How to Navigate the Difficult Topic of Suicide with Kids and Adolescents
Despite efforts to return to a version of “post-pandemic normalcy,” the reality is that youth in the United States are still struggling, concerningly so, with their mental health. It’s no question that the height of COVID-19 took a social, emotional and mental toll on school-aged kids who went through a uniquely isolating experience. But what pediatric psychology experts continue to clarify, and what a Lurie Children’s study revealed, was that the youth mental health crisis was serious long before their worlds changed in spring of 2020. According to the study, there was a surge of emergency visits related to youth suicide ideation from 2016 to 2019.
While it can be a scary and daunting subject for families to surface with kids and adolescents, what experts have learned is that communication about suicide can make all the difference in potential outcomes. The details below shed light on who suicidal ideation is impacting and the importance of raising these hard conversations at a time when suicide is the second-leading cause of death for individuals ages 10-14, and there’s a reported increase of suicide-related deaths in 2021, particularly among males ages 15-24 (CDC).
Know what to look for
Teens are particularly at risk for developing suicidal ideations or attempting suicide due to several factors, including puberty and increase in hormone development as well as ongoing brain development.
Parents and caregivers should be observant of their child’s behavior and know that risk factors can include things such as:
- School stress
- Community violence and trauma
- Lack of access to medical and mental health care
- Peer difficulty (i.e., difficulty with friendships, difficulty with romantic relationships)
- Bullying/interpersonal violence
- A history of mental health diagnoses, such as depression or anxiety
- Substance use
- Feelings of hopelessness
- A history of suicidal thinking or suicide attempts
There can also be additional risk factors dependent on gender, race and ethnicity, and being a member of the LGBTQIA community. Young people who identify with the BIPOC (Black, Indigenous, and People of Color) communities and with the LGBTQIA communities are at greater risk of mental health conditions and suicide attempts.
Having a diagnosed mental health condition, such as depression, also increases the level of risk of suicide attempts for a young person, as well as having a history of suicidal ideations or suicide attempts.
Warning signs of suicidal ideation may include, but are not limited to:
- Increased irritability
- Changes in appetite
- Sleep disturbance (either not sleeping or staying awake all night)
- Lack of energy
- Inability to think clearly/concentration problems
- Intense sadness and/or hopelessness
- Not caring about activities that used to matter
- Declining school performance/increased absences from school
- Social withdrawal from family, friends, sports, social activities
- Substance abuse
- Risky behavior
- Giving away possessions
- Preoccupation with death (such as repeated themes of death in artwork or written assignments)
Of equal importance is recognition of the protective factors a young person has access to. A protective factor is something in a young person’s life that helps decrease the risk of suicide and promotes resiliency.
Protective factors can include:
- Connection and access to medical and mental health care
- Engagement in social activities and strong connections to peers, family, and other communities
- Reasons for living
- Effective coping strategies
- Reduced access to lethal means, including secure storage of firearms
Conversation and connection are crucial
If families suspect their loved one is struggling with their mental health, one of the most important and encouraged actions to take is to inquire about suicide.
Myths suggest that by asking young people about suicide that it will ‘plant’ a thought in their head, however data consistently suggests that this is not true and continues to support the critical importance of asking young people directly about suicide and suicidal thinking.
It’s important to create a safe space for young people by not only hearing and validating whatever feelings they might bring up but thanking them for trusting you with the vulnerable details in the first place. Saying something like: “I really appreciate you talking to me about this, I know how hard these thoughts and feelings can be to talk about” can go a long way. Additionally, normalizing and validating stressors and feelings also sends the message to the young person that you are a safe person who is not there to judge.
In talking with a young person about suicide, whether they know anyone who has attempted suicide or if they themselves have ever had these thoughts, it can also be helpful to keep questions as open-ended as possible versus probing for a “why.” Follow-up questions that are rooted in empathy and that create trust, like “I want to understand this thought and feeling a bit more. Tell me more about what was causing this stress and what the thought felt like” tend to be more impactful.
Language is powerful, and when talking to a young person about their own thoughts of suicide, decreasing stigma by using “person-first” language can help the person not feel judged or ashamed of how they think and feel. For example, rather than describing an individual as “suicidal,” noting that the person is “experiencing suicidal thinking” helps create a neutral and safe space to further talk about what they are experiencing at that time.
In addition to creating open lines of honesty and communication, ensuring safety is vital when a young person reports suicidal thinking, a history of suicide attempts, or other mental health related concerns.
For parents, this may look like:
- Restricting access to all lethal means, including firearms and other weapons
- Reaching out to the child’s medical provider for further guidance
- Seeking an emergency psychiatric evaluation in an emergency department or through a community mental health agency
For peers and other individuals, this may look like:
- Talking to a school counselor about their concerns
- Providing friend(s) with crisis hotline numbers such as 988 and encouraging them to call
There is never a wrong time or reason to seek help for yourself or for someone you care about. If someone reports that they’re experiencing suicidal thoughts, it’s important to seek help immediately.
While navigating a mental health crisis can be tricky, it should never be ignored or assumed that it will resolve itself. Discussing scenarios and treatment options without shame and judgement helps reduce the stigma of mental health difficulties and creates emotional safety for children, adolescents and adults alike.
It’s recommended to always talk to a child’s primary care provider to explore options best suited to meet that child’s needs. If immediate safety concerns become apparent at any time, it’s recommended to go to the nearest Emergency Department where a psychiatric assessment can be provided, or to access crisis resources such as the National Suicide and Crisis Hotline (text or call 988) or the crisis line through the Trevor Project (1-866-488-7386).