated with a diagnosis of a psychiatric disorder, especially depression. However, thoughts about death and suicide are also seen in individuals who are not depressed. Additional risk factors for suicidal ideation and suicide attempts in teenagers include:

• A family history of suicide attempts
• A recent interpersonal loss, either through death or separation of a loved one
• Impulsivity
• Social exclusion or bullying
• A history of non-suicidal self-injury or self-harming behaviors
• A prior history of suicide attempts
• Access to weapons or other lethal means (e.g. pills or knives)

What are protective factors?

As described above, individuals who experience thoughts about suicide often feel disconnected and not accepted by others. Protective factors therefore include strong social and support networks. This includes feeling accepted by parents, teachers, peers and individuals in one’s environment. Protective factors also include strong communication and interpersonal problem-solving skills and an ability to seek help. The ability to identify reasons to live is also seen as a protective factor.

What are some warning signs that my child may be having thoughts about suicide?

• Emotional changes. Parents should look for changes in mood, which could manifest through a decreased interest in usual activities, increased agitation, and increased social withdrawal.
• Behavioral changes. In addition to increased isolation from others, parents should also be attentive to changes in sleep patterns, increased patterns of missing school or other related activities, increased physical complaints, or increased reckless behavior. Parents should also look out for statements related to suicidal ideation, notes about these thoughts, and patterns of giving his or her belongings away.

What can I do if I have concerns that my child may be having thoughts about suicide?

Many parents of adolescents who are experiencing thoughts about death or suicide are not aware that their child is experiencing these thoughts. People often feel uncomfortable talking about suicidal thoughts and behaviors due to concerns that these conversations will put ideas into their child’s mind. In contrast, you should feel comfortable addressing this topic directly with your child if you do have concerns, as you can then provide a source of support around these issues. Additionally, some statements made by youth surrounding death and suicide are not taken seriously by parents and other adults, due to the perceived function of these statements. Even if these statements are made in a moment of frustration from a teen, you should always follow up on these statements. Some questions that you can ask your children include:

• Have you been feeling sad or depressed?
• Have you been having any thoughts about hurting yourself, about death, or about killing yourself?
• Have you ever thought about killing yourself?
• Have you ever done anything to hurt yourself on purpose?

What should I do if my child is having suicidal thoughts or if I’m worried that he or she is not disclosing these thoughts?

You should always err on the side of caution and bring your child in for a psychological evaluation by a trained professional if you have any concerns.

• If you have immediate concerns about your child’s safety:
  1. You should bring your child to the emergency room or call 911 if you are worried that your child is at risk of hurting himself or herself.
  2. You should remove all dangerous objects from the immediate environment. These include medications, razors, knives, and weapons. This will prevent your child from hurting himself or herself in a moment of distress or impulsivity.
  3. You should closely monitor your child until he or she can be evaluated by a professional.
• If you are worried about your child’s emotional health but are not concerned about your child hurting themselves in the immediate sense:
  1. You should schedule an appointment with a trained professional, such as a psychologist or psychiatrist, to have him or her evaluated as soon as possible.
  2. You should continue to have open conversations with your child about his or her social and emotional functioning, including thoughts about suicide, and continue to take any statements made by your child seriously.

Numerous resources exist for individuals who may be having thoughts about suicide. Some places where you can find more support include the following websites and hotlines:

• American Academy of Child & Adolescent Psychiatry Suicide Resource Center: https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Suicide_Resource_Center/Home.aspx
• American Psychiatric Association (APA): https://www.apa.org/topics/suicide/signs
• Teen Lifeline, 602-248-8336 (TEEN) or 1-800-248-8336 (TEEN)
• National Suicide Prevention Lifeline, 1-800-273-8255

Additional References:

Plemmons, Gregory, Hall, Matthew, Doupnik, Stephanie, Gay, James, Brown, Charlotte, Browning, Whitney, . . . Williams, Derek. (2018). Hospitalization for Suicide Ideation or Attempt: 2008-2015. Pediatrics, 141(6).

Joiner T. Why people die by suicide. Cambridge, MA, US: Harvard University Press; 2005.