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Suicide and Teens

  • Throughout the past few years, the tragedy of youth suicide has become both a frequent front-page headline and a necessary topic of conversation for every family.
    While suicide is more common in the late teen and early adulthood years—it’s the third-leading cause of death among 15- to 24-year-olds in the United States—suicide is also a threat for younger children. In fact, suicide is the fourth-leading cause of death in children between age 10 and 14; in recent years, national news coverage has reported children as young as 7 attempting suicide. 

    Here’s what you need to know about youth suicide:

    • Between 12 and 25 percent of children and adolescents have thoughts of suicide at some point.

    • Behaviors and statements should always be treated with the utmost seriousness—and immediate action.

    • For every completed suicide among young people, there are as many as 100 suicide attempts.

    • While a suicide attempt may represent a genuine desire to die, it often is a desperate child’s request for help.

    • Children and adolescents often consider suicide because they feel so overwhelmed and hopeless that they can’t imagine things getting better.

    • Children of both genders and all ages, backgrounds and cultures are at risk for developing suicidal thinking and behavior.

    • Social isolation (lack of being plugged in with peers, activities, groups) is a major risk factor.

    • While boys are more likely to complete suicide than girls, girls are more likely to attempt suicide—and to tell others that they have either made an attempt, or are feeling suicidal.

    The most prevalent risk factors for youth suicide are:

    Losing a child to suicide is every parent’s nightmare. Your child’s suicidal thoughts, behaviors and statements should always be treated with the utmost seriousness—and immediate action.

    But there is hope: Treatment by a qualified mental health professional can make a significant difference for a child who is feeling suicidal. Children’s Hospital Boston’s expert psychiatrists, psychologists and social workers are here to help.

    How Boston Children's Hospital approaches suicide prevention

    Children’s Hospital Boston’s Department of Psychiatry is a national leader in identifying, treating and working to prevent the full spectrum of mental health disorders affecting kids and teens, including:

    Here at Children’s, we have developed several programs and therapies that not only treat kids and teens at risk of suicide, but also aim to prevent suicidal feelings and attempts in all children. Recognizing a need for better mental health support for children and families across Massachusetts and around the country, we’ve developed several programs that aim to educate kids, parents and teachers about suicide and its warning signs.
     

    • Every year, the Children's Hospital Neighborhood Partnerships counsels more than 2,600 young people and 400 parents and trains staff from several Boston public schools, community organizations and health centers.
       
    • The Swensrud Depression Prevention Initiative at Children’s aims to prevent and treat depression in school-aged children; to incorporate wellness into schools’ core curricula; and to train educators and parents about recognizing and responding to mental health issues.
       
    • Children’s psychiatrists have developed the Depression Experience Journal, an online collection of stories, pictures and personal reflections from kids, teens and families about what it's like to deal with (and recover from) depression—one of the most prevalent risk factors for suicidal thinking.
       
    • Children’s introduced a first-of-its-kind, youth-centered suicide prevention initiative in Boston schools. The program uses a peer mentoring approach to teach high school students about the warning signs of suicide and how to address them. 

    In addition, our Department of Psychiatry maintains a 24-hour, seven-day-a-week Emergency Psychiatry Service. The service is staffed by trained mental health professionals with special expertise in assessing and managing children and teens who may be struggling with suicidal thoughts.

    If you are concerned that your child is in the midst of a psychiatric emergency, please call 617-355-6369 and ask for the psychiatrist on call; even if we cannot treat your child here at Children’s, we can refer you to other sources of help and immediate care.

    Suicide: Reviewed by David R. DeMaso, MD
    © Children’s Hospital Boston; posted in 2011

    Emergency Psychiatry Service

    Boston Children's Hospital
    300 Longwood Avenue
    Main 1
    Boston MA 02115

     617-355-6369

  • The detailed information on the following pages will help you gain a better understanding of youth suicide. 

    What does it mean when a child or teen is suicidal?
    A child or teenager who is feeling suicidal is considering taking, or planning to take, his own life.

    In many cases, young people who consider or attempt suicide do not really want to die: Instead, they want to escape their problems, but can’t see a way out or imagine things getting better. Often, a suicide attempt is a “cry for help” from a child who doesn’t know where to turn.

    How common is youth suicide?
    Suicide is:

    • the third-leading cause of death in 15- to 24-year-olds nationwide
    • the fourth-leading cause of death in 10- to 14-year-olds
    • contemplated by up to 25 percent of children and adolescents at some point in their lives
    • attempted 100 times for every completion

    While any child or adolescent can develop suicidal thoughts or behavior, suicide is an especially significant risk for young people who are facing: 

    How can a child who is thinking of suicide be helped?
    Children and teens who are contemplating, or have attempted, suicide should be treated with immediate, qualified and comprehensive care from a licensed mental health professional. Essential components of treatment for suicidal thoughts or behaviors include:

    • psychotherapy (“talk therapy”)
    • in some cases, antidepressant medication
    • if necessary, hospitalization
    • family support
    • school support

    If you believe your child may be suicidal, you should always call 911 right away.

    Causes

    What causes kids to consider and attempt suicide?
    Adolescence is, almost universally, a very trying time. The late childhood and teen years are fraught with many challenges, from hormonal changes and peer pressure to tempestuous personal relationships, increased academic demands and possible tensions with family members at home.

    While all young people experience ups and downs that can cause periods of anxiety, sadness and stress, some kids are hit especially hard. The normal changes that come with growing up, when combined with certain situations or events—a divorce; a move to a new school or town; a bully at school; a broken romance or friendship—can be overwhelming. 

    Worse, they may begin to believe that “the way things are is the way things always will be” and that their problems are too many, too severe or too humiliating to overcome. For these children, suicide may seem like the only way out. 

    Children of both genders and all ages, backgrounds and cultures are at risk for developing suicidal thinking and behavior, and there is no foolproof way to determine which child will or won’t become suicidal. However, common risk factors for suicide are:

    • a prior suicide attempt
    • having a mood disorder, such as depression or bipolar disorder
    • abusing drugs or alcohol
    • a history of criminal behavior, including past arrests and/or incarceration
    • displaying impulsive, disruptive or aggressive behaviors
    • a family history of suicide
    • a family history of mental health or substance abuse problems
    • violence at home (physical, sexual or verbal/emotional abuse)
    • having a firearm in the home
    • social isolation (especially relating to gender/sexual identity issues)
    • exposure to the suicidal behavior of others (including suicide attempts or completions by friends, classmates or family members)
    • a tendency to “romanticize” or become fixated on suicides mentioned in news stories, books or movies

    Signs and symptoms

    What are the warning signs that my child may be feeling suicidal?
    There are many possible indicators of suicidal feelings, and the symptoms can vary from child to child and many are associated with other difficulties as well—so it’s vital to both know your child well, and to keep a close eye on her daily moods, activities and routines.

    Potential signs of suicidal feelings and thoughts may include:

    • sleeping too much or too little
    • changes in appetite and/or weight
    • loss of interest in activities previously enjoyed
    • withdrawal from family and friends
    • running away from home
    • “acting out” verbally or physically, at home or at school
    • using alcohol or drugs
    • neglecting personal appearance and hygiene
    • unnecessary risk-taking (for example, driving too fast or without a seatbelt)
    • preoccupation with death and dying
    • giving away prized personal items
    • posting worrisome messages  on the internet
    • loss of interest or participation in school life (both academic work and social activities)
    • sudden reports of trouble at school, either in the classroom (declining grades) or with peers
    • difficulty concentrating
    • deflecting, challenging or not responding to compliments and praise (“No, I’m not smart, I’m an idiot” or “You’re wrong—I’m really a bad person”)

    It’s important to note that—not surprisingly—many of these signs are also symptoms of depression. Whether you believe your child is depressed but not yet suicidal, or is actively considering suicide, you should seek immediate treatment.

    What are the warning signs that a child may actually be planning to kill himself?
    You should take any of the symptoms listed above—and any other unusual or distressing behavior or statements from your child—very seriously. Even a child who seems only mildly “down in the dumps” may be considering suicide.

    Any of the following behaviors should be construed as an urgent warning sign that your child may be actively planning a suicide attempt:

    • saying things like, “I want to kill myself,” “I want to die” or “I just want to disappear/sleep forever”
    • making threats or statements like, “Don’t worry, I won’t be a problem much longer” or “If anything happens to me, I just want you to know…”
    • giving away or discarding favorite possessions
    • writing a will
    • writing a suicide note
    • writing or expressing apologies to loved ones for “all the things I’ve done” or “all the trouble I’ve caused”
    • obtaining, or attempting to obtain, a firearm, knife or rope
    • obtaining, or attempting to obtain, large quantities of medication
    • becoming suddenly cheerful or tranquil after an extended period of depression (this may indicate that the child has made a final plan to commit suicide, and so feels “at peace”)

    Always treat any sign, suggestion or threat of suicide as a genuine cry for help. It’s essential to seek immediate professional help for your child—do not wait, even if your child tries to claim she is “better” or “didn’t mean it.” If you believe your child may be contemplating suicide, you should call 911 right away.


    FAQ

    Q: Is youth suicide common?
    A: Unfortunately, yes. Over the last several decades, the suicide rate among young people has dramatically increased. A recent survey of U.S. students in grades nine through 12 found that, during the year before taking the survey:

    • 15 percent of students had seriously considered suicide
    • 11 percent had formulated a plan for attempting suicide
    • 7 percent had actually attempted suicide
    • 1 out of every 10,000 complete suicide

    Suicide is now the third-leading cause of death in 15- to 24-year-olds in the United States, and the fourth-leading cause of death in 10- to 14-year-olds.

    Q: Which kids are at greatest risk of attempting suicide?
    A: Children and teens of both genders and of all ages, races and backgrounds can—and sadly do—attempt and complete suicide. Native American/Alaskan Native and Hispanic youth have the highest rates of suicide-related fatalities in the United States. And children and adolescents who are struggling with mental health issues—like depression or bipolar disorder—face an elevated risk.

    Q: Which kids are more likely to talk about vs. actually attempt suicide?
    A: 
    Adolescent and teen girls are more likely to attempt suicide—and to tell someone else that they are feeling suicidal. Males under the age of 25 are most likely to complete suicide. 

    Q: What are the most common methods of suicide in young people?
    A: 
    According to the U.S. Centers for Disease Control and Prevention, the most common methods used by in youth suicide are:

    • firearms (46 percent)
    • suffocation, including hanging (39 percent)
    • poisoning, including overdoses of prescribed and illegal drugs (8 percent)

    Q: Is youth suicide preventable?
    A: 
    Suicide can be prevented by recognizing that a child or teen is struggling with a mental, behavioral or substance abuse problem early on—and intervening with professional help right away. Suicide prevention measures most likely to succeed are those focused on:

    • identifying and treating underlying mental health issues
    • teaching kids to cope with stress and life changes
    • helping them control and reverse damaging and destructive behaviors

    Q: What should I do if I think my child may be considering suicide?
    If you think your child may feel suicidal, or is actively considering suicide, you should—first and foremost—seek immediate professional help by calling 911 right away.

    It’s also important to regularly:

    • ask your child how he’s feeling
    • tell him you are there to support him
    • promise to listen without judging
    • remind him that you love him unconditionally, “no matter what”
    • avoid criticizing him unnecessarily or trivializing his feelings or concerns
    • refrain from giving advice that may be well-intentioned, but can actually make your child feel worse—e.g., telling him to “just get over it,” “stop worrying about it” or “try harder to get better”
    • remove all firearms from the home
    • lock up and carefully account for household items like knives, prescription drugs and poisonous substances
    • research suicide prevention resources and support groups online and in your community

    Q: How should I talk to my child if a friend, classmate or family member has committed suicide?
    A: Even if your child is not depressed or suicidal herself, the loss of someone close due to suicide can be devastating, confusing and hard for her to talk about. Likewise, a suicide attempt by a peer or classmate is likely to be very upsetting and frightening for your child, even if she was not close to the other student. 

    One positive that can emerge from these tragedies is the opportunity to have a frank and loving discussion with your child. Guidelines can include:

    • asking her how she is feeling and coping
    • inviting her to talk about the person who died (or who attempted suicide) and the circumstances of the death or attempt
    • encouraging her to ask questions
    • asking her if she knows someone else who may be at risk of suicide, and offering suggestions for how to get that person help
    • asking her if she has thought of or considered suicide in the past
    • reminding her that you love her unconditionally and are always there for her
    • assuring her that no problem, no matter how big, is so bad that death is the answer
    • reviewing support services—such as guidance counselors, school psychologists and suicide prevention hotlines—available to her and her peers, both at school and in the community
    • “leaving the door open” for her to approach you at any time, with any problem, without fear of judgment or harsh criticism

    Q: How should I advise my child to help a friend who may be contemplating suicide?
    A: 
    Children and teens will often confide in their peers more readily and honestly than in parents or other adults. Offer your child these tips for helping a friend who is thinking about, or has attempted, suicide:

    • Always take any suicidal threats, comments or behaviors very seriously.
    • Encourage your friend to seek professional help from a teacher, school counselor, doctor or hospital, and offer to accompany her in going for help.
    • Even if you’ve promised not to tell anyone: always confide in an adult you trust if your friend is thinking about suicide. Never feel you have to deal with a friend’s crisis alone. Your friend may be upset with you in the short term, but it’s a small price to pay for potentially saving her life.
  • If your child is suicidal, it’s crucial to understand that he cannot just “snap out of it” or will himself to feel better. A depressed child feels a constant sense of discouragement, a loss of self-worth and an inability to imagine a better future. Treatment from a licensed mental health professional, in conjunction with loving support at home and at school, is critical to a full recovery.Your Children’s clinician will work with you and your child to determine the best approach to care during an immediate crisis, as well as over the long term.

    PSYCHOTHERAPY

    The mainstay of treatment for suicidal thoughts and behaviors—and for depression in general—is psychotherapy, or “talk therapy.” Here at Children’s, our clinicians use therapy to help your child understand and cope with her feelings. Coping strategies taught in psychotherapy can include:

    • identifying and talking about feelings, worries and relationships
    • stopping automatic negative thoughts (“Nothing I do will ever turn out right”)
    • relaxing the mind and body
    • identifying activities that are engaging and comforting
    • recognizing and appreciating positive self-attributes and achievements
    • building hope for the future

    Using these strategies, your child will be able to:

    • focus on changing her distorted views of herself and the environment around her
    • work through difficult experiences and relationships
    • identify stressors in her life and ways to avoid them
    • improve their general problem solving ability

    FAMILY THERAPY

    When a child is suicidal, the entire family is affected. Family therapy can be an invaluable resource in building a support system for the child and addressing the concerns and issues faced by other family members.

    ENVIRONMENTAL CHANGES

    If environmental circumstances in your child’s life—for example, being bullied at school or coping with a parent’s alcoholism—are triggering his suicidal feelings, it is critical to change these circumstances as much and as quickly as possible. Your Children’s clinician can advise you on managing issues at your child’s school, with peers and at home.

    MEDICATION

    Many children and teens who contemplate or attempt suicide are so depressed that therapy alone is not enough. In these cases, antidepressant medications may be recommended to help the child feel less depressed and subsequently relaxed, motivated and comfortable while working on coping skills in therapy.

    Medication is not a “standalone” treatment; Children’s always considers it part of a two-prong approach, with psychotherapy as a necessary component. Our Psychopharmacology Clinic is devoted to helping children, families and clinicians decide whether medication might be a useful part of treatment. 

    Commonly prescribed antidepressant medications include:

    SSRIs (selective serotonin reuptake inhibitors, which adjust the levels ofserotonin—a chemical that regulates mood—in the brain)

    • Celexa
    • Lexapro
    • Luvox
    • Prozac
    • Zoloft

    Atypical antidepressants (drugs that impact both serotonin and other chemical messengers in the brain)

    • Cymbalta
    • Desyrel
    • Effexor
    • Remeron
    • Serzone
    • Wellbutrin

    No single medication is effective in all children. Families should expect a trial-and-error process that can last weeks, or even months, as doctors find the drug regimen that works best.

    Since 2004, the U.S. Food and Drug Administration has placed a black warning label on antidepressant medications. The warning label states, in part:

    Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”

    If your child is prescribed any medication, your clinician will carefully go over the specifics of the drug, as well as any potential side effects you should watch for. Our team has years of experience in managing the use of psychiatric medications in children of all ages and with a wide variety of conditions. We will closely monitor your child for any sign of a negative response to the medication, and are always here to address any concerns you may have. 

    It is important to note that every study has shown that the combination of medication and psychotherapy  reduces  the risk of suicide.

    Learn more about psychiatric medications.

    HOSPITALIZATION

    A child who has attempted suicide—or is severely distraught and on the verge of an attempt—may require a period of intensive, inpatient treatment.

    Children’s Inpatient Psychiatry Service is a 16-bed psychiatric unit. The service provides comprehensive medical and psychiatric care for children, ages 8 to 18, who are experiencing a mental health crisis that calls for immediate treatment in a hospital environment. We offer:

    • family-centered assessments and customized treatment plans
    • medication consultations and management
    • referrals to other hospital and community mental health services
    • coordination of follow-up with primary care physicians and treating mental health clinicians after the child is discharged
  • The Children’s Hospital Boston research program is one of the largest and most active of any pediatric hospital in the world. We are dedicated to proving the effectiveness of our mental health treatment approaches through rigorous scientific testing; each day, our clinicians are working toward important discoveries to propel new advances in preventing, diagnosing and treating mental and behavioral disorders. This research reinforces our ongoing commitment to enhancing mental health for all children and adolescents. 

    Children’s research projects with promise for preventing and treating childhood depression and suicide attempts include the following:

    • Elizabeth Wharff, PhD, MSW, LICSW, director of the Emergency Psychiatry Service and director of the Social Work Training Program in Children’s Department of Psychiatry, is testing a family crisis intervention model in the emergency room. The goal of this approach is to avoid psychiatric hospitalizations for children whenever possible, and to keep the family together in the community.
       

    • William Beardslee, MDacademic chair of Psychiatry at Children’s, is the principal investigator of long-term study that he and several colleagues first began in 1979. Researchers closely examined at the lives of 275 children from 143 families in which the parents had depression or several risk factors for depression. Using data from this study, Beardslee has identified risk factors for depression in children and implemented a prevention program for families in crisis.
       

    • Eugene D’Angelo, PhD, chief of Children’s Division of Psychology, is working with Beardslee on large, multi-site study of families in which parents have depression and youngsters are manifesting its symptoms. The study uses a group approach in working with families to avoid depression.

    Learn more about research at Children's.

    Clinical trials

    It’s possible that your child will be eligible to participate in one of Boston Children's Hospital's current clinical trials. These studies are useful for a multitude of reasons:

    Some trials are designed to evaluate the effectiveness of a particular drug, treatment or therapy on a specific disease; others help doctors to better understand how and why certain conditions occur. At any given time, we have hundreds of clinical trials underway. Of course, your motives as a parent needn’t be entirely altruistic—you’ll naturally want to know how taking part in a trial can immediately benefit your child. If your child’s physician recommends participation in one of Children’s clinical trials, that likely means that your child’s physician believes that the plan outlined in that trial represents the absolute best, latest care your child can possibly receive.

    And participation in any clinical trial is completely voluntary: We will take care to fully explain all elements of the treatment plan prior to the start of the trial, and you may remove your child from the medical study at any time.

    Find a clinical trial

    To search current and upcoming clinical trials at Children’s, go to:
    http://www.childrenshospital.org/research/clinical/Search.cfm

    To search the NIH’s list of clinical trials taking place around the world, go to:
    http://www.clinicaltrials.gov/ct2/search

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