December 15, 2000

By Jonathan Freedhoff, M.D.

Carrie Cox

rowing up is hard. Considering what we went through during our own teenage years -- changes in our bodies, the pressures of school, and our first stabs at love and romance -- most of us would not want to revisit them. Among teenagers, stress and sadness are very common, and what some parents might consider "character building" events, teenagers may experience as overwhelming maelstroms of emotion.

In the past 50 years, teenage suicide rates have quadrupled, making suicide the third leading cause of death among 15- to 19-year-olds. And while there is no perfect way to predict who will attempt suicide, paying close attention to behavior and doing a few simple preventive measures may help stop your child from making a tragic mistake.

Warning signs and risk factors

Depression and psychiatric illness

It is estimated that in a high school of 1,000 students, 74 cases of clinical depression can be expected to occur within a one-year period. Much like adults suffering from depression, depressed teens may demonstrate decreased interest or pleasure in life, feelings of guilt and hopelessness, and impaired concentration and indecision. Changes in sleep and appetite are common, and drugs and alcohol are often used for temporary relief. Unfortunately, depression and psychiatric illness among teens often go undetected and untreated. In fact, a recent study showed that although more than 90 percent of teens who committed suicide retrospectively met criteria for a major psychiatric diagnosis (52 percent meeting those for clinical depression), only 46 percent had sought treatment from a mental-health professional.

In the past 50 years, teenage suicide rates have quadrupled, making suicide the third leading cause of death among 15- to 19-year-olds.

Self-destructive behavior

Suicidal teens may be more likely to engage in self-destructive behavior, such as self-mutilation; reckless driving; driving without seatbelts; partaking in unsafe sexual practices; or abusing drugs, alcohol, or cigarettes. Alcohol in particular has been associated with 50 percent of all adolescent suicides, and some researchers have even proposed that the dramatic increase in adolescent suicide rates since the 1950s is directly attributable to increased rates of teenage alcohol abuse.

Suicidal threats

Statements such as, "I'm better off dead," "I wish I had never been born," "You won't need to worry about me much longer," or "Everyone will be better off once I'm gone" are clear messages that should never be dismissed.

Suicidal planning and previous attempts

As with adults, suicidal teens may meticulously plan their suicide, giving away possessions they value, writing a will, or paying off debts. Special attention must be paid to teens who have attempted suicide in the past, as one-third of those who commit suicide have made a previous attempt.

Suicide clusters

Perhaps due to the intense media attention given to teenage suicide, there is often a predictable increase in teen suicide within two weeks after a suicide story breaks.

Firearms

Having a firearm in the home greatly increases the risk of suicide -- in 1994, 67 percent of teenage suicides involved a firearm.

What you can do: prevention and evaluation

Watch and listen

Always be on the lookout for signs of depression or suicidal behavior in your teens, and do not be afraid to ask them about their feelings. If there is a local suicide in the news, be sure to talk to your children about it. Always be diligent about listening.

Do not be shy

Never be afraid to discuss depression and suicide with your teens. Point out to them that sometimes when people are depressed, they think about hurting themselves. This is a good way to both normalize your teen's confused feelings, as well as to find out whether they have ever thought about suicide. If your child admits to having suicidal thoughts, try to resist knee-jerk responses such as "You have so much to live for" or "Imagine what it will do to our family." Instead, focus on letting your children know that you are there for them to turn to, and that they are not alone.

Help them get help

Provide your child with the telephone number of the national suicide hotline (1-800-SUICIDE). If you suspect your child is at risk, strongly encourage him or her to see a mental-health professional immediately. Offer to accompany your child to the appointment.

Do not sit back

If you feel there is an acute crisis, take your child to an emergency room, your family's physician, or a walk-in medical clinic immediately. Try not to leave your child alone, and remove any dangerous items from the vicinity (firearms, drugs, razors, knives, scissors, etc.). If necessary, call 911.

The bottom line

Suicide is an unpredictable event, and is often an impulsive decision. Creating a home environment where your children feel comfortable discussing their problems without worrying about your reactions may be the best prevention.

Growing up may be hard, but it does not need to be fatal.

Related links:

• Outside link: American Foundation for Suicide Prevention

• Outside link: American Association of Suicidology

• Outside link: American Psychological Organization

Send feedback on this article.