Understanding and Preventing Teen Suicide
June 18, 2004, KidsHealth.org

When a teen commits suicide, everyone is affected. Family members, friends, teammates, neighbors, and sometimes even those who didn't know the person well are united by feelings of grief, confusion, guilt - and the sense that if only they had done something differently, the suicide could have been prevented. The reasons behind a teen's suicide or attempted suicide are often complex. Read this article to learn about risk factors and warning signs and how to cope with such a devastating loss.

Suicide Statistics
Unfortunately, teen suicide is not a rare event. According to the U.S. Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death for those ages 15 to 24, surpassed only by car accidents and homicide. Suicide rates are on the rise for younger adolescents as well, with dramatic increases noted in this age group from 1980 to 1996. Suicide attempts are even more prevalent, though it is difficult to track the exact rates.

"Suicide rates jump precipitously in the teen years for a number of reasons," says David Sheslow, PhD, a pediatric psychologist. These reasons might include greater access to lethal weapons such as firearms and greater access to drugs and alcohol.

Gender differences affect the means teens use to commit suicide. Girls, who are about twice as likely to attempt suicide as boys, tend to overdose on drugs or cut themselves. Boys, who complete suicide more often than girls, use firearms, hanging, or jumping more frequently. Because they tend to choose more sudden, lethal methods, boys are three or four times more likely to succeed in their attempts than girls.

The risk of suicide increases dramatically when kids and teens have access to firearms at home, and nearly 60% of all successful suicides in the United States are committed with a gun. That's why it's imperative that any gun in your home be unloaded, locked, and kept out of the reach of children and adolescents. Ammunition must be stored and locked apart from the gun, and the keys for both should be kept in a different area from where you store your household keys. Always keep the keys to any firearms out of the reach of children and adolescents.

Risk Factors
Now that you're a parent, you might not remember how it felt to be a teen, caught in that gray area between childhood and adulthood. Sure, it's a time of great possibility but it can also be a period of great confusion and anxiety. There's pressure to fit in socially, to perform academically, and to act responsibly. There's the awakening of sexual feelings, a growing self-identity, and a need for autonomy that often conflicts with the rules and expectations set by others. A teen with an adequate support network of friends, family, religious affiliations, peer groups, or extracurricular activities may have an outlet to deal with his everyday frustrations. A teen without an adequate support network, however, may feel disconnected and isolated from his family and peer group. It's these teens who are at increased risk for suicide.

Teens who are at increased risk for suicide include those who:
o face problems that are out of their control, such as divorce, alcoholism of a family member, or exposure to domestic violence
o have suffered physical or sexual abuse
o have poor relationships with their parents, lack a support network, are o socially isolated, devalued, or rejected
o have a family history of depression or suicide. Because depressive illnesses may have a genetic component, some teens may be predisposed to suffer major depression.
o experience the feelings of helplessness and worthlessness that often accompany depression. A teen, for example, who experiences repeated failures at school, who is overwhelmed by violence at home, or who is isolated from peers, is likely to experience such feelings. "If a teen sees himself as inadequate and worthless and he believes the future is unchangeable, these are clear warning signs of possible trouble," says Dr. Sheslow.
o are dealing with homosexual feelings in an unsupportive family or community or hostile school environment. Several studies have reported greater rates of suicide attempts among gay, lesbian, and bisexual youth than among their heterosexual peers.
o use alcohol or drugs in an attempt to numb their pain. Substance abuse is a major risk factor for suicide.
o express their feelings violently
o have had a previous suicide attempt

Warning Signs
Teens are most likely to consider suicide at certain times in their lives, particularly if they have suffered a loss or rejection. Failures at school, breaking up with a boyfriend or girlfriend, the death of a loved one, their parents' divorce - all of these risk factors can be triggers for dangerous behavior.

Seek professional help if your child experiences serious mood changes that last more than a couple of weeks. Don't wait. The American Psychiatric Association recommends seeking help if your teen:
o withdraws from friends and family
o shows an inability to concentrate
o sleeps too much or too little
o talks of suicide
o has dramatic changes in personal appearance
o loses interest in favorite activities
o expresses hopelessness, helplessness, or excessive guilt
o exhibits self-destructive behavior (such as reckless driving, drug abuse, or promiscuity)
o seems preoccupied with death
o bequeaths his favorite possessions

Seek professional help as soon as possible if your teen says he is thinking about suicide. Contrary to popular belief, people who talk about suicide are likely to follow through. Pay attention to phrases such as, "It's no use, I'd be better off dead." Also be suspicious if a child who has been very depressed suddenly becomes extremely cheerful or hopeful. This intense mood swing may indicate that he believes suicide will be a solution to all his problems.

What Can Parents Do?
If your child seems depressed and withdrawn, the experts suggest that you watch him carefully. Poor grades, for example, may signal that your teen is withdrawing at school. It is important that you keep the lines of communication open by expressing your concern, support, and love.

It's also important to seek outside help and support for your teen. Make an appointment with a mental health professional and go with your teen to the appointment. Share your concerns and fears about suicide openly with the professional so that any problems, such as major depression, can be evaluated and treated.

Remember that any ongoing conflicts between a parent and child can fuel the fire for a teen who is feeling isolated, misunderstood, devalued, or suicidal. Get help to air family problems and resolve them in a constructive way. Also let the mental health professional know if there is a history of depression, substance abuse, family violence, or other stresses at home, such as an ongoing environment of criticism.

Providing Help
Although you may feel powerless, there are a number of things you can do to help a teen who is going through a difficult time. If you are concerned about your teen's behavior:
o Make sure your child has someone he can confide in. If your teen feels you don't understand, suggest a more neutral person - a grandparent, a clergy member, a coach, a school counselor, or your child's doctor.
o Don't minimize or discount what your child is going through. This will only reinforce his sense of hopelessness.
o Take your child's behavior seriously. Three quarters of all people who attempt suicide have given some type of warning to loved ones.
o Always express your love, concern, and support.
o Don't postpone seeing a doctor. Your child should be evaluated for depression so that treatment can begin immediately.
o Express to your child that with help he will begin to feel better and that his problems can be overcome.

If you think your child is suicidal, get help immediately. Your child's doctor can refer you to a psychologist or psychiatrist, or call your local hospital's department of psychiatry and ask for a list of doctors in your area. Your local mental health association or county medical society can also provide references. In an emergency, you can call the U.S. National Suicide Hotline at (800) SUICIDE.

Coping With Loss
What should you do if someone your child knows, perhaps a friend or a classmate, has attempted or committed suicide? First, acknowledge your child's many emotions. Some teens say they feel guilty - especially those who felt they could have interpreted their friend's actions and words better. Others say they feel angry with the person who committed or attempted suicide for having done something so selfish. Still others say they feel nothing at all - they are too overwhelmed with confusion and grief. All of these emotions are appropriate; stress to your child that there is no right or wrong way to feel.

When someone attempts suicide and survives, the people around him may be afraid or uncomfortable about talking with him about it. Tell your child to resist this urge; this is a time when a person absolutely needs to feel connected to others.

When a teen commits suicide, the people around him may become depressed and suicidal themselves. It's important to let your child know that he should never blame himself for someone's death; questioning whether he could have done something differently won't bring his friend or classmate back and it won't help him heal.

Many schools address a student's suicide by calling in special counselors to talk with the students and help them deal with their feelings. If your child is having difficulty dealing with a friend or classmate's suicide, it's best for him to make use of these resources or to talk to you or another trusted adult.

If You've Lost a Child to Suicide
For parents, the death of a child is probably the most painful loss imaginable. For parents who've lost a child to suicide, the pain and grief may be intensified. Although these feelings may never completely go away, there are some things that survivors of suicide can do to begin the healing process.
o Maintain contact with others. Suicide can be a very isolating experience for surviving family members because friends often don't know what to say and how to help. Seek out supportive people with whom you can talk about your child and your feelings. If you find that those around you are uncomfortable talking about your child, initiate the conversation and ask for their help.
o Remember that your other family members are grieving, too, and that everyone expresses grief in their own way. Your other children, in particular, may try to deal with their pain alone so as not to burden you with additional worries. Be there for each other through the tears, anger, and silences, and, if necessary, seek help and support together.
o Expect that anniversaries, birthdays, and holidays may be difficult. Important days and holidays often reawaken a sense of loss and anxiety. On those days, do what's best for your emotional needs, whether that means surrounding yourself with family and friends or planning a quiet day of reflection.
o Understand that it's normal to feel guilty and to question how this could have happened, but it's also important to realize that you may never get the answers you are looking for. The healing that takes place over time comes from reaching a point of forgiveness - for both your child and yourself.

Counseling and support groups can play a tremendous role in helping you to realize you are not alone.

Additional Resources
SA\VE - Suicide Awareness\Voices of Education
American Foundation for Suicide Prevention
American Academy of Child & Adolescent Psychiatry
National Alliance for the Mentally Ill

See also PsychLinks Suicide Resources