By Hongmarie Martinez, PsyD, Licensed Psychologist | Behavior Therapy Associates | Somerset, New Jersey
Suicidality can affect all age groups, including during the adolescent years (Centers for Disease Control and Prevention [CDC], National Center for Injury Prevention and Control, 2023). The CDC’s Division of Adolescent and School Health (2023) reported data concerning U.S. high school students’ mental health and experience with suicidal thoughts and behaviors from 2011 to 2021 in their Youth Risk Behavior Survey (YRBS). The findings from the survey revealed that the percentage of U.S. high school students who felt “persistent feelings of sadness or hopelessness” increased from 28% in 2011 to 42% in 2021. Since 2011, those who seriously contemplated attempting suicide rose to 22%, individuals who made a suicide plan increased to 18%, while those who made a suicide attempt rose to 10% in 2021. The data from the CDC’s YRBS survey further indicated that U.S. high school students across genders and racial/ethnic groups were affected in all domains. Moreover, currently suicide has also been found to be the third leading cause of death for adolescents aged 15-19 years-old (CDC, National Center for Health Statistics, n.d.). It can certainly be disconcerting for parents to think about your teens struggling with their mental health and feeling suicidal. Fortunately, there are indicators that parents can look for to better understand suicidality in adolescents.
The warning signs or “red flags” of suicidality that parents should attend to can manifest as changes in your teen’s thoughts, feelings, and behaviors, such as (Alvord, Kaslow, Owens, & Gurwitch, 2018; American Psychological Association, 2019):
- Making statements (verbally or in writing) related to death or suicide threats, such as “I wish I were dead”, “Everybody would be better off without me”, “I can’t go on”, “I want to die/kill myself”, “I thought about how I would end my life”, and “I tried to end my life”;
- Preoccupation with death and dying, which may show up via teen’s social media, art work, or writings;
- Exhibiting symptoms of depression such as persistent low/depressed mood, feelings/expressions of hopelessness (i.e., doesn’t indicate hope for the future) and worthlessness (i.e., negative thoughts about self, perception that one is a burden to others), self-harm behavior (i.e., cutting), loss of interest in activities and maintaining appearance/hygiene, withdrawal/spending less time with friends/family, difficulties with appetite, sleep, and focusing;
- Increase in risk-taking behaviors (i.e., reckless driving);
- Demonstrates extreme changes in behavior; Increase in substance use;
- Dramatic decline in academic performance;
- Giving away one’s possessions;
- Looking into methods for suicide and accessing the means (i.e., collecting pills, obtaining a weapon)
In addition to being familiar with the warning signs, it can also be valuable for parents to have knowledge about the risk factors for suicidality or various biological, psychological, and interpersonal factors that may increase the likelihood of suicidal thinking and behavior, such as (Bilsen, 2018; Alvord et al., 2018):
- Presence of mental illness (i.e., mood disorders such as depression are often commonly associated with suicide, bipolar, anxiety disorders, substance abuse, PTSD);
- Feelings of hopelessness and worthlessness;
- Family history of mental illness and suicide attempts;
- Challenges with substance use;
- Difficulties with impulsive behavior;
- Relationship challenges/loss (i.e., romantic breakup, friendship ending, death of a loved one, parental or peer conflict, lack of social support);
- Bullying (being either a victim or a perpetrator);
- Poor problem-solving skills and ways of coping with emotions;
- Access to means (i.e., firearm in the home);
- Exposure to a peer completing suicide;
- Past suicide behavior/attempts
As one’s mental health can be impacted by a complex set of genetic and environmental factors, teens may exhibit any combination of warning signs and risk factors. When parents have this knowledge along with an understanding of supportive practices to engage in with teens about addressing suicidality, both teens and parents alike may be better equipped to navigate this serious mental health challenge. So what steps can you take as a parent if you suspect or have knowledge that your teen is struggling with suicidality?
- Approach discussing the topic of suicide rather than avoiding it. Undoubtedly, it can be worrisome to associate suicidality with your teen. Parents may therefore be inclined to not talk about the topic out of fear that it will increase suicidality in their teen. However, talking about suicide may provide your teen with a sense of relief and comfort knowing that you care to ask and are willing to talk about their struggles. This can open the door for ongoing communication with your teen going forward.
- Communicate with your teen in a calm, empathic, and non-judgmental manner. Once you decide to approach talking about suicide with your teen, you may be wondering, “What do I say? How exactly do I start talking about it with them?” It may be helpful to start with a general check-in about their mental health overall before asking about more specifics, such as “I wanted to check-in and see how you’ve been feeling lately” which can be coupled with “I’m here to support you with whatever you may be feeling or going through.” And then really listen to what they have to say. If your teen chooses to divulge anything, including anything related to suicide, it can be beneficial to follow up with validating statements that can help them to feel heard and understood, such as “That sounds really difficult what you’ve been experiencing” with the addition of “I’m really glad you’re sharing this with me, I know this may not be easy to talk about.” Due to natural feelings of concern, parents may feel inclined to ask questions, such as “Why didn’t you tell me sooner you were feeling suicidal? Why would you be thinking that?” Questions like these may result in your teen feeling judged, invalidated, and want to retreat; as difficult as it may be for parents to address the topic, it may also be stressful for teens to discuss their mental health or suicide with parents. If your teen doesn’t appear to be ready to talk, emphasizing an open-door policy that you are always available to them when they are ready can also increase open communication.
- Be intentional about when and where you have check-ins with your teen. When and where you have conversations with your teen about their mental health may impact the outcome of your check-in. Identify with your teen a specific time of day and place that will be workable for you both. Having a conversation where you and your teen have privacy, have sufficient time to connect, and when both of you can be fully present and not distracted or interrupted are factors for consideration to help with appropriate timing of important conversations. For example, checking in before bedtime may be more ideal than during a ten-minute car ride to soccer practice.
- Ask direct questions to assess your teen’s safety. When asking questions to assess your teen’s safety, it’s important to ask direct questions about suicidality that allow your teen to freely respond; try to avoid inserting your own answer into the response. For example, you can ask, “Have you had any thoughts of ending your life?” versus “I just want to make sure…you’re not suicidal, right?” The latter may send the message that it’s not okay for them to be feeling suicidal. Additionally, if your teen responds ‘yes’, it’s critical to also ask if they have thought about any specific methods/plan, intend to follow through, or have engaged in any preparatory behaviors to end their life. Continue with empathy, non-judgment, and follow-up questions that may lend themselves to your teen elaborating further, such as “Can you tell me more so I can better understand?”
- Keep your teen safe; remove access to means and supervise your teen. If your teen expresses specific methods of how they plan to hurt themselves or has already taken steps to do so, it is important to maintain a safe environment for them by removing any access to means that they may describe (i.e., knives, firearms, medicine such as Tylenol). In any of these cases, you should assume that they are in imminent danger, and it is imperative to supervise them until they are connected with emergency care.
- Take your teen’s warning signs seriously and seek professional help/emergency care. Avoid assuming that your teen will “get over it” or assuming that they would never do anything to hurt themselves. Seek out mental health treatment for further evaluation/9-1-1/immediate emergency care at your nearest hospital if you suspect your teen is at imminent risk of harming or killing themselves.
- Consider pursuing psychotherapy for your teen. Therapy may provide your teen with some hope knowing there is professional support available to them. In pursuing a mental health therapist, you and your teen may better understand the nature of their suicidality, any possible underlying mental health diagnoses, and learn additional ways that you can support them. Also, it is important for your teen to have a professional who can help them navigate their difficult thoughts and feelings and gain the tools to address their mental health challenges/suicidality.
- Identify supports in all settings. Work with your teen to identify all of the trusted adults that they can connect with at home and school (i.e., school counselor, school psychologist), so your teen has the necessary supports in place when they need it. This may involve reaching out directly to your teen’s school-based mental health providers and/or working with a private therapist to ensure there is an ongoing support team in all environments.
Thus, it is critical for parents to familiarize themselves with the warning signs and risk factors for suicide and to approach the topic with your teen in a diligent, compassionate manner. It is also important to understand that additional supports and care may be needed. These steps may contribute to your teen feeling supported with their mental health and help to mitigate their experiences with suicidality.
References
Alvord, M., Kaslow N., Owens, S., & Gurwitch, R. (2018, April 19). Talking to teens: Suicide prevention. American Psychological Association.
https://www.apa.org/topics/suicide/prevention-teens
American Psychological Association (2019, November). Suicide warning signs.
https://www.apa.org/topics/suicide/signs
Bilsen, J. (2018). Suicide and Youth: Risk Factors. Frontiers in psychiatry, 9, 540.
https://doi.org/10.3389/fpsyt.2018.00540
Centers for Disease Control and Prevention, Division of Adolescent and School Health. (2023).
Youth Risk Behavior Survey Data Summary and Trends Report: 2011-2021 [PDF File].
https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf
Centers for Disease Control and Prevention, National Center for Health Statistics. (n.d.).
Adolescent Health. https://www.cdc.gov/nchs/fastats/adolescent-health.htm
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2023, May). Preventing Suicide [PDF File].
https://www.cdc.gov/suicide/pdf/NCIPC-Suicide-FactSheet-508_FINAL.pdf
Behavior Therapy Associates is proud to provide comprehensive services throughout New Jersey (including South, Central, and North Jersey) and Pennsylvania. We also provide telepsychology services under the Authority to Practice Interjurisdictional Telepsychology (APIT) to more than 25 states throughout the United States. Click here for to see if your state is included: https://psypact.site-ym.com/page/psypactmap
Hongmarie Martinez, Psy.D. is a licensed psychologist in New Jersey and New York and a certified school psychologist in New Jersey. She works at Behavior Therapy Associates in Somerset, New Jersey. Dr. Martinez has the authority to practice interjurisdictional telepsychology (APIT) from the PSYPACT commission, allowing her to provide telepsychology to clients in many states. She can be reached at hmartinez@BehaviorTherapyAssociates.com and at www.BehaviorTherapyAssociates.com.
This article originally was published in the Spring 2023 edition of the Behavioral Health News. Please click the following link to Behavioral Health News: https://behavioralhealthnews.org/bhn-summer-2023-issue/
