Talking about suicide is not normal, and any teen talking about it should be taken seriously. Some warning signs include avoiding friends, getting into trouble with school or doing risky things.
Youth suicide research has made significant advances in epidemiology and potential etiological mechanisms, and is making promising strides in intervention and prevention. But more work is needed.
Risk factors
Suicide risk factors for youth include mental health problems like depression, anxiety and substance use. Past suicide attempts and a family history of suicide are also big risks. Other risk factors include access to lethal means and high levels of stress and conflict in the home, school or community.
According to 2023 YRBS data, nearly one third of students reported that they experienced poor mental health most or all of the time. This number was higher for female and LGBQ+ students.
Protective factors include having good problem-solving skills and feeling connected to people in their lives, particularly those who are supportive of them. Kids who have access to healthy food and exercise are less likely to try to harm themselves. Also, kids who have a strong connection to their families and communities are at lower risk of suicide. Finally, limiting exposure to media violence and social media use is protective. This is a key part of addressing this crisis.
Warning signs
Regardless of their age, a person who threatens suicide should be taken seriously. Threats, thoughts, or actions related to suicide can be a cry for help and should be assessed by trained mental health professionals, preferably before a crisis situation develops.
Children and adolescents who suicide often have a combination of risk factors. They may have a history of mood disorders, like depression or bipolar disorder, or experience stress due to medical, social or family problems. They may have access to a means of self-harm, such as guns or pills, or be at risk of violence and bullying. They might be influenced by the suicide of a friend or relative.
Symptoms of suicidal ideation or behavior include talking about suicide, making threats or planning to kill themselves, frequent complaining about stomachaches and headaches, preoccupation with death or giving away prized possessions. A psychiatric assessment is recommended for all youth who have thoughts of killing themselves. The Patient Health Questionnaire-9 (PHQ-9), validated in adults and adolescents, or the Center for Epidemiological Studies Depression Scale for Children and Adolescents (CES-DC) should be used.
Treatment
The first step in effective treatment is to recognize that there is a problem and to get the teen in for mental health care. A mental health professional can help them work through their issues and learn coping skills to prevent future episodes.
Some psychosocial interventions have shown promising results, including those that include a family component. This makes sense, as most teens live with their parents and rely on them for transportation and financial support. Moreover, it is important for the teen to know that their family cares about them and is available to talk through problems.
Future-oriented therapy involves helping the teen imagine their life in a realistic and believable way, which can generate hope and reduce suicidal thoughts. However, this is an area where more research is needed. Studies need to be conducted in clinical, tertiary education/workplace and community settings. They also need to include a variety of study designs and intervention types.
Prevention
A teen’s mental health is a key factor in their ability to overcome challenges and maintain healthy relationships. Students need to know they can reach out to their parents and school staff for help when they are struggling. They should also be taught how to recognize warning signs of suicide in themselves and others.
It’s important for schools to have a comprehensive suicide prevention plan in place. Schools are a natural setting to support mental health. This can include intentionally examining existing programs and initiatives that can serve as youth suicide prevention access points. It can also include planning for youth suicide prevention through an upstream approach that supports a positive school climate and a multi-tiered system of support that includes universal support (Tier 1), targeted supports for groups or individuals at risk for suicide (Tier 2), and specialized responses to prevent, intervene, and respond to youth suicidal behavior (Tier 3).
Any young person who expresses thoughts, feelings, or behaviors associated with suicide should be taken seriously. They should be seen by a medical professional to rule out life-threatening physical problems and treated for their mental illness.