Suicide ideation — thoughts about or a preoccupation with suicide — isn’t just a term to me; I believed my life was worthless at age 17. It took me hours to fall asleep, and I saw no reason to leave the warmth of my bed and attend school. My parents brought me to a counselor, whom I easily fooled into believing I was fine. The next counselor managed to diagnose clinical depression. With therapy and medication, the thoughts of suicide abated, and I began building a mental health toolbox that I continue to use every single day.
As a parent now, my quest to be well versed in youth suicide prevention stems from the knowledge that mental health fluctuates for people all the time. Staying alert to distress signals from our children and other teens we know is vital work. Suicide is the third-leading cause of death for people ages 10–14 and the second-leading cause of death for people ages 15-24, and there are more than 5,400 suicide attempts by students in grades 7–12 every single day in the United States.
Unfortunately, in Washington state, the suicide rate is higher than our country’s national average: 15.2 per 100,000 compared to a national average of 14 per 100,000. A 2014 survey of our state’s middle and high schools reports that 1 in 10 students “had made a suicide attempt” in the last year while 1 in 5 students “had seriously thought about it.”
Focus on prevention
Parents can learn the warning signs, how to talk about mental health and about the suicide prevention resources within our community. “It is vital to remember: Most suicides are preventable,” writes Jennifer Stuber, Ph.D., cofounder and faculty director at Forefront: Innovations in Suicide Prevention at the University of Washington, in a recent Seattle Times editorial.
While risk factors include issues around relationships, academic pressure, anxiety and family survival issues, being different is also a significant factor, says Sue Eastgard, MSW, cofounder and director of training at Forefront. This includes teens who have physical health issues and teens who identify as lesbian, gay, bisexual or transgender. Some minority groups such as Native Americans are high-risk, but suicide ideation cuts across all populations. Upper-middle-class tweens and teens are under lots of pressure and are at risk, too, says Vicki Wagner, executive director of the Youth Suicide Prevention Program.
“Warning signs are often really subtle: a mood change, a young person who really excelled and now their grades are slipping. Isolation is a real warning sign; someone who is outgoing with family and now doesn’t want to interact. Multiple signs coupled together elevates the risk,” says Wagner. Something seemingly innocuous, like taking a favorite baseball shirt and giving it away, could raise parental alarm bells when paired with other signs, she warns.
Eastgard notes that although teens are notorious for moodiness, erring on the side of caution and investigating is a good idea. Gather information, starting at school and including venues your teenager frequents, from a faith community to a sports environment. If others who interact with your child are seeing worrisome behavior, too, Eastgard recommends seeking counseling for your child.
Start the conversation
Two of the biggest misconceptions regarding suicide are that talking about depression increases depression, and that saying the word “suicide” out loud plants the idea of suicide in a person’s brain. “Sit down with your child. It’s starting up a conversation where you are not confronting them, instead talking in an open, kind way. As you get into the conversation, ask, ‘Are you thinking about suicide?’ Suicide is a response to just not knowing how to deal with something going on in their life. You’re trying to confront that head on,” Wagner says.
She notes that a struggling child feels relief once he says it out loud, and once someone says they care. “With depression and suicide ideation, you shut yourself off from lots of people, so it’s a relief to get some help.”
Invite your child to counseling in a fairly forceful way, Eastgard says. “Say, ‘We will go as a family. It’s the family having the problem; it’s not your problem. We are all having trouble figuring out how to get through these years and this family needs some help learning how to communicate better. You are going to see this counselor three times, and if you don’t like it after that, we will try another counselor three times,’” she says.
When your teenager is in a hard place, it helps to find a therapist willing to converse with the parents about what’s going on (which means a signed release from the patient). “The parents’ tool kit comes not from a checklist on a website, but from a conversation between the parents, the therapist and the child sitting in same room. Ask what would be most supportive for your child right now,” Eastgard says.
Along with counseling, try to make school a supportive place. Think about who needs to know about your child’s situation and whether there can be leeway around schoolwork and tests for a period of time. Although Seattle Public Schools has middle school wellness centers and teen health centers in high schools, not all schools have staff members trained in the intricacies of dealing with depressed tweens and teens. Often at the high school level, the counselors are focused on academic counseling as opposed to mental health issues. This means parents need to advocate for their child at school.
It’s important to note that impulsivity plays a huge role in teens’ lives. “One study showed that [while adults] think for three days about suicide, a young adult thinks for a full day, and the average teen thinks less than eight hours before a suicide attempt. We know that a 15-year-old’s brain development means they have a harder time stepping back from challenges and visualizing safe paths and solutions with a long-range view,” says Mick Storck, M.D., associate professor, Division of Child and Adolescent Psychiatry, University of Washington School of Medicine/Seattle Children’s Hospital.
Lifeline: 800-273-TALK (8255)
Put the hotline number in your cell phone; if you are not worried about your own child, you can be sure you have a friend who has a child (or a partner) they are worried about.
— Jennifer Stuber, faculty director at Forefront
Make a safe environment
Teens’ increased impulsivity is why it’s vital to think about access to guns and medications. More than one in three households in the U.S. have guns, and medicine cabinets often contain stockpiles of unused medicines. In Washington state, 78 percent of firearm deaths are suicides. “If we could think about reducing lethal means around medications and guns, we would be doing something about suicide prevention. We have control over these things: Lock up guns and medicine,” Eastgard says.
When parents are dealing with a depressed or anxious teen, it’s helpful to know that your role as their overall case manager and cheerleader matters. “It can feel overwhelming, but the biggest thing parents can do is really expect their child is going to get better and to help their child persist in treatment and ask for more if they are not. If kids can persist in treatment, kids do get better,” says Laura Richardson, M.D., MPH, an adolescent medicine specialist at Seattle Children’s.
From my own history as a teen with clinical depression, I know my parents’ persistence was the first critical step to getting better, and their daily support mattered immensely. I know how to ask for help from others when I need it now, and for that I thank my parents.
Forefront, a suicide-prevention nonprofit, lists the following warning signs of suicide on its website. If you observe any of the following signs, call Lifeline at 800-273-TALK (8255).
- Talks about wanting to die or kill themselves
- Searches online for ways to kill themselves or buy a gun
- Talks about feeling trapped, in unbearable pain or about being a burden to others
- Begins using alcohol or drugs
- Acts anxious or agitated; behaves recklessly
- Sleeps too little or too much
- Withdraws or isolates themselves
- Shows rage or seeks revenge
- Displays extreme mood swings
This story was originally published on November 25, 2014. It has been updated with more recent statistics.