One of the most heartbreaking losses for any parent is the death of a child.  When the cause of death is suicide, the gut-wrenching pain is often more pronounced and excruciating than ever.  To add insult to injury, the parents’ pain is inevitably accompanied by a barrage of guilt, unrelenting “what ifs”, and harsh self-judgments.

Adolescent suicide has been on the rise for the past several decades.  In the U.S. suicide is one of the top two leading causes of death among teens.  Teens are faced with more pressures and challenges today than ever before. Those who are emotionally fragile and lack sufficient support are especially vulnerable to suicidal thoughts and behaviors. 

Most teens who commit suicide give clear warning signs.  However, these signs can be easily overlooked or chalked up to “typical adolescent drama” if you, as a parent, don’t know how to identify them.  This brief guide is designed to help you know what to look for and what steps to take if you suspect your teen is struggling with suicidal thoughts or actively considering suicide.

Suicide in Adolescents – Statistics and Facts

• According to 2014 CDC statistics, suicide is the second leading cause of death for individuals 10 to 24 years of age. At 17.4%, this percentage is much greater than for any other age group.  (It should be noted that less than a decade ago suicide was the third leading cause.)
• As of May 2017, the CDC lists suicide as the second leading cause of death for adolescents between the ages of 15 and 19 years. Suicide is second only to accidents.
• Here in the U.S., every day an average of 3,470 adolescents, grades 9 through 12, attempt suicide.
• A recent CDC report indicates suicide rates for adolescents have been gradually increasing since 2007. Between 2007 and 2015, the suicide rate for adolescent females (15 to 19 years of age) has doubled, and suicide rates for males in the same age group has gone up by 30%.
• Approximately one third of those who die by suicide have made previous attempts
• Individuals have a 100 times greater risk of a fatal suicide attempt within the first year following an attempt
• Suicide rates for adolescent females hit the highest point in 4 decades in 2015.
• Clear warning signs are given by 80% of adolescents who attempt suicide.
• Thirty percent of transgender individuals (ages 12 to 22 years) have attempted suicide at least once according to a 2016 study.
• The vast majority of teens who attempt suicide suffer from depression or another mental health disorder.
• Historically, adolescent males are approximately 4 times as likely to die from a suicide attempt than their female peers. Adolescent females, however, make more attempts overall. 

Mental Health Issues and Suicide Ideation in Teens

Adolescents who suffer from an underlying mental health disorder are especially vulnerable to suicidal thoughts and behaviors.  These include (but aren’t limited to) the following psychiatric disorders:

• Major Depression
• Gender Dysphoria
• Eating Disorders (anorexia, bulimia, binge eating disorder)
• Substance Use Disorder
• ADHD (Attention Deficit Hyperactivity Disorder)
• Autism Spectrum Disorder
• Borderline Personality Disorder
• Bipolar Disorder
• Body Dysmorphic disorder
• PTSD (Posttraumatic Stress Disorder)
• OCD (Obsessive Compulsive Disorder)
• Anxiety Disorders
• Schizophrenia  

It’s important to note that the risk of suicide is even greater for individuals who have both depression and another mental health disorder.  

Why Teens May Consider Suicide as an Option

Many parents naively assume that “my child” would never consider suicide.  This is a very common, but also very dangerous, assumption to make.  Adolescents today face myriad pressures and challenges that can leave them feeling more hopeless, alone, and overwhelmed than ever before.  Not only are their brains still developing, they also lack the maturity and life experience to see the bigger picture – that life can get better – when they experience a devastating loss or rejection or perceive their life to be imploding or ruined.  Many feel too ashamed or scared to reach out for help, leaving some with the tragically distorted belief that suicide is their only option for relief.  If no one is paying close attention, it’s easy to assume a struggling teen is coping far better than he or she really is. 

Risk Factors for Suicide in Adolescents

There are many potential risk factors for adolescent suicide.  These include, but aren’t limited to:

• Mental health issues, especially depression combined with another psychiatric disorder
• Being the target of bullying, including cyber bullying
• A recent loss or rejection (e.g. death or loss of a close family member, beloved pet, or close friend; a breakup with a girlfriend or boyfriend; a devastating disappointment)
• A family history of suicide attempts
• Prior suicide attempts by the teen
• Access to firearms
• Being exposed to violence, including domestic violence
• Impulsive tendencies
• Substance abuse or dependence
• Aggressive tendencies
• Lack of emotional support
• Belief that their current situation is hopeless
• Current or past physical, emotional, or sexual abuse or neglect
• Chronic or serious physical health issues
• Severe or chronic family problems or chaos
• Feelings of humiliation, especially in front of peers
• Lack of healthy coping skills

Recognizing the Signs of Suicidal Ideation and Behavior in Teens

While some adolescents wear their hearts on their sleeves, so to speak, far too many are quite adept at hiding painful emotions from adults.  If they’re seriously contemplating suicide, they may go to great lengths to hide their intentions from parents, siblings, and anyone else who may be inclined to pry or attempt to intervene.  Questions about their well-being (e.g. “How are you feeling?” or “Is everything okay?”) may be met with a casual “fine” or even “great”, accompanied by a forced smile – anything to thwart the suspicions of others. 

Following are several warning signs that your teen may be contemplating suicide:

• Decline in school performance for no apparent reason
• Increased withdrawal from family, friends, and normal activities
• Difficulties getting over a recent loss or rejection
• Changes in sleeping habits
• Changes in appetite or eating patterns
• Moodiness
• Frequent sadness and / or excessive guilt
• Giving away favorite or cherished possessions
• Preoccupation with death and dying (e.g. writing poems about death, drawing pictures that depict death or dying)
• Increased moodiness, irritability, hostility, aggressiveness, or anger outbursts
• Loss of interest in things that were once really enjoyed
• Frequent somatic complaints, such as headaches, extreme tiredness, or stomachaches
• Engaging in reckless or high-risk behavior
• Difficulties staying focused or concentrating
• Increased use of alcohol or drugs
• Writing suicide notes
• Decline in personal hygiene
• Saying goodbye to loved ones and friends

Teens often make frequent verbal statements about suicide when they’re seriously thinking about it or actively planning it, such as:

• “You’ll be better off without me”
• “I’m a burden to everyone”
• “I wish I were dead”
• “No one will care when I’m gone”
• “My life is over anyway”
• “I hate my life”
• “What’s the use? It’s hopeless!”
• “Maybe I’ll just kill myself”
• “Everyone would be better off if I died”

It’s very important to note that statements such as those above aren’t always spoken out loud, but rather end up posted on social media, such as Twitter or Facebook.  They may also be sent via email or text messages.  Statements such as the above should never be taken lightly or dismissed as adolescent angst or “typical teen drama”. 

Knowing the First Steps to Take  

If you have reason to believe your teen may be contemplating or actively planning suicide, don’t assume it’s just a phase that will pass.  Take action.  Self-harm in teens is dangerous and unhealthy, and the scars can last a lifetime.  The sooner you intervene and get help for your teen, the better.  Following are the first steps to take:

1 – Talk to your teen.  Have a conversation with your teens regarding your concerns.  Don’t be dramatic.  Do your best to keep any feelings of panic in check.  Let your son or daughter know you want to help and are available to talk and listen.  Avoid pressuring your teen – that last thing you want to do is create more stress or push your teen away. 

Understand that your teen may attempt to brush you off by convincing you that everything’s “fine”.  Often this is due to fear and shame. 

2 – Schedule an evaluation with a mental health professional.  Suicidal thoughts should never be taken lightly, so make sure you have your teen evaluated by a psychologist, psychiatrist, or other qualified mental health professional.  Find someone who specializes in working with adolescents if possible.  A professional can determine if your teen’s suicidal thoughts are due to an underlying psychiatric disorder or specific stressors.  Either way, he or she can recommend an appropriate course of treatment for your struggling teen. 

3 – Get your teen into treatment.  Once your teen has been evaluated, get him or her into treatment based on the recommendations made during the evaluation.  With suicidal thoughts and behavior, the treatment approach and methods will depend on the underlying cause.  Ensuring your teen’s safety will be the initial primary goal of any type of treatment.  

Treatment for suicidal adolescents almost always involves some form of psychotherapy or “talk therapy”.  It may also include medication to help alleviate symptoms of disorders such as depression, anxiety, or another mental health disorder.  Hospitalization may be necessary if your teen has attempted suicide or is believed to be a high suicide risk.

Psychotherapy – There are several types of psychotherapy or talk therapy that can help an adolescent who’s struggling with suicidal thoughts.  These include:

• Cognitive Behavioral Therapy (CBT) – CBT is a relatively short-term type of talk therapy. It focuses on helping your teen identify and change negative thought patterns and behaviors, distorted beliefs, and unhealthy self-talk that may be contributing to and reinforcing suicidal thoughts and behaviors.  There is substantial research supporting the effectiveness of CBT in the treatment of depression and many other disorders. 
• Dialectical Behavior Therapy (DBT) – A specific form of CBT, DBT can be particularly beneficial for teens who have been struggling with persistent suicidal thoughts. This therapy focuses on teaching four main skills: mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.
• Interpersonal Psychotherapy – This short-term therapeutic approach focuses on looking at your teen’s suicidal thoughts and feelings from an interpersonal standpoint, and teaching skills that will help improve your teen’s relationships with others.
• Family Therapy – Family therapy is indicated when chaos, conflict, and other unhealthy family dynamics play a significant role in your teen’s suicidal thoughts and behaviors. It can help families learn healthy ways to resolve conflict and interact in more appropriate, positive ways.  It can also help the family work together to provide a dedicated support system for the suicidal teen.

Medication – Medication can play a key role in treating symptoms of depression and other disorders that may be contributing to your teen’s suicidal ideation.  Often, when troubling symptoms start to abate, the desire to end one’s life subsides as well. Unfortunately, medications typically involve trial and error, may take two or more weeks to start alleviating symptoms, and inevitably come with side effects. They should be used only in conjunction with other forms of treatment, such as psychotherapy.  

Hospitalization – Hospitalization in an adolescent psychiatric hospital may be necessary if your teen has made a suicide attempt or is considered a high suicide risk.  Medical staff can monitor your child 24/7 to help ensure safety until your teen is stable and no longer a danger to himself or herself.  

Supporting and Encouraging Your Child  

Teens grappling with suicidal thoughts need all the support they can get.  As a parent, there are several things you can do to help your teen feel understood, valued, and less alone.  They include:

• If you own any weapons, make sure they are either secured under lock and key or removed from the home
• Make time to make yourself available to listen to your teen; let your teen know you’re truly there for him or her
• Don’t assume your teen’s suicidal behaviors are attention-seeking ploys
• Take an active role in your teen’s treatment
• Be willing to listen – really listen – to your teen, without judgment and with genuine and compassion
• Remember, especially when interacting with your teen, that his or her suicidal thoughts are not an indication of weakness or a lack of faith
• Learn everything you can about your child’s mental health, if it’s been determined he or she has a disorder (or disorders) that may be fueling the suicidal thoughts
• Don’t pressure your teen to talk to you about his or her feelings
• Be very careful to not minimize, criticize, dismiss, or ridicule what your teen is going through
• Avoid nagging or lecturing your teen regarding his or her suicidal thoughts
• Strive to stay calm, even though you may feel very scared, when talking to your child
• Respect what your teen’s going through, even if you can’t relate or understand
• Encourage your teen to practice healthy, new coping skills at home
• Understand that self-harm behaviors typically aren’t suicide attempts; however, always take any type of self-harm seriously and, ideally, work with your child’s therapist to determine what the underlying issue is
• Respect your teen’s privacy; don’t talk to everyone about his or her suicidal thoughts or behaviors. Don’t so may exacerbate the problem by contributing further to your teen’s shame, embarrassment, guilt, and other painful feelings
• Make sure your actions and words show that you love your teen unconditionally
• Strive to create a supportive and peaceful atmosphere at home
• Work with a therapist individually or as a family to address any parenting or family dynamics that may be contributing to your child’s suicidal thoughts

What to Do When Things Escalate

Sadly, for some adolescents, thoughts of suicide can gradually or quickly turn into actively planning suicide.  Early intervention and treatment can and does help many teens, but for others, the suicidal ideation may get worse over time even with treatment.  If medication is prescribed for depression or other symptoms, it can take a lot of time and trial and error to find something that might work.  This can serve to add another level of frustration and hopelessness for your teen, and potentially escalate the desire to end the suffering they’re experiencing. 

It’s also important to note that it’s not unusual for someone who’s severely depressed to become actively suicidal after they start to feel better.  It’s essential for parents to refrain from assuming the worst has passed, as this can still be a high-risk time for their teen.  One of the reasons the risk may be even higher is because the individual now has the energy to act upon the suicidal thoughts with which they’ve been struggling.

If things do start to escalate at some point, don’t hesitate to reach out for help:

• Contact your child’s provider asap

Or, if after hours:

• Enlist the help of a close family member or friend for support and assistance
• Take your child to the nearest hospital emergency room (if you can do so safely) 
• Call 911 

When Individual Therapy isn’t Enough

Individual therapy doesn’t always adequately address the underlying issue in suicidal teens.  If your child doesn’t have a sufficient emotional support system, is battling a serious psychiatric disorder, and / or has experienced a devastating loss, trauma, or other crisis that is causing or exacerbating his or her suicidal thoughts and behaviors, you  may need to consider more intensive treatment.  Options include:  

• Intensive outpatient treatment (IOP) / Psychiatric day treatment
• Residential treatment
• Inpatient psychiatric treatment 

Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how often your child is required to go.  These programs are the next step up from regular outpatient treatment that usually consists of an hour of therapy per week. 

Residential treatment involves having your teen stay at a non-hospital treatment facility that specializes in helping adolescents with psychiatric disorders.  Residential treatment typically lasts between 30 to 180 days, depending on the disorder and its severity. 

Inpatient psychiatric treatment is the highest and most intensive level of treatment for suicidal adolescents.  It involves admitting your child to an adolescent psychiatric hospital unit where patients are monitored by medical personnel around the clock. Inpatient treatment may last for a few days to a few weeks. 

Each of these intensive levels of treatment typically provides daily or bi-weekly visits with a psychiatrist and daily psychotherapy (often both group and individual, and a combination of several other types of therapy, such as art therapy, music therapy, etc.).

Taking Care of Yourself

While you may feel obligated to spend all your energy and focus on your teen during this time, it’s crucial that you don’t neglect your own self-care.  The stress can take a significant toll if you’re not doing things to keep it manageable.  Some things you can do include:

• Surrounding yourself with plenty of emotional support, such as though your church, a support group, therapy, and close friends
• Make sure your physical needs are getting met, particularly getting plenty of rest and eating a healthy diet
• Make time for yourself.  When you’re doing well, you’re far more able to give to others. 
• Practice effective ways to reduce your stress, such as meditating and exercising regularly

Your teen will be looking to you for unconditional love and acceptance, understanding, encouragement, hope, and the sense that he or she truly matters and has value in this world.  Taking care of yourself will help ensure that you can provide plenty of support for your child during this challenging time.