A Rising Concern: Suicide in Children and Teens

A Growing Problem

Suicide in the United States is the 2nd leading cause of death in youth ages 10-24, according to the Centers for Disease Control and Prevention (CDC). While the U.S. saw rates decline for several years, from 2007 to 2017, the rates almost tripled for pre-teens and steadily increased for older teens. Many of the youth who have attempted suicide have never received previous mental health services, and nearly half of all first-time attempts are fatal.

Suicide rates are often a report in the number of Emergency Room visits of attempted suicides that require medical attention and often lag a few years behind. What this data does not tell us is the rate of teens who are thinking about suicide or who have attempted suicide but did not require medical attention.

In 2015, 43 public high schools in Indiana had their students surveyed to gauge how prevalent the rate of suicide is in Hoosier youth. The results showed that over the previous year in the 1,900 students surveyed:

• 19% had seriously considered attempting suicide
• 17% had made an actual plan
• 10% had attempted suicide
• 4% attempted suicide that required medical attention

While data from Emergency Room visits are still important, this survey highlights how large the problem is overall for our state specifically. It is important to note that while it’s estimated that the impact of COVID-19 may have caused suicide rates to increase, we may not be able to get an accurate picture as more and more people chose to not seek emergency room care - particularly at the start of the pandemic. Regardless, the big question that many have is, what can parents and caregivers do to help?

The Signs

Some of the signs that a teen or youth may be contemplating suicide are:

• Talking about suicide or death in detail and excess
• Feelings of hopelessness (may often say "I’m never going to get through this")
• Talks of passive suicide ideation ("Everyone is better off without me.")
• Emotional pain, distress, anger
• Significant changes in mood or behavior such as becoming very irritable
• Changes in habits such as eating and sleeping, both in terms of not enough or in excess
• Withdrawing or isolating from activities that once brought them joy
• Any form of loss

While these signs might be present in some children and teens, they may not be present in all children and teens that are struggling or contemplating suicide. Dr. Butler also says to keep in mind that in children and teens, depression may look different from depression in adults. “Children and teens may experience irritable mood rather than the sadness and crying spells seen with adult depression. If your child is showing increased irritability or other mood changes, it may be time to check-in and have a conversation with them to determine what’s going on.”

The pandemic has also changed a lot in how these signs are detected as well. Teachers and other school staff can be among the first to notice changes in a child or teen’s behavior or social interactions that may prompt further intervention. But with schools being on a hybrid or remote learning basis, this can be quite challenging to identify. “There’s a lot of kids now who may never have even met their teachers in person so teachers are not going to know what normal behavior or mood is for that particular child to be able to best provide support and intervene when needed. Virtual learning also decreases teacher and student interaction. There are more and more kids who just turn their camera off during a zoom class and no one ever sees them. It’s proving to be a challenge.”

While it may be a challenge, friends may be able to provide a secondary resource. Dr. Butler recommends that parents have open conversations with their children by asking them how they might handle a friend who made concerning comments around suicide or other self-harm thoughts and behaviors. By having the conversation, parents and caregivers can provide an opportunity for their children to come to them to not only help their friends but also provide open communication for their child to discuss their feelings as well.

One warning sign that a child or teen may be struggling is if they are no longer interested in activities or don’t seem to enjoy things anymore. Dr. Butler points out the difference between what may be perceived as withdrawing or lack of enjoyment from a favorite activity and what may just be intermittent burnout. “Many children and teen’s interests in activities wax and wane over time and is no cause for concern. But if your child or teen loved being in band and all of a sudden they’re not enjoying band and talking about not wanting to go anymore, and if they really enjoyed playing Fortnite with their friends and now they haven’t played with them in weeks, and are showing a general lack of interest in doing most things they used to enjoy then this might be a time to check-in.”

Specific groups as well can be more vulnerable to suicide ideation such as:

• Those who are being bullied at school or online through social media
• LGBTQ+ youth
• Minority group members
• Black youth - a group that has seen a dramatic increase in suicide rates compared to other racial and ethnic groups
• Those who may already have a mental health concern, even children with ADHD

Dr. Butler also points out that one big area to pay attention to is social media. “Teens often post online before they say it in person in terms of how they’re feeling.” It’s helpful to monitor your child or teen’s social media postings but not always possible. If your child or teen doesn’t allow you to be their friend or follow them on social platforms, pose the question on if you would be allowed to in a nonintrusive way so they still feel their privacy is valued but also allows you to monitor their safety. Having a serious talk with your child or teen about social media use is important and a good first step. While it can be uncomfortable, you can start by asking what your child or teen would do if they saw a close friend post something online that was concerning.

I think my child may be showing signs; what should I do?

Dr. Butler points out that the best thing you can do if you think your child is showing signs is to talk to them. “One of the best things you can do is to have a serious talk with your child about suicide. It’s a common myth or concern that talking about suicide puts the idea in people’s heads, but research consistently shows that this isn’t the case.” Often, those who are wanting to seek help don’t know who they can trust or who will take them seriously. Talking openly with them and validate their feelings and emotions. By talking to your children even just about what they would do if a friend were to experience or show signs of distress helps create an open environment and line of communication to talk about emotional struggles they may be facing, now or in the future.

It’s a natural response for parents or caregivers when their children are in distress to try and make it all better. When children or teens come to their parents to talk about an issue, the parent’s natural response may be to act as a cheerleader for their child, saying things like ‘oh but you have straight As why would you be sad’ or ‘You have so many friends, why would you think that you feel alone?’ “These comments, while they may have good intentions, can often lead to feelings that the adult who they hoped would understand them doesn’t and can cause children and teens to isolate themselves even more,” says Dr. Butler. If and when you do have this important conversation with your children, be sure to actively listen without judgment. The idea that their child or teen is having suicidal thoughts is often very scary for most parents but it’s important to remain calm. Try and actively listen to what your child is saying, ask questions and let them know you understand or are trying to understand where they are coming from. Having a calm and serious discussion will show your child or teen that you do take their feelings seriously and they will be more likely to come to talk to you in the future if these feelings return or worsen.

If you want to seek help for your child such as therapy, be sure to check with your insurance provider to see who’s covered under your plan. There are also community mental health centers for those with nonprivate insurance or Medicare/Medicaid. Dr. Butler also points out that “the process of seeking help can be hard. However, don’t get discouraged. Reach out to resources such as teachers, school counselors or your primary care physician to get pointed in the right direction to get the help your child needs.” When you do find someone for your child to speak with, make sure that they are a licensed mental health professional and are trained to provide care to your child. “One positive of the pandemic is that a lot of therapists are now offering virtual sessions - which increases our access and our ability to help more patients.”

There are also national and state resources to help those in need. The National Suicide Prevention Lifeline can be reached by either calling at 1-800-273-TALK (8255) or visiting their website and using their online chat feature if talking on the phone is uncomfortable or not an option. Indiana also has a texting option specific to the state that can be reached by texting IN to 741741. Both options are free and confidential to use. Your child’s school or primary care provider may also be able to connect you with more community resources local to your area or specific need.

If your child is in distress and you’re concerned for their safety, call 911 or take them to the nearest emergency room.

Ending the Stigmas on Mental Health

One of the bigger stigmas around mental health is seeking treatment and being judged for doing so. Sadly, it’s often part of the societal norm that those who do seek mental health treatment are seen as having a defect or weak. Teenagers can often feel this as well and feel that they’re broken and no one will understand their problem - leading them to not seek out help.

One thing that’s often seen in teens and children is the stigma or encouragement to not seek help. “It’s often portrayed in television shows or movies that teens are all alone and no one gets them and that talking to adults is not helpful. This is the opposite message that we need to give to our teens. We want them to know that help is out there and they are not alone.” Dr. Butler recommends that children and teenagers be encouraged to find an adult they trust, even if it’s a friend’s parent, a coach, a neighbor, etc. and have an open conversation with them about their feelings. More than likely, it will not unfold in the same ways that it does in the media and that person will take you seriously and support you. It’s also important to talk with your child or teen about how they should tell someone when they see a friend or peer struggling.

Dr. Butler also mentions that one of the bigger things she sees is the idea that this could never happen to my child. “Every teen, unfortunately, has the potential to attempt suicide. There isn’t just one demographic or characteristic that’s seen in those who do.” This points even more to the importance of having an open and serious conversation with your child. While it may not seem like your straight-A student or quarterback of the football team may be struggling with their mental health, they have the same potential as any other student. Open, honest and nonjudgmental communication is important to help put an end to the rising suicide rates of youth in America.

World Mental Health Day may be on the same day every year, but it’s this year with all of the stress and anxiety that we’ve been all been dealing with that the topic is discussed openly and honestly. Talking about your feelings is the first, and often the hardest step, but by encouraging your teens to do so you can potentially help save them.

If your child is in distress and you are concerned for their safety, call 911 or take them to the nearest emergency room.