Teen suicide: What parents need to know : Inside Children's Blog

Dr. Laura Markley, a child and adolescent psychiatrist at Akron Children’s Division of Pediatric Psychiatry and Psychology, answers questions about teen suicide.

Suicide is one of the leading causes of death in adolescents in Ohio. According to the 2020 Ohio Child Fatality review, more teens and young adults in the U.S. die from suicide than cancer, heart disease, AIDS, birth defects, pneumonia, influenza, and chronic lung disease combined. Dr. Markley talks about some common myths.

The biggest myth that comes to mind is that if children are asked about suicide that it “gives them the idea.” This has been found time and again to not be the case. Asking about suicidal thoughts and ideation creates a much needed opportunity to address emotional crises and provide treatment. However, there is a phenomenon called “suicide contagion” where youth exposed to a suicide in their community are more likely to have an attempt following the initial incident. It tends to be more likely to affect at-risk youth who are exposed to the suicide peripherally – that is, they are often more likely than youth who were emotionally close to the suicide victim to feel compelled to follow. This is why details of suicides are ideally not publicized and victims are not memorialized publically as much as teens who die by other means. It is not to be unfair; it is to protect peers from following suit. Recently, it has become a concern that this effect could also stem from exposure to and over-identification with fictional suicide portrayals in the media. Controlling exposure has become difficult in the age of social media. Parents should monitor what their children are being exposed to with respect to suicide, and in general.

“Only depressed people kill themselves.”

While depression is definitely a significant risk factor for suicide, in teens, suicide attempts/suicide are often impulsive acts following what the teen perceives to be a serious stress, and this affects many with no known history of depression. The situation is brought about when the stressors exceed the teen’s ability to cope, and though they may proclaim that they will never do it again, suicidal attempt or behavior is the strongest predictor of a future attempt. Acute psychiatric hospitalization following an attempt focuses on increasing emotional awareness, opening communication, and learning and strengthening coping skills.

“Well, if they didn’t have a gun, they would have found something else to do it with.”

It has been proven, over and over, that the most effective intervention to decrease the risk of completed suicide is removing access to lethal means, especially firearms. This is not a judgment call on firearms. This is understanding that when an impulsive, emotional teen is looking for a way to harm themselves in the heat of the moment and has unsupervised time and/or access to a firearm – this situation creates a high risk of a resulting in death.

People often blame themselves for missing signs of suicide ideation in loved ones. How can parents know what their kids are really thinking?

None of us can confirm what another individual is thinking. In general, the best thing you can do is keep an open dialogue with your teen. Simple things like family meals have been found to be protective. Have times when everyone puts down their devices and talks. Asking about simple things, like how their day went, can make it easier for them to come to you about the tougher things, like difficulties with peers or feeling depressed.

If your teen comes to you with a concern, take them seriously, and if you don’t know what to say, consider that listening is almost always the best thing you can offer. For example, if your teen is sad about a break-up, saying something like, “Well, it’s not like you were going to get married – you’re great and you’ll find someone better” is not as helpful as saying, “That sounds really upsetting. How are you feeling?”

It is normal for teens to have more independence as they get older, but if the expectation and routine is set early on that there is a supportive, open dialogue, it will be very helpful in the long run.

If parents do notice behavioral changes in a child – acting more moody, withdrawn, sleep problems, falling grades, change in peer groups – it is prudent to consult a healthcare professional, even if the teen is dismissive.

Is substance abuse a risk factor for suicide?

Substance abuse is also a significant risk factor. With the marijuana legalization efforts in the news, many teens are getting the idea that abusing marijuana is not only benign, but possibly beneficial to their mood, which has never been proven to be the case. What is known is that cannabis was the most prominent substance found on autopsy in teens who completed suicide in Ohio. It cannot have a “black box warning” because it is an illegal substance – but it is associated with attempted and completed suicide. Substances decrease one’s ability to stop and think before acting. Combining this with the already impulsive nature of a teenager can lead to several negative outcomes. It can be difficult to motivate a teen into treatment, but parents can consider restricting their teen’s ability to obtain a license or drive until they feel that they are in a state where they will be safe on the road.

Any other advice for parents?

Be a role model for your children, by addressing your own mental health needs and displaying healthy coping mechanisms. They are learning from watching you from an early age. Don’t be afraid to seek treatment for yourself or your child. Asking for help is a display of strength, and the earlier you address an issue, the better the outcome will be.

Be sure ALL pills, over-the-counter and prescription, are locked up at your home as well as the homes of your loved ones. The most frequent overdoses that we see are on over-the-counter medications, which can be very dangerous in overdose, and on a teen’s own prescriptions, that they have been allowed to control.

If symptoms of depression persist, seek professional help. Your child’s pediatrician is a wonderful resource who can offer evaluation and treatment for mental health concerns and/or make a referral to a mental health specialist if necessary.