Talking to Your Child About Suicide

A new study from the U.S. Centers for Disease Control and Prevention (CDC) confirms what pediatricians and mental health experts have suspected for months – the COVID-19 pandemic and the dramatic changes to our daily lives have had a significant negative impact on the mental health of young people, particularly adolescents.

In the recent CDC study, researchers found a steady increase in emergency department visits for suspected suicide attempts by adolescents during the pandemic. The increase was most significant among girls aged 12 to 17. And while death by suicide has not increased during this time, the 50 percent increase in attempts clearly shows the distress many of our young people are experiencing.

September is National Suicide Prevention Awareness Month – which makes now a good time to start the conversation about mental health and the risk of suicide with your adolescent or teen.

Startling statistics about adolescent suicide

If you’re like most parents, you probably think suicide isn’t something you need to worry about. You may believe if your child was upset or depressed, you’d know about it.

You could be wrong on both counts. Consider these facts:

• Suicide is the second leading cause of death among youth between the ages of 10 and 24
• One in every five high school students has considered suicide in the past year
• One in 11 high schoolers have made a suicide attempt (CDC data)

What can parents do?

Parents are often surprised by a child’s suicide attempt, not realizing how unhappy or desperate their child was. Sometimes, even when parents see their children are struggling – as many adolescents have during the past 18 months of the pandemic – parents are hesitant to start a conversation about suicide. Many worry that asking about thoughts of self-harm will plant suicidal ideas in their child’s head.

However, research has repeatedly shown screening for suicide risk actually decreases the chance the child will make an attempt. Suicide is preventable. By opening a dialogue, you can help your child feel more connected and supported. Talking may be the first step toward helping your child get what could be life-saving help.

When starting a conversation about suicide and your child’s risk, consider the following suggestions by Stacy McAllister, MD, Attending Child and Adolescent Psychiatrist with the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children's Hospital of Philadelphia.

Choose a time when you and your child will be able to talk and listen without distractions or interruptions. This may be when you are in the car together or at night when your child is winding down before bed. Don’t wait until your child is in crisis to start a conversation. Use occasional talks as touch points – ask your child how they are feeling and what they are excited or worried about. Reinforce that you are available to talk about anything. If they are uncomfortable talking to you about something, offer some alternative resources – a teacher, coach or other trustworthy adult in their life.

Use a news item or something you recently read to start a conversation, i.e., “I just read a surprising statistic about the number of teenagers who have considered suicide.” Or, if there’s been a recent publicized suicide or suicide attempt in your community, consider using that as a starting point for your discussion.

If you feel uncomfortable bringing up the subject of suicide, say that. It’s probably hard for your child to talk about it, too. But it’s important, and that’s why you need to start the conversation with your child. Reinforce that you want the best for them, for them to be happy and achieve their personal goals for happiness.

Ask your child direct questions. “Is suicide something you’ve ever thought about?” “Have any of your friends ever talked about suicide?” “Do you have any questions or worries about suicide?” Use age-appropriate language whenever possible. For younger children, this may include referring to suicide in less clinical terms such as “hurting yourself” or ”going to sleep forever.”

Give your child time to answer. Listen to what your child says without interrupting. Ask clarifying questions, if needed. The goal is to hear how your child is truly feeling, to provide supports when needed, and to allow them to grow into functional and contributing adults.

Teens feel emotions strongly and often in extremes. Ask about their day, and often you’ll hear “great” or “horrible.” In most cases, there’s not a lot of in between. But just because teens’ moods can vary greatly – sometimes within the same hour – does not make their feelings any less valid. Parents need to understand the vast changes going on in adolescents’ minds. It’s a period of intense brain growth and the emotional toll can be steep. Teens can share how they are feeling with words, actions and reactions. Pay attention to any out-of-the-ordinary or troubling responses.

Be mindful of your responses. Don’t overreact, criticize or minimize what your child says or is feeling. This can shut down the conversation or make your child reluctant/afraid to confide in you. But don’t underreact and dismiss your child’s feelings, either. You want to make your child feels heard. Acknowledge their feelings and seek to better understand where they are – in that moment – and what help they may need now or moving forward.

Ask for time. If your child says something that concerns you, or you don’t know how to respond in the moment, ask for time to think about it and permission to continue the conversation later. Then, once you have your thoughts together or have gathered additional resources, follow through with your promise to resume the conversation within the next couple of days. It’s important not to let too much time go by before reconnecting. Your child may believe you don’t care or that their concerns or feeling are not important to you.

Look for changes in behavior that are out-of-character for your child. Have they become sullen and withdrawn with peers? Do they have a lot of new friends they don’t want you to meet? Are they participating in high-risk behaviors that could put their life at risk (i.e., drugs, guns, sexual activity)? If your child has a dramatic personality change, ask questions and don’t stop until you feel confident your child is not a danger to themselves.

Get support for your child – even if it’s not from you. If your child has trouble opening up to you, ask if there is another adult they trust enough to confide in — perhaps a relative, someone at school, or someone in your faith community. If not, offer to help find a licensed therapist.

Keep your eyes and ears open for warning signs of suicidal thoughts and plans. If your child admits to having current thoughts of suicide, seek help immediately. In this case, it’s not an overreaction to bring your child to a hospital emergency department or crisis center. This may help your family get mental health resources sooner than making inquiries from home. Getting professional help is especially important if your child is or has become impulsive and/or unpredictable.

Include your child’s pediatrician. If your child is seeing a therapist or other mental health professional, make sure your child’s primary care doctor knows about it and any treatments or medications prescribed. The primary care pediatrician can follow up with your child and family long-term to address any ongoing mental or physical health issues that develop.