Talking about teen suicide: Why it’s increasing and what parents and doctors can do

Across the U.S., stories of teen suicide are increasingly more common on news and social media channels. Nationally, rates of suicidal thoughts, suicide attempts, and self-harm have more than doubled, up from less than half a percent in 2008 to 2 percent in 2015.

Here in Dallas County, the numbers are alarming. The suicide rate for children 14 to 17 in Dallas County increased 79 percent from 2015 to 2016. Between 2008 and 2015, rates of children seen for suicidal ideation and behaviors in hospitals and emergency rooms almost doubled. Children’s Medical Center has also experienced a similar increase in those seen for suicidal thoughts and behaviors during that time period.

In 2016, suicide became the second-leading cause of death in individuals age 10 to 24 years. Data from a 2016 study conducted by the Centers for Disease Control and Prevention (CDC) indicates that suicide deaths among young women ages 15 to 19 doubled from 2.4 to 5.1 per 100,000 people between 2007 and 2015. 

Why are rates of suicide increasing? There are many theories:

• Families and teens are under more stress, which can influence rates of depression and mood disorders – the primary diagnosis in patients with suicidal behavior.
• There is more awareness of suicidal and self-harming behaviors, which may result in more teens being referred to emergency settings for these events.
• Teens today are less able to escape negative communication and bullying because it happens online and over text messaging. Teen use of technology has skyrocketed in the same timeframe as the spike in social media which does not indicate causation, but some speculate that it may play a role.

Researchers across the country are working on determining causal factors, treatments, and screening techniques. UT Southwestern and Children’s Medical Center have worked to improve patient care for young people who attempt suicide or have worsening suicidal thoughts. We have developed a suicide-focused intensive outpatient program to reduce suicide risk and promote safety while allowing patients to stay at home and remain in school. We also completed a pilot study in 2018 to determine whether adding an intervention to improve the ability to regulate emotion and increase safety planning in youth hospitalized for suicidality can reduce subsequent suicide attempts.

In the face of these remaining questions, one thing is clear: Suicide prevention is our primary goal, and getting there, while challenging, is possible. It is helpful to understand the risk factors and warning signs of suicidal behavior in youth as well as protective factors.

Signs of suicidal behavior in teens

As with many medical conditions, there typically is no single sign a family can point back to that explicitly indicated a teen was suicidal. There are several signs that may indicate suicide risk, including the following behaviors:

• Depressed mood/mood disorders
• Difficulty regulating emotions
• Difficulty with problem solving
• Hopelessness
• Impulsivity
• Hostility and aggression
• Quitting or struggling to enjoy favorite activities
• Social or interpersonal problems, interpersonal skill deficits
• High situational stress
• Insomnia

Identifying the signs of suicide risk can be challenging because many can be attributed to normal adolescent behavior. To that end, we must also consider the risk factors for suicide.

Risk factors for suicidal behavior in teens

High risk groups for suicidal behaviors include Alaska native and American Indian youth, young adults with substance use problems, youth with parents who suffer from depression, and youth who identify as sexual or gender minorities. In addition, we’re seeing some increases among Latino populations in the U.S., particularly first-generation Latino Americans.

Additionally, boys and men are more likely to die by suicide, whereas girls and women are more likely to attempt suicide. This is because boys and men typically use more lethal means, such as firearms, while girls and women use less lethal means, such as ingestion of pills. Teens who have previously attempted suicide also are at increased risk.

There are many known risk factors of suicidal behavior in teens, which include:

• Abuse, neglect, or trauma at home
• Depression or another mood disorder
• Family or social relationship with someone who attempted suicide or died by suicide
• Insomnia or other sleep disturbances
• Parents with psychiatric conditions, genetically
• Problems with drug or alcohol abuse
• Self-harm (cutting, for example)
• Situational stress at home or at school, including face-to-face or cyberbullying

Additionally, research has found three seemingly indirect risk factors that can increase teen suicide risk. Just having access to these items in the home can increase suicide risk in not only the teens who live there but also in teens who visit the home regularly, such as friends, neighbors, or cousins:

• Presence of controlled prescription medications, such as pain pills
• Presence of guns and other lethal agents
• Presence of illegal drugs 

It’s acceptable and recommended to ask the adults whose homes your teens frequent – as well as the teens themselves – about the availability of these items. It’s OK not to allow your children to visit homes in which these items are available, if you are concerned.

Though risk factors are abundant, there is hope and the potential to save the lives of teens and young adults who are at risk. Today’s teens have the advantage of increased awareness about suicide and mental health, as well as the availability of more advanced therapies than in years past.

Protective factors for teens at risk for suicide

Researchers have identified several areas in which teens’ friends, parents, and adult mentors can positively impact or protect against the risk of suicide.

• Protective factors can include having:
• A circle of friends who are positive and supportive
• Personal goals and purpose, such as participation in art, sports, extracurricular activities, volunteering, or a part-time job
• Positive family connections
• Religious or spiritual connections
• Success at school

Depression and other mood disorders can make it difficult for teens to stay active or get to all their activities. As part of our treatment program, we encourage teens to participate in activities if they can because of the positive effects involvement can have on their mental well-being.  

Talk to your teen about mental health

Mental health can be difficult to discuss. Unfortunately, a stigma exists around many areas of mental health care, particularly suicide, in which patients and families fear judgment or retribution if they discuss it or ask for help.

But consider this: You talk to your teens about sex, drugs, and alcohol. It’s equally important to talk to them about their mental health beyond, “How was your day?” It’s a myth that if you talk to teens about suicide you will make their depression worse or plant the seed that suicide is a way to cope. In fact, research shows that it’s important to talk about stress and depression regularly with teens to ensure they have the support they need.

In spring 2018, UT Southwestern and Children’s Medical Center completed a pilot study along with researchers at the University of Pittsburgh that focused on interventions for teens who were hospitalized after a suicide attempt. The goal was to determine whether providing guidance around how to manage stress, regulate mood, access positive emotions, and plan for ongoing safety through the use of a safety plan phone application could decrease the rate of repeated suicide attempts.

Though the initial study was small, the findings are promising. Teens who received the intervention experienced subsequent suicide attempt at a rate of 16 percent, whereas teens who did not receive this intervention had a reattempt rate of 31 percent. The final results of the study will appear in the American Journal of Psychiatry in 2018. Our next step is to repeat the study but with a larger pool of participants. We also want to take what we have learned from this study and our intensive outpatient program into the community to improve pediatric mental health care in the Metroplex.

What to do if you’re concerned about your teen

Your teen’s pediatrician or primary care doctor is a good place to start. Pediatricians in North Texas are knowledgeable about mental health in teens and have access to resources to help get your child the right type of care. For example, the pediatricians at Children’s Medical Center have implemented a universal screening tool to assess our young patients’ risk of suicide.

UT Southwestern offers the collaboration of a strong child psychiatry team to assess, diagnose, and treat children with mood disorders that increase suicide risk. Through our intensive outpatient therapy program, teens and families can access individual, family, and group therapy programs to encourage lasting success after treatment for a suicide attempt or suicidal behavior.

Though no parent wants to consider that their child might be at risk for suicidal behavior, being alert to signs and symptoms can be preventative. Mental health care should be considered just as important as physical health care, particularly during the teen years.

Please don’t be afraid to discuss mental health with your teens. Ask the uncomfortable questions. Have the tough conversations. Get help from a doctor when you feel in your gut that you should. Doing so might save a teen’s life.

To find out whether your teen might benefit from mental health care, call 214-456-5900 or request an appointment online. 

Teens and adults in crisis can call the National Suicide Prevention Lifeline toll-free, 24/7, at 1-800-273-TALK (8255). This service is confidential and available to anyone. Learn more.