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Treatment for a Suicidal Teenager: Understanding the Line between Passive Suicidal Thoughts and Active Intentions

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 >

Suicide is a serious problem among young people in the U.S.

Data from the Centers for Disease Control (CDC) revealed that in 2014, suicide became the second leading cause of death for people age 10-24. In 2017, the CDC revised that finding to indicate that suicide became the second leading cause of death for people age 10-34. It’s now also the fourth leading cause of death for people age 34-54, the fifth for people age 45-54, and the 10th leading cause of death overall for people in the U.S.

For teenagers age 15-19, death by suicide is second only to death by accidents.

These increasing rates of suicide in the U.S. – especially among teens – are cause for alarm. Parents of teens who think or talk about suicide – known as suicidal ideation – should take it seriously. We’ll define the differences between passive suicidal thoughts and active intentions in a moment. For now, any parent reading this article should know that any talk about suicide by their teenager, which by default means the presence of thoughts about suicide, should not be ignored.

It’s a mistake to assume that when a teen talks about suicide, they do it to shock you, scare you, or get attention. It’s a mistake to think they’re simply engaging in what many people might call typical teen drama.

It may well be all those things, but the chance that it’s none of those things 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, the potential consequences eclipse the consequences of the chance they’re not.

What is Suicidal Ideation?

In their 2003 publication “The Textbook of Suicide Assessment and Management” the American Psychological Association (APA) defines suicidal ideation as “…thoughts of serving as the agent of one’s own death. Suicidal ideation may vary in seriousness depending on the specificity of suicide plans and the degree of suicidal intent.”

Experts in mental health and adolescent development identify two types of suicidal ideation: active and passive. Those distinctions are equivalent to the terms in the title of this article: passive suicidal thoughts and active intentions.

We’ll elaborate on those distinctions now.

Passive Suicidal Ideation

A person who engages in passive suicidal ideation has no plan to commit suicide, has no means by which to commit suicide, and has no time frame in which they plan to carry out a suicide attempt. 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.”

Active Suicidal Ideation

A person who engages in active suicidal ideation has a plan to commit suicide, has a means by which to carry out their plan, and a time frame within which they plan to carry out a suicide attempt. In addition, 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.”

Understanding and recognizing the distinction between passive and active suicidal ideation is important, because there are different treatment options appropriate for both circumstances. Treatment that is clinically appropriate for an adolescent who engages in passive suicidal ideation may not be clinically appropriate for someone who engages in active suicidal ideation, and vice-versa. The content of a treatment plan for a teen who engages in either passive or active suicidal ideation is determined by a mental health professional. What parents need to know is that any teen who engages in suicidal ideation needs some form of professional mental health treatment and support.

With all that said, a baseline understanding of the difference between the two types of suicidal ideation is this: passive suicidal ideation is characterized by the absence of a suicide plan and the means to carry it out, whereas active suicidal ideation is characterized by the presence of a suicide plan and the means or access to the means to carry it out.

We’ll outline the contours of the suicide problem among adolescents in the U.S. by sharing the latest statistics, then discuss warning signs, risk factors, and protective factors for suicide among teens. We’ll end by discussing the types of evidence-based treatment available to teens who engage in suicidal ideation, whether passive or active.

Teen Suicide: Facts and Figures

The following data appear on the public websites of the American Foundation for Suicide Prevention (AFSP) and the Centers for Disease Control (CDC), and the 2019 National Youth Risk Behavior Survey (2019 YRBS). The most up-to-date data available on suicide prevalence rates among teens appear in the 2019 YRBS.

Teen Suicide Statistics: Overall

  • Experts estimate that 3,703 teens in grades 9-12 attempt suicide every day.
  • Between 2009-2018, the suicide rate among adolescents age 14-18 increased by 61.7%
  • Suicide accounts for more deaths among teenagers and young adults than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease,
  • 80% of adolescents who attempt suicide give clear warning signs beforehand.
  • A majority of teens who attempt suicide also suffer from a mental health disorder such as depression.

Teen Suicide Facts: Details

In 2019, among high school students (9th-12th grade):

  • 8.9% reported at least one suicide attempt
  • 23% of LGBTQI+ students reported at last one suicide attempt
  • 6.4% of heterosexual students reported at least one suicide attempt
  • 16.4% of students who were not sure of their sexual orientation reported at least one suicide attempt
  • 18.8% reported seriously considering suicide in the past 12 months
  • 47% of LGBTQI+ high school students reported seriously considering suicide
  • 14.4% of non-LGBTQI+ students seriously considered suicide
  • 30.4% of students who were not sure of their sexual orientation seriously considered suicide

These figures show, in stark relief, the scope of the suicide problem among young people in the U.S. Across the board, rates of suicide are on the rise. Here’s another set of facts from a study of preteens that shows an equally disturbing trend:

  • 29% of kids age 10-12 reported suicidal ideation
  • 17% reported suicidal behavior
  • 54% of kids with a psychiatric disorder reported suicidal ideation
  • 7% of kids who visited the emergency room for medical complaints – and no psychiatric history – reported suicidal ideation

Those figures tell us that our teens are not the only ones with an increasing suicide problem. It’s present among our preteens, as well. Yet there’s one datum in those statistics that we want parents to focus on, and another fact we’ll share, for those who don’t know. First is the point that 80 percent of teens who attempted suicide gave clear warning signs beforehand. Second is the fact that, with appropriate treatment and support, suicide is preventable.

Teen Suicide: Warning Signs, Risk Factors, and Protective Factors

The fact that suicide is preventable means that parents of teens need to know what to watch for in order to offer their teens the treatment and support that can keep them from harming themselves. The things to watch for are known as warning signs.

Warning signs are factors that may set into motion the process of suicide in the short term (i.e., minutes and days).

Teen Suicide: Warning Signs

Warning signs include:

  • Threats to harm or end life
  • Looking for means: seeking pills, weapons, or other means
  • Evidence or expression of a suicide plan
  • Writing or talking about suicide, wishing to die, or death
  • Hopelessness
  • Rage, anger, seeking revenge
  • Reckless, impulsive, and/or risky behavior
  • Feeling trapped and seeing or thinking there’s no way out
  • Increasing or excessive substance use
  • Withdrawing from family, friends, and loved ones
  • Anxiety and agitation
  • Atypical sleep patterns: sleeping too much or too little
  • Extreme mood swings
  • Talking about having no reason to keep living
  • Feeling or talking about having no sense of purpose in life

The next thing parents need to understand are suicide risk factors. Whereas warning signs are related to short-term danger, risk factors are related to the bigger picture. They’re associated with a person contemplating suicide at one point in time over the long term.

Teen Suicide: Risk Factors

Risk factors include:

  • Prior traumatic life events or abuse
  • Previous suicide behavior
  • Chronic mental illness
  • Chronic, debilitating physical illness
  • Financial hardship/unemployment
  • Divorce or separation in the family
  • Social Isolation

In addition to warning signs and risk factors, parents need to understand the concept of and be able to identify the presence of protective factors. Protective factors are relationships, circumstances, beliefs, or personal habits/skills that can mitigate or decrease the risk of suicide for an individual.

Teen Suicide: Protective Factors

Protective factors include:

  • Strong connections to family or community
  • Problem solving, coping, and conflict resolution skills
  • A sense of belonging
  • A sense of personal identity
  • Strong self-esteem
  • Spiritual, religious, or cultural beliefs or connections
  • Future goals, plans, and aspirations
  • Productive and constructive use of leisure time
  • Hobbies, activities, passions
  • Therapeutic relationships with mental health professionals
  • Access to effective care for physical, mental, or substance use disorders
  • Restricted access to lethal means of suicide

It’s important to identify protective factors because they allow parents and mental health professionals to leverage strengths and assets that increase resiliency in a potentially suicidal teen. Parents and therapists can use the presence of protective factors to encourage and support teens. Protective factors enable the therapist and client to establish a group of facts that increase hope and promote the recognition of alternatives to suicide or self-harming behavior.

Parents should understand, however, that the presence of protective factors do not supersede evidence or presence of severe warning signs. Both parents and therapists should use the presence of protective factors as part of the risk mitigation, care, support, and treatment process.

Treatment for Suicidal Teens

If your teen engages in suicidal ideation – either active or passive – there are specific steps you need to take. First, we need to reiterate what we wrote in the first section of this article:

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.

Next, if your teen engages in suicidal ideation but they’re not in immediate dangers, take the following three steps:

1. Talk to Them

We really mean start a conversation about your concerns and then listen more than talk. Listen without interrupting. Listen without judgment. Communicate in a calm, cool, and collected manner. Do your best not to add to the emotionality of the situation. Validate their emotions. Make sure they know you’re there for them no matter what.

2. Get A Professional Evaluation.

Arrange for an evaluation or assessment with a psychologist, psychiatrist, or other qualified mental health professional. A trained professional can determine if your teen’s suicidal thoughts are due to an underlying psychiatric disorder or specific, short-term stress.

3. Get Your Teen into Treatment.

Work with a mental health professional to determine the best course of action for your teen: Residential Treatment, Partial Hospitalization, Intensive Outpatient, or Outpatient Therapy.

Evidence-Based Treatment: Safety Now and Hope for the Future

Evidence shows that integrated treatment at a specialized mental health facility for adolescents offers the best chance of preventing suicidal ideation from escalating to a suicide attempt. Treatment for teens who engage in suicidal ideation most often involves a combination of individual therapy, group therapy, family therapy, experiential therapies, lifestyle modifications, and community support. The combination of therapies your teen will engage in depends on the outcome of their evaluation. You’ll work with your teen and their treatment team – i.e. the professionals providing treatment – to determine the exact contours of and individualizes treatment plan.

The most important thing to keep in mind is that treatment works. Teens and families around the country participate in life-saving therapies every day. They learn that with commitment, time, and effort, teens at risk of suicide can learn to manage their emotions and impulses and develop the resiliency it takes to embrace recovery and create the life they want, and plan for a future that they choose.

Suicide Hotlines

Teens, parents, or friends of teens who need help can call or text the following numbers:

  • The National Suicide Prevention Lifeline (24/7/365): 1-800-273-8255
  • The Trevor Project Phone (24/7/365): 1-866-488-7386
  • Trevor Project Text (7 days/wk, 6am-am ET, 3am-10pm PT): Text START to 678678
  • The Trevor Project Chat: CLICK HERE
  • The Crisis Text Line (24/7/365): Text CONNECT to 741741
  • The Youth Yellow Pages TEEN LINE (6pm-10pm PT) 310-855-4673
  • The Youth Yellow Pages TEXT: Text TEEN to 839863

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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