Heart-breaking news stories of young people taking their own lives have become all-too-familiar in recent years. So, new findings that suicidal ideation and suicide attempts among children and teens are on the rise in the United States unfortunately comes as no surprise.
This disturbing trend indicates that parents, schools and the pediatric health system need to focus more than ever on recognizing red flags and acting on them effectively. The key questions on everyone’s minds include what are youth suicide warning signs, and how to effectively act on them?
Suicide is the second leading cause of death for children and teens between the ages of 10 and 24. Children’s hospitals across the country have seen a steady increase in the number of children and teens with suicide ideation (SI) and suicide attempts (SA’s) over the past decade, according to research recently reported by the journal Pediatrics. Researchers found children’s hospitals have experienced a growing number of emergency and inpatient encounters for SI and SA’s, particularly for adolescents 12 to 14 years old and 15 to 17 years old. In fact, the annual percentage of all visits for SI and SA’s nearly doubled over a seven-year period, increasing from 0.66 percent in 2008 to 1.82 percent in 2015.
Over the past three years, my colleagues, O’Nisha Lawrence, M.D., Jason Lewis, Ph.D., and I have conducted training for all staff and new trainees of the Department of Child and Adolescent Psychiatry & Behavioral Sciences at CHOP on suicidal ideation and behavior, assessment approaches for children and adolescents, and recognizing when youth are at increased risk. We emphasized, among other things, that timely identification of suicidal ideation and behavior is an essential component in suicide prevention.
What Can Adults in the Community Do?
Parents, teachers, coaches, and other adults who regularly interact with children and teens are on the front lines of identifying and responding to warning signs in youth as soon as possible to guide them appropriately.
Children and teens who express thoughts about killing themselves, also known as suicidal ideation, should always be taken seriously, no matter how vague their statements might be. Thoughts such as “I wish I weren’t here anymore”, “I wish I’d never been born”, or “I hope I don’t wake up tomorrow” could be a general expression of frustration, disappointment, or a sign of a more significant inner struggle. The most effective way to find out is for people who know the child to initiate a discussion to explore the thoughts and feelings behind the words.
More concerning are specific statements in which the child or teen talks about killing themselves (such as “I want to kill myself”). A person identifying using a specific method or plan (such as day, time, place, and/or means) is associated with more severe suicidal ideation, as this suggests an even stronger desire to take his or her own life. It is particularly important in such situations for adults to immediately respond to support the child or teen in getting through the crisis, and connect them with behavioral health professionals:
- Calmly engage with the child or teen with a supportive and caring attitude, and talk through his or her thoughts and feelings.
- Do not leave the child or teen unsupervised if you have concerns about their safety.
- Contact a health care provider, starting with their regular doctor or mental health provider, or a suicide support phone, text or chat hotline.
- Secure guns and restrict access to any other means the child or teen may be able to use to harm themselves (such as medications, sharp objects, means of strangulation).
Other warning signs that parents and authority figures should take seriously include:
- Worsening in anxiety, agitation, or sleep patterns;
- Withdrawal from family, friends and community activities;
- Expressing feelings of being trapped and there’s no way out of their situation;
- Giving away prized possessions; and
- Increasingly reckless behavior and/or uncontrolled anger.
Without sufficient and consistent emotional support, children and teens struggle to cope with complex situations and emotions. The combination of a youth’s immature impulse control and understanding of the permanence or ramifications of death increases the risk that suicide seems like a way to solve or escape problems. By acting on suicidal ideation and other warning signs as soon as possible, parents, educators and the healthcare community can help children and teens understand and cope with their thoughts and feelings in a healthy manner.
Resources Focusing on Suicide Prevention
1-800-273-8255 – National Suicide Prevention Lifeline
1-800-799-4889 – Deaf/Hard of Hearing Suicide Prevention Lifeline (chat also available)
1-888-628-9454 – Spanish Language Suicide Prevention Lifeline
Crisis Text Line: Text “Home” to 741741 for free, 24-hour support
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