Suicidal Ideation and Behavior

Feeling Hopeless

Studies indicate that suicidal ideation and behavior are common in adolescence. Suicide is the third leading cause of death for teens and has increased dramatically compared to the general population in the past 4 decades. A far greater number of youth attempt suicide each year.

Although suicide attempts are more common among females, males are more than four times as likely to complete suicide. For females, suicidal behavior is frequently precipitated by a fight with family or a boyfriend, is often associated with depressive symptoms, and most commonly involves drug ingestion.

Teens who are struggling with sexual identity issues, especially males, are at greater risk for depressive symptoms and suicidal ideation and behavior than teens in the general population.

Questions to Ask

For the Teen

It sounds like you’ve been feeling pretty hopeless. Have you felt so bad that you wished you were dead or thought you would be better off if you were dead?
Have you ever thought about killing yourself?
Have you ever tried to kill yourself or hurt yourself? What did you do? Did you tell anyone?
If you’ve thought about committing suicide, have you thought about how you would do it? Do you have a way to carry out your plan?
Is there a gun in your home?
Do you feel safe?

For Parents

Has anyone in your family had mental health problems or committed suicide?
Are you concerned that your teen might try to kill himself?
Do you keep track of and check quantities of prescription and over-the-counter drugs in your home?
Do you have a gun in your home? Are you aware of the risk of suicide with a gun in the house? Have you considered not owning a gun because of the dangers involved?

Provider Tips

When assessing a depressed teen, ask about suicidal thoughts and plans using questions such as those listed above for the teen.
Screen for suicidal risk factors
- Previous suicide attempt
- Family history of suicide
- Friends who have committed suicide
- Access to guns
- Conduct or psychotic disorder
- History of neglect, physical and/or sexual abuse
- Concerns about sexual identity
- Increase in risky behavior
- History of impulsivity
- Change in school or social functioning
- Alcohol and/or substance abuse
Source: Bright Futures in Practice: Mental Health, page 276
Asking teens about suicidal thoughts does not necessarily cause them to have these thoughts. Not asking a teen who has symptoms of depression about suicidal thoughts can mean a missed opportunity to prevent suicide. Many teens with suicidal thoughts are relieved at the opportunity to express and discuss them.
Arrange for emergency intervention if needed. Psychiatric evaluation should be obtained if the provider believes there is suicidal intent, or if the teen appears severely depressed. Inpatient or partial hospitalization is indicated if the teen appears to have suicidal intent.
Using the guidance listed below, address suicidal ideation, behaviors, and prevention with the teen and parents.

Guidance for Teens and Parents

For the Teen

If you are having problems and thinking of hurting yourself, immediately tell someone who can help. If you cannot talk to your parents, find someone else to tell—a relative, a friend, a teacher, the school nurse or guidance counselor, or a friend's parent. Or, call the National Suicide Prevention Lifeline at (800) 273-TALK (8255), and they will help you.
Don't be ashamed or embarrassed. A lot of teens and adults have problems that they can’t solve on their own. Finding the courage to get help is often the first step toward solving your problems and becoming a happier person.

For Parents

Monitor your teen’s computer use for suicide content in communications and Web sites.

If you suspect that your teen might be thinking about suicide:

Ask him about it. Let him know that you have seen his sadness and want to help. Encourage him to talk about his feelings. Listen to what he has to say and don’t dismiss his problems. Show him that you love him. Let him know that no matter how awful his problems seem, they can be worked out, and that you are willing to help.
Even if he is reluctant to talk about his troubles, he may show some signs that he is thinking about harming or killing himself. Look for possible suicidal behaviors:

Depression
Decline in school performance
Sudden cheerfulness after a period of depression
Difficulties with eating or sleeping
Unusually extreme violent or rebellious behavior
Withdrawal from family and friends
Risky behaviors
Purchase of a gun or interest in firearms

Neglect of hygiene and appearance
Drastic personality change
Imagined physical complaints
Preoccupation with death and dying
Giving or throwing away prized possessions
Talking or writing about suicide or threats of suicide
Cutting
Running away from home
Suicide attempts

Seek professional help immediately. Ask his health care provider to guide you.
Once your teen is in treatment, advise him not to expect results right away. Tell him not to get discouraged. Let him know that even though it will take time for him to feel better, he will eventually feel better.
Remove all lethal weapons from your home, especially guns. It is also a good idea to keep alcohol and medications locked up during this crisis period.

Resources for Providers and Families