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Don’t Ignore the Subtle Signs of Suicidal Thoughts and Behavior

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Take Passive and Active Suicidal Ideation Seriously

When you have a teenager, one thing you have to learn to handle is the drama.

If you can remember back to your teen years, you may remember that everything in your life seemed like a big deal.

The new romantic interest. The breakup in your friend group. The classmate who got busted drinking and driving. The big test coming up on Friday. Plans for the homecoming dance and prom. Making the cheerleading squad. Getting a varsity letter in football.

Remember the way you talked about things?

This is the worst day ever!

Studying trig is literal torture.

This is the best day ever!

If I have to hear this teacher lecture one more time I think I might kill myself.

It all sounded funny to you back then, when you were the teen, and didn’t have to try to figure out the subtext behind your hyperbole.

Now that you’re the parent of a teen, and the shoe is on the other foot, you realize that teen exaggeration can, indeed, be cute and endearing, but it can also be the opposite.

It can be scary.

Like when your teenager says something in a text or on the phone to one of their friends like this:

OMG…FML…I want to die.

So, what do you do about that?

Do you take it seriously? Does your teen really hate their life?  Do they really want to die?

Or is it all just teen drama, exaggeration, and hyperbole?

Does your teen say those things because they mean them or because they’re kidding and it sounds funny to their friends?

Maybe you’re one hundred percent sure they say those things to shock you, scare you, or get your attention.

You’re positive it’s all just typical teen drama.


You Have to Take It Seriously

It may well be all those things. It might all be drama and exaggeration. Your teen might not have any desire to end their life at all.

But the chance it’s not drama and exaggeration is far too great to risk minimizing or dismissing any talk of suicide.

If your teen talks about suicide and you think they’re in immediate danger, we recommend you call 911 immediately or take them to an emergency room at a regular hospital or a psychiatric hospital.

Don’t wait. If they’re serious – and the drama is serious and not typical teen drama – the possible consequences far outweigh the consequences of the chance they’re not serious.

With that said, there’s another thing we need to discuss. It’s a topic we introduce in the title of this article: the subtle signs of suicidal thoughts and behavior that are easy to miss. Some teens – including teens with mental health disorders such as depression or anxiety – might be quiet about their troubles. They may not voice their thoughts to anyone out loud. And when they do, they may do it under their breath, in a way that seems offhand.

They may roll their eyes about something in their lives they don’t like and mutter I wish I were dead or I just wanna die and then go to their room.

As a parent, what do you do with that?

What we can tell you is that in order to gauge the seriousness of statements like that, you have to look at the big picture. You need to consider everything going on in your teen’s life at the time and decide how the various factors and circumstances at play inform or shed light on any statements they might make about suicide.

And you need to consider one more thing:

Sometimes it’s when a teen goes quiet that the risk is greatest.

What Issues Increase Risk of Teen Suicide?

We’ll start with what we just mentioned.

If a teen makes repeated threats to you or others about suicide or talks openly and often about suicide – meaning they engage in suicidal ideation in front of you frequently – and then they suddenly go quiet about it, withdraw, and change their behavior dramatically, that’s what mental health professionals call a warning sign and what most non-experts would call a red flag.

It falls under the category of warning signs called dramatic/drastic/extreme changes in behavior. If your teen goes from agitated and vocal about their problems or goes from talking about or threatening suicide all the time to saying nothing at all, that’s a radical behavioral change.

Among adolescent mental health experts, that radical behavioral change is a known and accepted warning sign for increased suicide risk.

if you’re the parent of a teenager, that’s something you should know. We think you should also know about the other factors, risks, and warning signs that increase the risk of teen suicide. Knowing the warning signs, risk factors, and the protective factors can help you make sense of your teen’s words and behavior during this often challenging, sometimes chaotic, and occasionally turbulent period of development known as adolescence.

We’ll start by defining important terms, like suicidal ideation.

There are two types: active suicidal ideation and passive suicidal ideation.

We’ll start by defining active suicidal ideation.

Active Suicidal Ideation

Active suicidal ideation implies three things. A teen who engages in active suicidal ideation has three things:

  1. A plan to commit suicide. They’ve gone past thinking about it to deciding how they can do it.
  2. A time frame during which they’ve decided to put their plan into action. They’ve gone from “I wish I wasn’t here” to “By [insert specific date/time], I won’t be here anymore.
  3. A means by which to carry out the plan. This means they have acquired the ability to carry out their plan. It might mean they’ve acquired a gun, acquired medication that can induce death, or finalized other details that allow them to follow through with their decision to end their life.

It’s also important to understand that active suicidal ideation includes “…a conscious desire to inflict self-harming behaviors [when] the individual has any level of desire, above zero, for death to occur as a consequence…the individual’s expectation that their attempt could produce a fatal outcome is the key consideration.”

Now let’s define passive suicidal ideation.

Passive Suicidal Ideation

A teen who engages in passive suicidal ideation does not have the three critical things a teen who engages in active suicidal ideation has. They do not have:

  1. A plan to commit suicide.
  2. The means to commit suicide
  3. A time frame within which they plan to carry out a suicide attempt. I

In addition, passive suicidal ideation includes “…indifference to an accidental demise which would occur if steps are not taken to maintain one’s own life.”

Here’s the takeaway from those two definitions:

Active suicidal ideation is defined by the presence of a suicide plan and the means or access to the means to carry it out.

Passive suicidal ideation is defined by the absence of a suicide plan and the means to carry it out. With regards to passive suicidal ideation, it’s important to pay attention to that last part of the definition. While a teen who engages in passive suicidal ideation does not plan to attempt suicide, they’re also “indifferent to accidental demise.”

That’s a scary thought. It’s also another reason why you should never ignore suicidal ideation of any type, whether it’s active or passive – and why you should read the following section about risk factors and warning signs for teen suicide.

The Risk Factors and Warning Signs of Teen Suicide

The primary reason we’re writing this article is that a recent, large-scale analysis of data released by the Centers for Disease Control (CDC) showed that in 2014, suicide became the second leading cause of death for people age 10-24. They subsequently updated that disturbing revelation with another: in 2017, suicide became the second leading cause of death for people age 10-34.

Suicide is now the 10th leading cause of death overall for people in the U.S.

We want to help reverse this trend in any way we can. One way we can help is to inform parents like you that when teens get quiet – and have previously engaged openly in suicidal ideation, active or passive – it could be a serious warning sign. Since the adage is the squeaky wheel gets the grease often applies to mental health issues, and teens with mental health issues, in particular, we want you to have the tools to identify increased suicide risk when your teen is not that figurative squeaky wheel, or when they go from being vocal to being silent.

You can take the following risk factors and warning signs, compare them to your teen’s behavior, and make an initial determination based on what you know and your parental instinct. However, if you are truly concerned, there are two things you absolutely must do:

  1. We mention this above: if you think your teen is in imminent risk, do not wait. Go to the emergency room or call 911.
  2. Arrange a full biopsychosocial evaluation to be administered by a mental health professional experienced in adolescent mental health, teen suicide, and teen self-harm.

An article like this can educate, but not diagnose. That’s crucial to understand.

The risk factors are also crucial to understand. Here’s what we know

Factors That Increase Risk of Teen Suicide

  • Clinical diagnosis of a mental health disorder. The disorders most often associated with suicide are:
  • Identifying as a member of the LGBTQ + community. Data from the National Alliance on Mental Illness (NAMI) shows:
    • Suicide is one of the leading causes of death for LGBTQI individuals age 10-24
    • LGBTQI youth are four times more likely to engage in self-harm than non-LGBTQI youth
    • LGBTQI youth are three times more likely to engage in suicidal ideation or attempt suicide than non-LGBTQI youth
    • 38-65% of the total transgender population engage in suicidal ideation
  • History of trauma
  • History of physical, emotional, or sexual abuse
  • Major loss or grief, such as the death of a loved one, family member or close friend
  • Social isolation
  • Previous suicide attempts

Those are the risk factors. Just so we’re on the same page, risk factor means circumstances/events that increase the likelihood of suicide. A risk factor is different from a warning sign. Whereas a risk factor refers to an increase in overall, general risk, a warning sign refers indicates an immediate risk of suicide.

Warning Signs of Teen Suicide

  • Threatening to harm oneself or commit suicide
  • Seeking means to harm oneself or commit suicide
    • Presence of a suicide plan
  • Extreme mood swings
    • e. going quiet when they were previously vocal about suicide
  • Persistent sense of hopelessness
  • Increasing or escalating alcohol or substance use
  • Withdrawing from family, friends, and loved ones

What we encourage you to do with this information is use it when you think about and analyze your teen’s behavior. In light of the topic of this article – don’t ignore the subtle signs – we want you to take a step back and see all the factors present in their life. Mood swings in a teen aren’t a warning sign by themselves. However, a swing from being vocal about suicide or self-harm to being completely silent about it – in combination with other risk factors and warning signs – could qualify as a mood shift or radical behavioral change, which, in context, could be a very real warning sign that you, as a parent, need to pay attention to.

What You Can Do

First, you can understand that in addition to risk factors and warning signs that increase the overall and short-term risk of suicide, there are also protective factors that decrease the risk of suicide. Protective factors include:

  • Strong, positive connections to family or community
  • Strong, practical emotional coping skills
  • High self-esteem
  • Spiritual, religious, or cultural beliefs or connections
  • Hobbies, activities, passions
  • Access to effective care for mental health or substance use disorders

The most important protective factor is you. Your ability to recognize when your teen needs help and support that’s beyond your skill or ability to provide is essential. You can arrange an assessment, you can get them into a treatment program, and you can be the bedrock of love and support they need to manage stress, challenging circumstances, or the symptoms of a mental health or addiction issue that may lead to suicide.

The data shows that treatment works. The sooner a teen who needs treatment gets the treatment they need, the better the outcome. That means that if you’re worried your teen is at risk of suicide, you can get them evidence-based mental health treatment that decreases their risk of suicide.

That’s a very important thing for you to know.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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