Many youth suicides result from the onset of a psychiatric illness such as depression, bipolar disorder or schizophrenia. Often, these conditions are not diagnosed and left untreated.
Any teen who talks about or behaves as though they are considering suicide should be taken seriously. They need to have their physical health checked first and then a mental health evaluation and treatment.
Risk Factors
The “ingredients” that lead to suicide vary from person to person and may not be readily apparent. However, it is known that some risk factors are common among youths who take their lives. These include depression, drug and alcohol abuse, family history of mental illness, poor coping skills, and the ready availability of lethal means to commit suicide.
Adolescents are particularly vulnerable to psychiatric problems due to the developmental and hormonal changes of the time. This makes them more susceptible to mood swings and impulsiveness, which increases the likelihood of suicide attempts.
Important life events like death of a loved one, breakups with friends or a partner and other losses increase the risk of suicide in adolescents. School problems and academic stress also appear to be major factors in many suicide cases. Acute conflicts with parental figures also are a common feature of youth suicide cases. Domestic violence and other family problems are associated with suicide in young people as well.
Symptoms
The teen years are a time of major changes, including physical development. They are also a time of emotional turmoil, including stress, confusion and uncertainty about the future. Problems can feel insurmountable, especially when family or friends don’t understand.
A child or adolescent who feels suicidal may show warning signs such as poor performance in school, withdrawing from normal relationships and efforts to hurt themselves. These might include cutting or scratching the body, giving away prized possessions and writing about death or suicide in journals.
Children who talk about suicide should be taken seriously and get expert help. Call 988, Kids Helpline, or your local hospital emergency department right away. Remove any lethal items from the home, such as guns and knives. Help your teen follow their treatment plan, and make sure that they have access to medicines that can lower the risk of suicide, such as antidepressants. Help them find support groups, such as Beyond Blue.
Treatment
A variety of therapeutic approaches have been developed and tested to manage suicidal behavior among adolescents, including in-school programs, suicide prevention hotlines, individualized psychiatric care at hospital outpatient clinics, cognitive behavioral therapies, psychotherapy and medication management. However, because suicide is a relatively rare event, obtaining large enough sample sizes to detect clinically meaningful changes using the gold-standard of controlled trials is difficult.
Trauma centers caring for adolescent patients should consider universal screening for depression and suicidality, using tools such as the PHQ-9 and CES-DC (e.g., a suicide screening questionnaire with high sensitivity in trauma patients), and establishing a system for referrals and patient support. In addition, family treatment such as Attachment Based Family Therapy has been shown to reduce suicide risk in teens with PTSD after trauma.
It is important for parents to remember that any child who has attempted suicide needs a complete medical and mental health evaluation, and may need an extended stay at a hospital inpatient facility to ensure their safety. Often, a teen who is in crisis will refuse to go to a mental health professional, but it is vital for them to attend.
Prevention
There is much that can be done at the community level to prevent youth suicide. Families, friends, school administrators, teachers, coaches and extracurricular activity leaders, religious and spiritual leaders, and community organizations can all take steps to reduce youth suicide by addressing risk factors and warning signs.
For example, limiting access to medications that can cause sedation or agitation (including over-the-counter and prescription drugs), removing means of self harm, such as razor blades and hanging ropes, and keeping all firearms locked away are important measures to take. Many communities have a medication disposal program that you can use to safely dispose of old medications.
Educating teens and promoting hope is also important. Many campaigns, such as It Gets Better, Born This Way, I Get Bullied Too, and The Trevor Project, are aimed at giving hope to gay, lesbian, bisexual, transgender, and queer youth and abolishing the sense of isolation and depression that can lead to suicide.