Suicide is rapidly increasing in teens and even children despite a strong nationwide push to raise awareness and prevent it.  In fact, suicide has increased 21% in young males and 50% in young females since 2000.  These are devastating statistics and if we are going to change this we must first understand suicide in order to prevent it.  You can watch the video about this or read a summary of the video below.

If you or a loved one is having suicidal thoughts, please go to the nearest emergency room or call 911.

 

1. Increasing National Awareness and Suicide Rates

In 1999, the US Surgeon General issued a report calling for increased awareness and treatment of suicide because it had become the second leading cause of death in teens and young adults.  While rate dropped a bit a first, but it increased in 2004 after the FDA issued a black box warning about antidepressants causing suicidal thoughts causing prescriptions of antidepressants to plummet.

The black box warning had a chilling effect and you couldn’t get a pediatrician or primary care doctor to prescribe an antidepressant for about 3 years until more research came out that showed it was only certain antidepressants that caused suicidal thoughts and no antidepressant increased suicidal behavior.  The rate of suicide started to come down again, but the financial crisis of 2008 hit and suicide rates started climbing again.

The suicide rate started to come down a bit in 2012 and 2013, but with the explosion of social media, it has sharply increased since then.  Some research studies have linked the increase in suicide to high social media use and a tendency to compare one’s life to the “perfect” lives of others presented on social media and may explain why the suicide rate is increasing twice as fast in young females as it is in young males.

Suicide attempts have also increased as well and now there are 100 to 200 attempts in teens for every completed suicide.  Suicidal thoughts are also extremely common and 25% of teens report have at least one serious suicidal thought in the past year.  Young males still complete suicide 3-4 times more and females attempt 4-5 times more, but the gap is closing.

2. The Spectrum of Suicidal Thoughts

Suicidal thoughts exist on a spectrum from mild to extreme with the mildest form of suicidal thoughts being apathetic or not caring if you are alive or dead.  The next level of suicidal thought is a passive wish for death without any thoughts of killing yourself.  Mental health professionals often refer to a passive wish for death as “passive suicidal ideation” and it is typically treated at an outpatient level unless the suicidal thoughts become active.

Moderate suicidal thoughts cross the line into thoughts about killing yourself, but lack a plan for how and lack intention or desire to act on the suicidal thoughts.  Mental health professionals refer to these types of thoughts as “active suicidal ideation without plan or intent”.  This level of suicidal thoughts often has to be carefully evaluated by mental health professionals and psychiatric hospitalization is a possibility.

Severe suicidal thoughts include an active desire to kill one’s self with a viable plan for how to do it, but with variable intent or desire to act on the plan.  People with this level of suicidal thoughts are uncertain if they will act on their thoughts and psychiatric hospitalization is usually necessary.

Extreme suicidal thought include a strong desire or intention to kill one’s self now or in the immediate future by an available means. It also includes an intense desire to kill yourself and actively looking for any means possible.  This level of suicidal thoughts requires psychiatric hospitalization and often being placed on suicide watch where a staff member constantly watches the person within arms reach.

3. Suicide Methods

Males in the US died by firearms in 56% and hanging in 30% of cases.  Females in the US died by overdose 40% of the time, but the use of firearms and hanging is increasing in females.  Worldwide hanging is the most common method of suicide.

4. Suicide Risk Factors

• Prior suicide attempt – 60x higher (prior attempt may be trivial and non-lethal)
• Cutting (if it was to relive stress with no intention to die) modestly increases risk 4 later, not in present
• Sexual orientation and gender identity issues increase the risk about 4 times
• Drug and alcohol abuse
• Family history of suicide
• High levels of family discord and/or conflict with a parent
• Early abuse and neglect
• Sexual abuse and physical abuse or exposure to domestic violence
• Unintended pregnancy especially in a family or culture that forbids premarital sex
• Breakup with a romantic partner, especially if the person is already depressed
• Bullying is a major and growing cause because social media allows enables 24/7 and wide spread social bullying
• Legal problems or being charged/committing a crime if you are from an upstanding family

5. Differences Between Suicide in Adults and Teens

When teens attempt suicide it is usually impulsive and rarely planned, which partially accounts for the lower level of lethality of suicide attempts in teens.  Availability of means is a major factor in teen attempts because many teens aren’t thinking about attempting suicide until the see the means for doing it.  Teens may also only be suicidal for a short period, often just minutes, so if no means is immediately available, they won’t attempt.

Access to unsecured firearms in the home is a major facilitator for impulsive suicide in teens (Firearms also severely maim even when they are not lethal.) . Unlocked medication, including over the counter medication such as Tylenol, acetaminophen, Advil, Motrin, ibuprofen, Aleve, naproxen and cold medicines, is the most common method of impulsive suicide attempts.

Suicide attempts in teens are so impulsive that often, the teen is just upset about something and then walk in to the bath room and see a pill bottle on the counter.  The teen is then swallowing the pills without any clear intention or desire to harm themselves.  They will often say afterwards that they don’t know why they did it and were just upset.

6. Suicidal Gestures Do Not Exist in Teens

The problem is that with teens many first attempts are impulsive and don’t seem to be serious, but then the second attempt is lethal or severely maims the teen.  The point is that there is no such thing as a suicidal gesture in a teen because teens (and especially children) don’t have clear sense of what would kill them.

Teen and children mistakenly think that 4 pills will kill them if the bottle says to only take 2 pills.  All suicide attempts, even trivial ones are serious because they strongly predict future attempts and teens quickly figure out that they have to take a a lot more pills or use a gun or hang themselves next time.  That trivial attempt is often the only warning you get that a teen is distressed and in trouble before they kill themselves.

Another difference between teens and adults is that depressed teens often engage in extreme risk taking behavior rather than having frank suicidal thoughts, which is called para-suicidal behavior.  They may not wearing helmets or seatbelts.  They may use dangerous drugs and get involved in gangs, which is actually more lethal than attempting suicide.  This is particularly common among urban Hispanic and African-American males.

7. Suicide Risks in Psychiatric Disorders (all ages)

• Major Depression – 10-12% lifetime risk
• Bipolar Disorder – 10-20% lifetime risk
• Panic Disorder – 5-7% lifetime risk
• Schizophrenia – 7-10% lifetime risk
• Alcoholism – 3% lifetime risk
• Borderline Personality Disorder – 7-10% lifetime risk
• PTSD – 7-10% life time risk (highest of all anxiety disorders)

8. Suicide in Children

The childhood suicide rate has doubled over the last several decades.  It is now 0.9 per 100,000.  Approximately 1% of children report a suicide attempt at some point in their life, often by non-lethal means like smothering themselves with their pillow or trying to drown themselves in the bathtub.

Suicide is much less common in childhood than in adolescence, but it is often hard to tell if the child died by accident or if they tried to kill themselves.  We are probably misidentifying many childhood deaths as accidents, which were really suicide attempts.  The point is that suicidal children must be taken seriously.  If a child is having suicidal thoughts, it is a sign that something is gravely wrong.

9. How to Talk to Your Teen about Suicide

• Asking if a teen has suicidal thought does not cause suicidal thoughts or suicide (this has been extensively researched)
• Ask calmly and directly like how was their day.
• “When was your last suicidal thought?” (this question gets around the reflex to say “no”)
• ”How many times have you tried to kill yourself?” (use this question if they admit to having suicidal thoughts)
• “What is the closest you’ve come to killing yourself?” (use this question if they deny attempting suicide)
• Suicidal intent is not necessary if an overdose or act was clearly dangerous (teens don’t always have a clear intention to die when they attempt suicide)

10. Treating Suicidal Thoughts in Teens and Children

• Professional mental health treatment is always necessary
• Psychiatric hospitalization may be necessary
• The first step is to alter the risk factors if possible
• Do anything necessary to stop the bullying from closing social media accounts to changing schools
• Lock up firearms and all medication including over the counter medications
• Treat their associated mental illnesses whether it be depression, anxiety, ADHD or drug use
• Teach coping skills to handle emotional distress (these have been adapted for teens from DBT)
• Improve relationships with family and peers
• Always be a source of hope that life will improve and be worth living

This a brief introduction to suicide in teens and children so please leave any questions in the comments below or send me a question using the contact form.  If you or a loved one is having suicidal thoughts, please go to your nearest emergency room or call 911.