What to Look for in Teens to Assess Suicide Risk
Disclaimer: If you think your teen is at imminent risk of harming themselves, call 911 or take them to the emergency room at a regular hospital or a psychiatric hospital. Do not wait. If you think your teen is not at imminent risk, we strongly encourage you to arrange a full psychiatric evaluation with a mental health professional as soon as possible.
Do not wait.
Taking action now is the best thing you can do to address suicide risk in your teen. When a teen needs professional support for a mental health disorder associated with risk of suicide, the sooner they get support, the better the outcome.
Act now. Do not wait.
This article is designed to help you identify risk and empower you to make an informed decision about seeking expert mental health support for your teen. This article does not replace a suicide risk assessment administered by a trained, licensed, experienced professional.
Mental Health and Suicide Risk in the U.S.
The past year and a half took a toll on us all. We experienced disruptions in almost every area of our lives. Our children and teens have, too. In addition to the serious practical problems stemming from changes in employment, education, and our family and social lives, the cumulative effect of the stressors associated with the coronavirus pandemic had an adverse impact on our national mental health. This is true across the board. From seniors, to adults, to young adults, to adolescents and children, the rate of mental health disorders – including those associated with risk of suicide – increased dramatically between 2019 and 2021.
Let’s look at the numbers from the most recent, population-level report 2022: The State of Mental Health in America. These statistics give us a clear idea of why parents, teachers, school administrators, friend, tutors, coaches, community members – in short, anyone involved in the life of a teen – should know the facts about our collective mental health, and the details about how to identify suicide risk in our teens.
The 2022 MHA Report: Key Findings
- 58% of adults reported serious suicidal ideation, an increase of over half a million people from last year.
- 08% of adolescents (12-17) reported a major depressive episode (MDE), an increase of 1.25%. In some states, close to 19% of adolescents report at least one MDE.
- 60% of youth with major depression did not receive treatment.
- 27% of adolescents with severe depression receive consistent treatment. In some states, as few as 12% of adolescents with severe depression receive consistent treatment.
This article is about adolescents and written for people involved in the lives of adolescents. We include the nationwide data and statistics on adults because none of us live in a vacuum: young adults who report suicidal ideation were recently adolescents, and the adolescents we discuss will soon grow into young adults. The factors affecting one group affect us all, and it’s critical to understand the big picture situation regarding mental health in the U.S. Collective understanding can lead to collective action, which, in turn, can create an environment where we minimize stigma and maximize the importance of mental health on a national level.
And right now, our teens need help. We retrieved the following data from What we present next is teen-specific data from the American Foundation for Suicide Prevention (AFSP), the Centers for Disease Control (CDC), and the 2019 National Youth Risk Behavior Survey (2019 YRBS).
Teen Suicide Statistics: Big Picture
- More than 3,500 adolescents attempt suicide every day.
- The adolescent suicide rate increased 61.7% from 2009-2018.
- Suicide is the second leading cause of death among teens in the U.S.
- Most teens who attempt suicide have a mental health diagnosis such as anxiety or depression
We’ll end this statistics section with one more point:
80% teens who attempt suicide display recognizable warning signs.
That’s what this article is about: how to recognize those warning signs in that most vulnerable 80% of teens.
As a parent, assessing teen behavior can be frustrating. Adolescence is characterized by radical physical, psychological, and emotional change. That’s why it’s important to pay attention to the details, but always consider the big picture. For example, your teen may change their interests, behavior, and social group/activities, but those changes alone don’t indicate increased risk of suicide. However, when significant risk factors accompany changes in their interests, behavior, and social group/activities, that’s different. That’s why it’s helpful to view your teen in the larger context of their past and present, rather than focus on one behavior or factor at a single point in time.
When mental health professionals assess suicide risk, they look for three things:
- Risk Factors. Risk factors are conditions or circumstances in the life of an adolescent that are associated with a person contemplating suicide at one point in time over the long term.
- Warning Signs. Warning signs are behaviors, words, and indicators associated an adolescent initiating the process of suicide in the short term, i.e., minutes, hours, and/or days.
- Protective Factors. Protective factors are relationships, circumstances, beliefs, or personal habits/skills that can mitigate or decrease the risk of suicide for an individual.
Since those are the things professionals look for, the next thing we’ll do is share the most common risk factors, warning signs, and protective factors related to suicide risk. We retrieved the following information from the suicide risk assessment codified by the U.S. Department of Veterans Affairs (VA). To read the complete VA Suicide Risk Assessment Guide, click here. When appropriate, we added items specific to adolescents, which may not apply to adults: we do not attempt to reinvent the wheel, but we have added items relevant to teenagers.
We’ll start with the risk factors.
Teen Suicide: Risk Factors
- Presence of mental illness/mental health disorder:
- Chronic physical illness
- Previous suicide attempts
- Identifying as a member of the LGBTQ+ community
- Recent death of family member or loved one
- History of traumatic life events
- History of physical, emotional, or sexual abuse
- Recent divorce or separation in family
- Social Isolation
- Recent academic problems
- Recent problems with teachers/authority figures at school
- Significant social or romantic disappointments
- Recent legal problems such as arrests
Now, the warning signs.
Teen Suicide: Warning Signs
- Threatening to harm or end one’s life
- Seeking or access to means of committing suicide: seeking pills, weapons, or other lethal means
- Evidence or expression of a suicide plan
- Suicidal ideation:
- Expressing (writing or talking) about thoughts about suicide, wish to die or death
- Feelings of hopelessness
- Feelings of rage or anger
- Talking about revenge
- Escalating reckless or risky behavior
- Includes increasing or excessive alcohol or drug use
- Risky sexual activity
- Unsafe driving or other related activities
- Expressing feelings of feeling trapped, with no way out
- Withdrawing from family, friends, and loved ones
- Ceasing participation in formerly loved activities:
- Social activities
- Excessive anxiety/agitation
- Disrupted sleep: sleeping too much, too little, or not at all
- Extreme, uncharacteristic changes in mood and/or behavior
- Expressing no reason for living or having no sense of purpose in life
- Giving away possessions
- Using language like “When I’m gone” or “Soon none of this will matter”
- Preoccupation/fixation with death, violence, or lethal weapons such as guns or knives
Next, the protective factors.
Teen Suicide Risk: Protective Factors
(The presence of protective factors does not supersede evidence or presence of warning signs)
- Having a strong connection to family, friends, or community
- Having robust problem solving, emotional coping/processing, and conflict resolution skills
- Feeling a sense of belonging to family, friends, school, or community
- Having a well-developed personal identity
- Having a well-developed sense of self-esteem
- Presence of spiritual, religious, or cultural beliefs or connections
- Having or making future goals, plans, and aspirations
- Making productive and constructive use of leisure time
- Actively participating in hobbies, activities, passions
- The presence of therapeutic relationships with mental health professionals
- Having unrestricted or efficient access to effective care for physical, mental, or substance use disorders
- Absence of access to lethal means of suicide
That’s a lot of information to digest – but it’s important information for parents to know and understand. We’ll reiterate that it’s crucial to focus on the big picture, rather than zero in on a single behavior. If you think a behavior or set of behaviors indicates a risk of suicide in your teen – but your teen is not at imminent risk – our advice is this:
Arrange a full biopsychosocial assessment with a licensed mental health professional experienced in working with adolescents as soon as possible.
If your child is at imminent, immediate risk of harming themselves, call 911 or go to the emergency room ASAP.
How to Find Help
If you feel comfortable and have a positive, established, relationship with your family general practitioner or your teen’s pediatrician, then they’re a good place to start. They can perform an initial screen, but they may not have the skills or experience to administer a full psychiatric assessment. If your teen has a mental health therapist, counselor, or psychiatrist already they’re your next best choice.
If neither of those options are available to you, 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.