Youth suicide rates are increasing at a concerning rate. A 2019 Centers for Disease Control and Prevention report noted that the suicide rate for children ages 10-14 nearly tripled from 2007 to 2017, and the rate for those ages 15-19 rose 76%. While traditional factors like hopelessness, abuse, trauma and substance abuse remain significant, researchers are trying to determine whether others, including social media engagement and economic and political stressors, could be fueling the increase. And these factors likely are only exacerbated by the disruptions and anxiety caused by the COVID-19 pandemic.
Regardless of the cause, most experts agree that parents and caregivers can be the first line of defense in protecting at-risk children. U.S. News spoke with John Ackerman, psychologist and suicide prevention coordinator for the Center for Suicide Prevention and Research at Nationwide Children’s Hospital, and Rhonda Boyd, a psychologist and assistant director of the Youth Suicide Prevention, Intervention and Research Center at Children’s Hospital of Philadelphia, about the emerging crisis and families’ roles in slowing the trend. The interview has been edited for length and clarity.
How should parents tackle this issue with their kids? What if they don’t see a problem? Is there a need for them to address the issue at all?
Rhonda Boyd: A paper that colleagues and I did earlier this year found that half of the parents interviewed were unaware that their kids had ever had thoughts about killing themselves. If you notice changes in your kid’s behavior, whether they’re more anxious, more distressed, they’re acting out, talk to them. Typically, parents know their child best. They may not know their internal state of mind, but they may see outside changes — they’re eating less, they’re in their room more. There are things parents could see.
John Ackerman: That was a really good paper, because it underscored the idea that not all kids are going to come out and openly share with adults that they are distressed or considering suicide. To meaningfully reduce suicide rates, we need to make sure that trusted adults such as family members and teachers know what to do and that the kids themselves have an opportunity to identify warning signs and be part of the support network. I’ve worked with kids who are very dedicated to masking information about their suicide risk, and so it takes different people looking at behaviors and what’s being said to inform an effective response. In the future, we may get to a point where we can explore social media footprints and other novel ways to better predict risk. In the meantime, our best options involve building more informed, curious and compassionate approaches to young people in distress.
But if parents talk about suicide with their kids, don’t they need to be afraid of sparking the idea?
RB: There is no evidence that asking a kid about suicide or suicidal thoughts or behaviors leads to their doing those behaviors. I think it should be an honest, very direct conversation asking them what they are thinking about. You want open communication so if they’re distressed, they will be able to talk without thinking that it will cause problems.
JA: What we’re finding when we ask young people if they’ve thought about killing themselves or if they’ve ever done anything to harm themselves is that they feel a sense of relief that an adult is willing to have this difficult conversation — as long as that adult is empathetic and willing to sit there with them in their emotional pain. It can be really empowering for a young person to share and have the adults around them say, “We’re going to walk alongside you and get through this together. You’re not alone. Other people do have this experience.”
Are depression and anxiety the main factors in suicide risk?
JA: The generally accepted standard of practice used to be to determine whether a young person had depression or anxiety, and if so, you would assess for suicide risk after that. What we’re learning is that that approach is not sufficient, because there are other pathways to suicide risk. Especially for younger kids, we know ADHD and impulsive aggression, for example, are larger risk factors for suicide attempts and behaviors than mood disorders alone. There are lots of other precipitating factors that can lead to suicide attempts, especially among young people whose brains are developing at a little bit different speed and who can’t always regulate their emotions, especially intense ones. Of course, mood disorders are still a major risk factor, but we really want to ask very direct questions of all kids with behavioral or emotional challenges.
Are you finding that suicidal behaviors can be transmitted to children by parents suffering from depression?
RB: When parents have depression and other types of mental health problems, it increases their kids’ risk for having mental health problems both early and later on, as well as increasing their risk for suicidal thoughts and attempts. Risk can be transmitted multiple ways; there is a genetic piece that could be happening, but parenting can also be impaired. This population of children should especially be targeted for prevention efforts, I would argue.
When we hear about suicides of celebrities or see suicide featured in movies and TV programs, does the potential impact on young people concern you?
JA: Media can play a positive role in suicide prevention and health care when done well, like stories of hope and recovery that highlight the use of coping skills to navigate mental health challenges. But there are lots of programs done poorly. When [the Netflix series] “13 Reasons Why” came out, I wrote a parent-oriented blog about it, because it violated many of the media’s consensus standards of how we should portray suicide responsibly. Unfortunately, it depicted suicide in a really graphic way, which can actually provide a blueprint for young people. It also talked about adults being completely unhelpful and indicated that seeking support in a crisis is futile. In subsequent seasons, show creators have done more to mitigate those issues and to provide more resources, but it’s a bit of a case of too little too late. When the media glorifies suicide, by depicting the method, by failing to provide resources or by not understanding suicide as part of a broader mental health condition where effective treatment is available, this all undermines our prevention efforts.
RB: Clinically, I saw when it was released that patients were coming in — often teenage girls who have depression and suicidal ideation — and they were binge-watching these shows. That was the part we were concerned about. In therapy we were able to talk about how it affected them. The teens didn’t always recognize the negative impact it had on their emotional well-being, and these are kids who are already vulnerable because they had depression. “13 Reasons Why” became sort of a lesson for us, as mental health providers, to be more aware of what’s coming out so we can help prepare our patients for these types of shows.
If parents have a child they believe to be at risk, how can they find helpful resources?
RB: It can be challenging. Depending on your community, there may not be that many resources available, and there may be waitlists. But it’s important for parents to find a mental health provider who has expertise with children and adolescents if they can, because it’s very different for adults. And do not wait. Sometimes I see kids whose parents are kind of waiting it out, and it’s been years that the kid has been suffering. We want to be able to prevent a trajectory of increasing mental health problems and risks. I think doing something as soon as possible is the best option.
JA: I completely agree with Dr. Boyd. If it turns out a child doesn’t have a big clinical issue, then you’ve helped provide him or her with some core skills on how to address emotional distress in the long-term, which is really important to every one of us. But often we are reactive and wait until individuals are at their sickest, in terms of their emotional health, before giving them skills. What we know, whether it’s financial investments, car maintenance or mental health, you want to invest early and strengthen the foundation to promote resilience, so that crises are less likely to emerge.
Can parental engagement significantly reduce risk, even in times of crisis like the pandemic has caused?
JA: Parents have a huge ability to help a child express emotions effectively and to develop trust. They can send the critical message that they will be there for them when things get tough. And they set the stage for kids to think, “the people around me can be counted on, my future is hopeful, and I am valuable.” That makes a difference for kids. When families and trusted adults are highly invested in young people — regardless of biological relationships — it can have a major protective effect against suicide.
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