Suicidal Behaviors

Suicide in children and adolescents is a major public health issue. Nationally, suicide is the second leading cause of death for 10- to 19-year-olds. Suicide affects people of all backgrounds. No one is immune. Most children and adolescents who attempt suicide show signs of depression and suicide. It is vital that families understand these warning signs and discuss concerns, preferably prior to a life-threatening mental health crisis.

  • A survey by the Centers for Disease Control and Prevention found that roughly 1 in 4 high school students report having suicidal thoughts during any given year.
  • Approximately 1 in 13 high school students indicated they had made a suicide attempt within the past year and almost 3% receive medical attention for a suicide attempt.

Research is helping us better understand youth suicide.

  • Suicide attempts are more common than deaths by suicide.
  • Most teens who are suicidal do not actually want death. They are in unbearable emotional pain and want the pain to stop.

The good news is that suicide is largely preventable. Early identification, timely treatment and support from families, schools, friends and communities play key roles.

What are Suicidal Behaviors?

  • By definition, a suicide is a death caused by self-directed, harmful behavior with the intent to die as a result of the behavior.
  • A suicide attempt is a non-fatal, self-directed, potentially harmful behavior with intent to die as a result of the behavior. A suicide attempt may or may not result in injury.
  • Suicidal ideation refers to thinking about, considering or planning suicide.

Although rates of suicide increase as children grow older because of the increased prevalence of mental health disorders, even young children express thoughts of suicide and have taken their own lives.

There are well established differences between boys and girls. Girls are more likely to express thoughts of suicide and attempt suicide two to three times more often than boys. However, boys are four times more likely to die by suicide than girls are, in part because they choose methods that are lethal, like firearms, and because they tend to act more impulsively than girls. There are also strong messages sent to boys that they should be self-reliant and that expressing painful emotions is a sign of weakness.

Suicide is rare in children before puberty but can occur. Impulsivity is a notable risk factor for suicide in young children. Warning signs should always be taken seriously.

What Warning Signs should Parents Look For?

Family members, caring adults and friends should respond whenever a child talks about or posts on social media about wanting to die or hurting themselves on purpose. Children expressing such ideas are typically in deep emotional distress or do not know how to get their needs met in more conventional ways. It may be helpful to take the perspective that the child is going through a severe illness process if they are viewing death as the best alternative. That illness requires a lot of support and a large safety net.

The following warning signs indicate that a youth is severely depressed or at risk for suicide and should be responded to immediately:

  • Talking to others or posting on social media about:
    • Suicide or wanting to die
    • Feeling hopeless, trapped or like they are “a burden” to others
  • Looking for ways to kill themselves:
    • Gathering medications, sharp objects or firearms
    • Searching online for ways to end their life
  • Expressing unbearable emotional pain
  • Visiting or calling people to say “goodbye”
  • Giving away prized possessions
  • Suddenly becoming calm or cheerful after a long period of depression

The following warning signs indicate that a youth may be struggling with depression, which requires evaluation by a mental health professional:

  • Feeling sad or irritable more often than not
  • Sleeping or eating more or less than usual
  • Showing little to no interest in pleasurable activities
  • Withdrawing from others
  • Participating in reckless behavior that is out of character
  • Engaging in self-injurious behavior
  • Having trouble concentrating or performing poorly in school
  • Complaining frequently about physical symptoms (e.g., fatigue, stomachaches, headaches)
  • Increasing use of alcohol and drugs

What are the Risk Factors for Suicide in Children?

Suicide is complex and can rarely ever be attributed to one single cause.

Risk factors for suicide include internal and environmental factors. Although some risk factors can be changed and others cannot, families can be aware of them. Suicide risk is greatest when a youth has multiple risk factors.

Risk factors may include:

  • Previous suicide attempt
  • Mental health disorders, especially depression and other mood disorders, anxiety disorders
  • Substance abuse
  • History of abuse or mistreatment
  • Family history of mental health disorders and/or suicide
  • Feelings of hopelessness
  • Impulsivity
  • Easy access to means for suicide (e.g., firearms)
  • Exposure to others who have died by suicide
  • Identification as lesbian, gay, bisexual, transgender or questioning
  • Exposure to bullying or bullying others

What are Protective Factors Against Suicide?

Protective factors are strengths that protect youth from attempting or dying by suicide. It is important to increase the availability of protective factors to at-risk youth.

  • Feeling supported by family
  • Reasons to live and future goals
  • Social or academic support
  • Therapeutic relationship with a therapist
  • Strong coping and problem-solving skills
  • Family restricts access to lethal means during crisis

How are suicidal thoughts and behaviors treated?

The level of intervention for suicidal thoughts and behaviors depends on the level of suicide risk. In Franklin County, it is strongly recommended that families call the Youth Psychiatric Crisis Line at 614-722-1800 so that professionals can support the evaluation of risk and level of care required. Often crisis clinicians can support a plan to increase safety and begin the process of getting effective mental health care. When there is an imminent risk of suicide, immediate psychiatric evaluation and/or hospitalization may be recommended. If medical attention is needed related to a suicide attempt or self-injury, parents should take children directly to the closest emergency room.

If the risk is not imminent and safety of the child is clearly established, the child may be referred to a mental health professional for outpatient treatment.

Two psychotherapies that have proved effective in treating youth at risk for suicide in the outpatient setting are:

  • Cognitive behavior therapy (CBT)
  • Dialectical behavioral therapy (DBT)

Regardless of therapy type, clinicians supporting the mental health care of a child with a history of suicidal thoughts or behaviors should be comfortable directly treating suicidal behaviors as well as underlying mental health conditions.

When Should You Seek Help?

When a youth shares thoughts of wanting to die or warning signs are evident, consider the following strategies:

  • Remain calm, take a deep breath and do not react emotionally. It’s OK to feel uncomfortable.
  • Be patient and speak in a relaxed, reassuring tone.
  • Tell your child you care and acknowledge they are hurting.
  • Be direct about your concerns:
    • State the specific changes you see in your child’s mood and/or behavior.
    • Ask if they are thinking about suicide or have tried to kill themselves.
  • Get professional help.

Some ways of responding to a youth who is having suicidal thoughts are ineffective. Please consider the following tips:

  • Don’t debate whether suicide is right or wrong.
  • Don’t lecture on the value of life or question why someone could feel this way. You do not have to agree with how they feel to offer support.
  • Don’t be sworn to secrecy or promise confidentiality. Share that safety and getting help are top priority.
  • Convey the message that suicide is preventable and treatment is effective.

Always treat suicidal threats or behaviors as an emergency. If your child reports suicidal thoughts, threatens suicide or shows suicidal behaviors, do not leave them alone.

Call 9-1-1 or your local emergency number immediately if your child has made a suicide attempt or is showing warning signs of suicide, or take your child to the nearest emergency room.

In Franklin County, call (614) 722-1800 for the Franklin County Youth Psychiatric Crisis Line for youth ages 17 and younger. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). If you don’t like talking on the phone, text "START" to the Crisis Text Line at 741-741, or in Ohio, text "4HOPE."