Suicide Risk Factors, Communication and Prevention for Kids & Teens

Contributing experts: Mallory Hilliard, LCSW, CADC, and Maria H. Rahmandar, Medical Director, Substance Use & Prevention Program (SUPP), The Potocsnak Family Division of Adolescent and Young Adult Medicine

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 is 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. And these trends have continued.

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, and knowing how to identify the risk factors, can make all the difference in potential outcomes. The details below shed light on the importance of tuning into your child’s behavior and raising these hard conversations at a time when suicide is the second-leading cause of death for individuals ages 10-14 and there is a reported increase of suicide-related deaths in 2021, particularly among males ages 15-24 (CDC).

Suicide risk factors and warning signs

Teens are particularly at risk for developing suicidal ideations or attempting suicide due to several factors. Parents and caregivers should be observant of their child’s behavior and realize that they might be facing a variety of risk factors they have not considered before. These might include:

• 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 self-harm behavior, suicidal thinking or suicide attempts
• Loss of a loved one to death, divorce, deployment, deportation or incarceration
• Financial instability that causes worry and insecurity
• Dealing with a major health issue
• Stigma (the belief that it is wrong or shameful to talk about mental health or suicide)

There can also be additional risk factors dependent on discrimination gender identity, sexuality, and race and ethnicity. A supportive family and community can help decrease risks for minoritized populations.

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.

It is important to be aware of your child’s behavior and keep an eye particularly on non-verbal cues. Do not assume their changed behavior is a passing mood or “teenage drama.” 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 use 
• 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

Talking to kids about suicide in a safe way

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. Do not wait for a child to come to you.

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 is 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” or "It sounds like you're in tremendous pain and you can't see a way out" 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 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. Removing shame and blame is also important to decrease stigma, using terms such as “died by suicide” instead of “committed suicide” and “suicide attempt” instead of “unsuccessful or failed suicide.”

Taking action and prioritizing safety

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. If depression, self-harm or vague spoken or written references to suicide are made, consult their primary care provider as soon as possible and consider contacting a school therapist, local mental health provider or a national suicide hotline for guidance.

Healthcare providers can help to outline a safety plan that covers:

• Warning signs or triggers your child feels will lead to suicidal thoughts
• Possible steps to help them cope when they feel triggered
• Sources of support: family, friends, teachers, mentors and others
• Emergency contacts and steps to take if things get worse

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). As the primary caregiver, prioritize the child’s safety at home by doing your best to remove or restrict access to all lethal means. This includes:

• Firearms
• Medications
• Alcohol
• Illicit drugs
• Household cleaners and other poisonous products
• Canned dusting products
• Inhalants
• Antifreeze
• Knives, razors, or other weapons
• Ropes, belts and cords

For peers and other individuals, consider talking to the family of the person struggling or the school counselor about your concerns, and offer your friend(s) crisis hotline numbers such as 988 and encourage 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 are experiencing suicidal thoughts, it is 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 judgment helps reduce the stigma of mental health difficulties and creates emotional safety for children, adolescents and adults alike.

Being supportive and proactive through treatment

When your child’s mental health and safety is in danger, their care team will likely recommend a combination of support tactics such as medications, talk therapy, and lifestyle adjustments or interventions that help to reduce stress, such as yoga, meditation or journaling.

As they begin their treatment journey, keep these things in mind:

• Focus on creating hope and remind them that the challenging times will not last forever. Effective treatment works.
• Eliminate the mental health stigma by reminding the child that 1 in 5 people have mental health symptoms at some point in their lives. Mental health is just as important as physical health.
• Gently encourage them to spend time with family and friends once they feel up to it, as social support is a helpful tool.
• Encourage an open dialogue around social media use and ask how your adolescent feels after using social media. Consider discussing boundaries around social media to help lessen potential triggers.
• Encourage healthy sleep habits and physical movement they enjoy, even if it is just a daily walk outside. Both greatly help to balance stress.
• Remind them that healing takes time and that self-care, balance and moderation are all important while in treatment. Help them be patient and go easy on themselves.

Seeing your child struggle with suicidal thoughts or behaviors can be incredibly difficult for caregivers, so it is important to also take care of yourself along the way.

Additional resources

The American Foundation for Suicide Prevention (AFSP)

Language Matters: Safe Communication for Suicide Prevention (Canada.ca)

Suicide Prevention: 12 Things Parents Can Do (HealthyChildren.org)

Suicide Prevention (cdc.gov)

What should I do if my child or teen is thinking about suicide? (HealthyChildren.org)

Youth, Adolescent, and Young Adult Suicide Prevention (illinois.gov)

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