September 12, 2014
“Doctor, he said he just doesn’t care about living anymore. He’s been really upset for a while, and when his girlfriend broke things off, he just shut down.”
Steve and I get calls like this all too frequently.
Situations like this are terribly frightening for parents. Kids break up with girlfriends and boyfriends all the time; how, parents wonder, could it be so bad that life might not be worth living? How could anything be so bad?
For the clinicians among us who work with kids, these moments endure for us the strange paradox of being both common and potentially anxiety-provoking. We know that kids suffer all sorts of challenges as they navigate the murky waters of growing up. We also know that rarely do these kids take their own lives. Nevertheless, some of them do, and parents and clinicians alike must share the burden of the inexact science of determining where the greatest risks lie.
Let’s look at a fictional—yet highly representative—scenario.
Charlie, a 16-year-old high school junior was not acting like himself. In fact, those were his parents’ very words. Previously a great student and popular kid, Charlie gradually started acting like a different person. He became more irritable, more isolative, and seemed to stop caring about or even completing his homework. Then one morning, just before before school, he told his mother that he wished he were dead.
Myths: Common But Distorted
There are countless other examples. Sometimes kids say something. Sometimes they post a frightening array of hopeless lyrics on Facebook. And most of the time—and this is important—kids don’t do anything to hurt themselves. Morbid lyrics and even suicidal sentiments are surprisingly common in adolescence. Still, this does not mean for a second that we take these warning signs lightly. In fact, there is a common myth that asking about suicide perpetuates suicide. There is not a shred of evidence in support of this concern, and in the studies that have been done, the opposite appears to be true. Kids are glad to be asked.
We have to ask. It’s really that simple.
But, we ask with some very basic facts in mind.
Suicidal thinking, and even serious contemplation of suicide, is, as we mentioned, very common among high school students. In the Centers for Disease Control and Prevention Youth Risk Behavior Surveillance Survey distributed every two years to about 14,000 high school kids in grades 9-12, students are queried about a range of high-risk behaviors, including suicide.
The Underlying Mood Disorder
In 2013, 17% of teens reported seriously considering suicide, and 8% made actual attempts. Current studies indicate that each year in the United States, up to 15 in 100,000 kids will die by suicide, making suicide the third leading cause of death in this age group. Additionally, we have no idea how many deaths by accidents (the leading cause of death) were, in fact, the product of latent or active suicidal behavior.
The greatest risk factors for a teenager to commit suicide include the presence of some mood disorder (most commonly depression), coupled with the use of substances and previous attempts. Although research suggests that girls attempt suicide more often, boys more often die from suicide. Add these risk factors together, and it turns out that Caucasian boys are at the highest risk.
Some of this is also driven by a still immature brain. Impulsive behavior is notoriously common in teens, and in many cases, it looks as if the act of suicide was the result of a rash and sudden decision.
So, we know kids mostly don’t try to hurt themselves, but we also know that sometimes they do. That sounds like a recipe for unfettered worry among parents. What can parents do when faced with these frightening scenarios?
Tips For Parents
However, having an organizing set of principles when engaging in these difficult conversations is immeasurably important.
First, keep in mind that the thought alone is not, by definition, dangerous. Many people will find themselves thinking at some point in their lives that the world would be better off without them. Still, finding out whether those thoughts exist is an important warning sign. If those thoughts are combined with intent, then concern should immediately heighten. Most importantly, the presence of a plan should sound the alarm.
So, begin by asking general questions about what’s going on, and how your kid is feeling. Ask if he or she has thought about self-harm. Then, if there is any reason at all to suspect that your child is at risk, ask more specifically about what he or she is thinking, intending and/or planning.
Pay special attention during these inquiries to the meaning of dying for your child.
For example, if Grandma has just died (who happened to be your child’s closest friend and support), this kind of stressor could tip the scales negatively. Perhaps your teen might feel that things would be better if he or she were with Grandma in heaven.
Consider as well the meaning of life events at home, in school, and among your child’s peer group. If you and your partner have been fighting, is your child upset about the possibility of divorce? Would suicide be an angry response, an enacted desire to get back at you for the problems at home? While this may seem an immature response, it may seem an entirely reasonable response to your teen.
Remember as well that these life stresses and emotional responses usually do not precipitate suicide. However, if your teen is clinically depressed, taking substances, or suffering from another psychiatric disorder, the act of suicide or suicide attempts become more likely.
We can know by checking in with others who also know your child. Often, kids know each other best. If you’re worried, it makes sense to (within reason) inquire among the peer group or the peer group’s parents. This may seem awkward, and these kinds of questions are by definition difficult. Still, you want to ask. The increasing presence of alcohol or drugs, for example, can be discovered in this way. As we’ve discussed, substances can decrease the inhibition that would otherwise be utilized to prevent self-harm.
Finally, if there is a family history of mood disorder, suicide, or substance use disorders, your worry meter should increase.
How To Navigate The Mental Health System
The mental health system is not easy to understand. Access to care is limited, especially among professionals trained in child and adolescent psychiatry and psychology.
If your inventory of questions leads you to really worry, go to a local emergency room immediately. If possible, you should try to go to an emergency room that has a department of psychiatry or professional mental health workers readily available. Don’t, as we said, worry alone. Enlist others in the difficult decision about what to do next.
Suicide is a problem among adolescents. While mental health clinicians may receive these calls often, they’re never—and shouldn’t be—easy. But, this is also what we in mental health have signed up to do. We cannot be slow in taking the necessary steps to ensure the safety of our teens.
A version of this post originally appeared and was written by the authors (Beresin and Schlozman) on WBUR’s CommonHealth on September 12, 2014.