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Teen Suicide Prevention

Know the Warning Signs

Most suicidal young people don’t really want to die; they just want their pain to end. About 80% of the time, people who kill themselves have given definite signals or talked about suicide. The key to prevention is to know these signs and what to do to help.

Watch for these signs. They may indicate someone is thinking about suicide. The more signs you see, the greater the risk.

  • A previous suicide attempt
  • Current talk of suicide or making a plan
  • Strong wish to die or a preoccupation with death
  • Giving away prized possessions
  • Signs of depression, such as moodiness, hopelessness, withdrawal
  • Increased alcohol and/or other drug use
  • Hinting at not being around in the future or saying good-bye

These warning signs are especially noteworthy in light of:

  • a recent death or suicide of a friend or family member
  • a recent break-up with a boyfriend or girlfriend, or conflict with parents
  • news reports of other suicides by young people in the same school or community

Other key risk factors include:

  • Readily accessible firearms
  • Impulsiveness and taking unnecessary risks
  • Lack of connection to family and friends (no one to talk to)

What to do if you see the warning signs?

If a friend mentions suicide, take it seriously. If he or she has expressed an immediate plan, or has access to a gun or other potentially deadly means, do not leave him or her alone. Get help immediately.

Show You Care

Often, suicidal thinking comes from a wish to end deep psychological pain. Death seems like the only way out. But it isn't. Let the person know you really care. Talk about your feelings and ask about his or hers. Listen carefully to what they have to say.

“I'm worried about you, about how you feel.”
”You mean a lot to me. I want to help.”
”I'm here, if you need someone to talk to.”

Ask the Question

Don't hesitate to raise the subject. Talking with young people about suicide won't put the idea in their heads. Chances are, if you've observed any of the warning signs, they're already thinking about it. Be direct in a caring, non-confrontational way. Get the conversation started.

“Are you thinking about suicide?”
”Do you really want to die?”
“Do you want your problems to go away?”

Get Help

Never keep talk of suicide a secret, even if they ask you to. It’s better to risk a friendship than a life. Do not try to handle the situation on your own. You can be the most help by referring your friend to someone with professional skills to provide the help that he or she needs, while you continue to offer support.

“I know where we can get some help.”
”Let's talk to someone who can help...let's call the crisis line,now.”
“I can go with you to get some help.”

Why do some teenagers commit suicide?

We don’t know for sure, because when youth die by suicide they take the answers with them. But teens who attempt suicide and survive tell us that they wanted to die to end the pain of living. They are often experiencing a number of stressors and feel that they do not have the strength or desire to continue living. We also believe that the majority of youth who die by suicide have a mental disorder, like depression, which is often undiagnosed, untreated or both.

What are the most common warning signs?

Some estimate as many as 80% of those thinking about suicide want others to be aware of their emotional pain and stop them from dying. A warning sign does not automatically mean a person is going to attempt suicide, but it should be taken seriously. The warning signs that we pay particular attention to are: a prior suicide attempt, talking about suicide and making a plan, giving away prized possessions, preoccupation with death, signs of depression, hopelessness and anxiety, increased drug and alcohol use.

How many people know about the warning signs and how to detect if a teen is going to commit suicide?

Not enough, but more are learning everyday. Preventive organizations work to teach professionals, parents, educators, clergy and especially young people. We believe that middle & high school students and college students can and should learn the warning signs and intervention strategies to help their friends. We don’t expect them to conduct a professional assessment but we want them to befriend a person in despair and offer support and reassurance and referral to help.

Are there particular youth who are more at-risk of suicide?

Some reports suggest that gay and lesbian youth are two to three times more likely to complete suicide than other youth. Alcohol and substance abuse also place a youth at higher risk for suicide.

Is there an increased risk for suicide because of bullying behavior? 

Yes; being a victim, perpetrator or even a witness to bullying has been associated with multiple behavioral, emotional, and social problems, including an increased risk for suicidal ideation.

Are the suicide rates different for males and females?

Across the country, males are much more likely to die by suicide, while girls are more likely to make suicide attempts that result in hospitalization. Hanging and use of a firearm are the most frequently used methods for youth suicide. Cutting and overdose are the most frequency used methods for suicide attempts that result in hospitalization.

If someone suspects that a friend or family member is considering suicide, what should they do?

There are three very important things to do if you notice the warning signs for suicide or the young person tells you directly that they are thinking about suicide. The first thing is to always show the person that you are concerned about them – listen without judgment, ask about their feelings and avoid trying to come up with a solution to their problem. Next ask directly about suicide – be direct without being confrontational; say “are you feeling so bad that you are thinking about suicide?” Finally, if the answer to your question is “yes” or you think it is yes, go get help – call a crisis line, visit the school counselor, tell a parent or refer the teen to someone with professional skills to provide help. Never keep talk of suicide a secret!

How many teenagers die by suicide in America each year?

In 2001 in the US, 4,250 young people between the ages of 10 and 24 died by suicide. This is an average of one suicide roughly every two hours! The national rate of suicide (per 100,000) is 9.9.

Why has the suicide rate been increasing in the past few decades?

Suicide rates across the USA have actually gone down since 1990. When the Youth Suicide Prevention Program began in 1995 the number of suicides and the rate were both higher than they are now. There was a significant increase in the late 70’s and early 80’s but the trend lately has been downward. It may seem that there is an increase because you are reading and hearing more about suicide. Media reports hopefully are educating about the warning signs and the resources for help.

Why are some state’s teenage suicide rates much higher than others?

Youth suicide rates are highest in Alaska and the Rocky Mountain states. If you map the youth suicide rates by state, there is a striking difference between the eastern half of the USA and mountain regions in the west. We don’t know for sure why these rates are higher, but some theories include the largely rural territory, the vast land allocations to Native American reservations, poverty and a lack of easy access to resources.

What are common myths about teen suicide?

Some believe if you ask directly about suicide that you “plant” an idea in the brain of a teenager; this is just not true. Others think that teens who talk about suicide are not really serious about dying – they think they are just seeking attention.

How can schools and communities work together to prevent suicide?

The Centers for Disease Control recommends that local mental health agencies, crisis centers, clergy, health departments, medical organizations, injury prevention agencies, schools and other community members should work together to develop goals and strategies to prevent suicide.

What is a family's reaction when a teen family member completes suicide?

Most feel a combination of emotions: anger, sadness, guilt, shame and fear. They wonder what they could have done and why they didn’t do more. Suicide is different from other kinds of sudden death because the reason for the death is difficult to understand. With a car accident there is an external explanation or cause – an icy road, loss of vehicle control, etc. With a homicide, the grief-stricken can point to a perpetrator. With suicide, we don’t have an external cause, and so we ask ourselves over and over: 'why?'

Is it okay for a school to plant a tree or dedicate a bench in memory of a youth who has died by suicide?

These types of memorials can keep the death 'alive' and serve as a grim reminder of the loss. Because of the real concern about contagion there is a delicate balance between commemorating the life of the deceased and glamorizing a suicide.

About Depression and Suicide

Not only adults become depressed. Children and teenagers also may have depression, as well. The good news is that depression is a treatable illness. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function.

About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct, or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.

The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters. If one or more of these signs of depression persist, parents should seek help:

  • Frequent sadness, tearfulness, crying
  • Decreased interest in activities; or inability to enjoy previously favorite activities
  • Hopelessness
  • Persistent boredom; low energy
  • Social isolation; poor communication
  • Low self esteem and guilt
  • Extreme sensitivity to rejection or failure
  • Increased irritability, anger, or hostility
  • Difficulty with relationships
  • Frequent complaints of physical illnesses such as headaches and stomachaches
  • Frequent absences from school or poor performance in school
  • Poor concentration
  • A major change in eating and/or sleeping patterns
  • Talk of or efforts to run away from home
  • Thoughts or expressions of suicide or self destructive behavior

A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way of trying to feel better.

Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.

Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.

When a Friend is Talking About Suicide
by Christine Henderson

Time is the crucial thing when dealing with a friend who is having suicidal thoughts. It is important that once you hear your friend talking about these feelings, to recognize them for what they are: a serious threat to your friend's life. Don't ignore them and assume the person is just being dramatic. If your friend is talking about killing him or herself, you just can't handle it on your own- you HAVE TO tell a trusted adult! This may seem like something you hear all the time: tell an adult. But in this case, we're talking about someone's existence on earth, someone's life. That is something that should grab your attention and motivate you to tell someone immediately. Don't be a fool and think you can take care of this yourself- you can't!

You may be nervous that this person will be upset with you if you tell someone. To be honest, that is a risk you are going to have to take. You have to understand that having this person alive and on earth is more important than having them for a friend. You are going to have to risk sacrificing the friendship and get up your courage or else your friend might lose his or her life. This fact may seem scary and daunting, but having that person kill themselves will make that fear seem like a walk in the park. Feeling suicidal is indescribable pain that no one should have to deal with, and the pain of losing someone to suicide is just as bad, trust me. You don't want to look back and wish you had told someone. You will carry that regret with you for the rest of your life, so please, do something about it! Tell an adult you trust will know what to do in the situation.

Acting like an adult yourself and asking for help is a big step and can be quite overwhelming and stressful. However, you need to think about this situation in the grand scheme of things – like how will you feel if you keep this information to yourself and your friend dies? This can be difficult to think about, but challenge yourself to think about this very real reality. And if you do decide to tell someone, and your friend's distress is caught early enough, then your friend can get help. The point is: the ability of your friend to have the option of living a happy life can ultimately depend on your telling someone. You will be making a proactive and potentially life-saving decision to intervene at the right moment.

One last time I want to remind you, time is of the essence. Maybe your friend will ultimately thank you, and maybe not. But in the big picture, that really doesn't matter. If you get the slightest inkling that someone might not be okay, do something about it! Don't wait around. And don't try to be a rescuer and take care of it on your own to save the friendship. Act on your instincts, trust your gut, be a grown-up, and tell! It could save the life of someone very dear to you.

**Christine is a college freshman whose personal experience with the suicide of her mother has inspired her to become an advocate for youth suicide prevention**

A First-Person Message for Teens 

by Stacy Hollingsworth, College Student

I used to think that depression and suicide were things that happened to other people, that the way I approached my life somehow prevented me from becoming a victim of mental illness.  I realized just how incorrect that assumption was when my own life was turned upside down by major depression.

I first noticed that something was wrong in 8th grade. Apparently, so did one of my teachers, because she asked me if anything was wrong. Unfortunately, she did so in front of the whole class. From that day on, I put up a wall to protect myself from the embarrassment of having a stigmatized illness. I wore a mask—a façade—to cover up what I was actually going through. I didn't feel comfortable sharing my feelings with any adults in my life at that time.

My depression continued in high school. I was hoping that someone—anyone—would bring up the topics of depression and suicide, so that I wouldn't have to. In school, there were always lessons about alcohol, drugs, and safe sex—but never ONCE were depression or suicide mentioned. Maybe, just maybe, if the adults in my life had been educated in these topics, I would have felt comfortable asking for help, and I would have been spared years of suffering.

But I'm one of the lucky ones. I did get help. I'm here today as the voice of those who are not yet being heard - the child who's sitting in a class full of students thinking he or she is the only one feeling this way...or the teen who can't focus in school because he or she is trapped by the isolation and pain of depression.

Help IS available—ask your friends, your resource staff at school, your parents, or call the suicide hotline at 1-800-273-TALK (1-800-273-8255). The right resources are there—look for them—because they CAN save your life!


What is self-harm?

Non-fatal intentional behavior that results in actual tissue damage, illness or risk of death.

Who self-harms? Self-harm is correlated with the following behaviors and symptoms but is NOT caused by these:

  • depression
  • loneliness/isolation
  • hopelessness
  • perfectionism
  • impulsivity
  • impaired family communication
  • anxiety
  • self-blaming
  • low self-esteem
  • hypercritical parents
  • awareness of self-harm by peers

Why do teens self-harm? Reasons vary, but tend to fall into one of these categories:

  • to stop bad feelings
  • to feel something
  • to avoid doing something unpleasant
  • to get a reaction

Is a teen who self-harms also suicidal?

Typically teens who self-harm are trying to feel better, while a teen who attempts suicide is trying to end all feelings, BUT... the intent of the behavior can vary and needs to be assessed. Self-harm can be a risk factor for suicide; the higher the frequency of self-harm, the greater the risk for suicide.

What can be done about a teen who is self-harming?

  • Don't react with criticism or horror
  • Remain non-judgmental; let the teen know that you care
  • Understand that the behavior is a coping mechanism
  • Validate the emotion that triggered the behavior, not the behavior
  • Get professional help that will provide the teen greater insight into their emotional states and replace the self-harming behavior with effective coping skills (see below, questions for interviewing and selecting a therapist)

Suggested Interview Questions for Therapist

  • Have you previously treated children and/or adolescents who were cutting or intentionally hurting themselves?
  • If so, what is your theoretical orientation to treating this behavior?
  • How do you involve parents/guardians in the treatment?
  • How do you balance confidentiality between the patient and the parent?
  • Do you tend to recommend medication for the teens that you are treating for self-harm?

Whatever their theoretical approach, the therapist should be able to explain it to you in a specific, understandable fashion. Preferably their approach is focused less on understanding why your child is engaged in self-harming behavior and more on teaching and reinforcing coping skills.

If the therapy is not making sense to you or if you feel that your child is not making adequate progress, talk with the therapist. Be an advocate for your child and consider interviewing and selecting another therapist. The first therapist may not be a “match” with your child.


Overview and Perspective Regarding College Students

With the pressures facing most people today, it is essential to take your mental health seriously. This is especially true for college students and young people, whose lack of experience in the real world could lead to major mental health issues resulting from stress, overwork, fatigue, or even the onset of a more serious mental illness. In fact, up to 75 percent of college students with possible mental health issues do not seek help for what ails them.

While this resource is meant to provide college students and young people with quality information on maintaining good mental health and identifying mental health issues, it is not meant to take the place of professional advice from a qualified mental health specialist. Anyone who wishes to learn more keeping tabs on their mental health should consider taking this mental health 

assessment before diving into the resource.

Most Common Mental Health Issues Facing College Students

Below is a list of serious mental health issues known to affect college students and young people:

  • Depression: While it might be easy for a busy college student to write their depression off as school-induced stress, depressive tendencies can of course be symptoms of more serious mental health issues. In fact, a 2012 study reported that 44 percent of college students have one or more symptoms of depression. This startling statistic shows that hits depression faced by nearly half of all college students could lead to more complex mental health issues without the proper counselling to help them identify the source of their depression.
  • Anxiety: It goes without saying that most college students experience some degree of anxiety. As you might expect, juggling assignments, exams, and part-time jobs can lead to serious levels of anxiety, which could then escalate into a major mental health issue or disorder. Students who feel like anxiety is getting the better of them should schedule some time to speak with a counsellor or mental health specialist in order to pinpoint the source of anxiety and figure out solutions to overcome it.
  • Suicide: The worst possible outcome of an untreated mental illness is suicide. Even for people without a serious mental disorder, the stress of an independent environment can lead to suicidal thoughts. Anyone who has seriously considered suicide should seek professional help immediately. Suicide hotlines staffed by specialists are usually the quickest and most discreet options for people to get the care and attention they need.
  • Bipolar Disorder: This is a major mental health disorder often characterized by extreme bouts of depression followed by periods of manic activity. With the stress and workload many college students face, it’s easy to pass off symptoms of bipolar disorder as mood swings. According to WebMD, severe enough mood swings will interfere with a person’s functioning could be related to an underlying bi-polar disorder. Young people who find that their mood swings are causing difficulties in their personal or academic life should seek counseling from a mental health specialist immediately.
  • Eating Disorders: According to the National Eating Disorders Association, approximately 20 percent of women and 10 percent of men in college struggle with an eating disorder. For some, the pressure of losing weight and “looking good” might be enough to trigger the beginning of an eating disorder. For others, the stress of a busy social, academic and work schedule may make it difficult for them to find time to eat properly, which could also lead to a serious eating disorder down the line. While there are several different eating disorders, anorexia and bulimia are two of the most common. Eating disorders are serious and could lead to devastating consequences for a young person’s health without immediate treatment from a mental health specialist.
  • Addiction: For individuals of any age, addiction can lead to significant and life threatening health issues without proper treatment. Addiction can be especially devastating for young people, who may turn to drugs, alcohol, or food to deal with general stress or an underlying mental health disorder. Binge drinking is an especially common form of addiction found on American campuses. According to the National Survey on Drug Use and Health, of the 61 percent of surveyed colleges students that drank, 40.5 percent binge drank and 16.3 percent were heavy drinkers. For many who struggle with addiction, often the hardest hurdle for them to overcome is admitting that they have a problem. If you or a young person you know is struggling with addiction, counselling from a mental health specialist or admission to a substance rehabilitation center are two viable treatment options.
  • Self-harm: Unlike other mental health issues, the underlying reason behind why young people choose to physically harm themselves still eludes researchers. Moreover, people who do harm themselves tend to do so in private and on areas of the body that may not be visible to others. Some estimate that up to 15 percent of college students have engaged in some form of self-harming behavior. Self-harm is a serious mental health issue that should be monitored by a trained mental health specialist.
  • Struggles with Identity: U.S. society has gradually come to accept the many disparate identities found within its borders. That said, in certain areas of the country, there is still a significant amount of intolerance directed towards people who identify themselves in a certain way. While a given identity will not necessarily indicate mental health struggles, the pressures of withstanding a hostile social environment could lead to severe stress and anxiety. Anyone struggling with extreme social pressures due to their lifestyle or identity should immediately seek help from a qualified specialist at their school or workplace.

What’s Your Anti-Stress?

For college students and young people who do not struggle with significant mental health issues, there are still actionable steps to take in order to relieve stress and anxiety. Here are some suggestions to take into consideration:

  • Physical Activity: Physical activity releases “happy chemicals” in our brain known as endorphins that can have an almost immediate impact in balancing our mind and body’s negative reaction toward stress and anxiety. Physical activity can also boost self-confidence and increase our ability to think clearly, focus, and inspire others to do the same.
  • Sleep and Diet Changes: Major changes in diet or sleep habits can also lead to elevated levels of stress or anxiety in a college student. Consistently staying up late to study for exams or finish assignments can mean some degree of sleep deprivation, which could lead to poor academic performance or more serious mental health issues. What’s worse is that sleep deprivation and poor diet often go hand in hand. Dramatic shifts in diet will also impact a student’s academic performance and mental health.
  • Psychiatric Care: If a student finds that the amount of stress they face is becoming too much to handle on their own, obtaining psychiatric care should be given serious consideration. Inpatient or outpatient care may be pursued depending on the severity of the mental health issues faced by the individual in need of care. Mental health specialists are there to help us overcome stress, anxiety, and many other issues impacting mental health. Remember that seeking psychiatric care should never be thought of as unreasonable.
  • Relaxation Exercises: No matter how stressed or anxious students become, there should always be something to count on as a source of positive relaxation. That said, many young people may not be able to find the opportunity to relax in the way that they prefer. Nonetheless, there are several quick and easy relaxation exercises to explore. Taking a few breaks each day to stretch, meditate, or even pick out a comfortable set of clothing can work to significantly reduce anxiety throughout the day.
  • Therapy and Counseling: Even if a young person feels that the stress in their life is not affecting their mental health, seeking therapy and counseling to understand how to better manage anxiety can still be helpful. Students may feel they have an exceptionally high tolerance for stress and anxiety, but that failing to learn new and better ways to manage their stress could rapidly lead to more serious mental health issues. Seeking therapy and counselling is often the safest and most effective way to get personalized advice before stress becomes a much more serious problem.

Your Right to Mental Health: Understanding Confidentiality and Insurance

As the public’s awareness about the importance of mental health grows, more attention is being directed toward insurance and confidentiality solutions for people struggling with mental health issues. The stigma of mental health as being less important than maintaining good physical health has led to a crisis of mental health, which can only be corrected as more and more citizens recognize the power of quality mental health treatment.

A major trend bringing attention to the mental health of college students is the fact that more student than ever before are seeking mental health care. As with any rising demand for an important health service, institutions that work closely with students –  like their colleges and universities – are incorporating mental care into the health care offered to students. Moreover, people who are 26 years old or younger are now able to be covered by their parent’s health insurance policy as a result of the 2010 Affordable Care Act (also known as “Obamacare”).

On top of providing young people with more health insurance options, the Affordable Care Act has also introduced some great provisions regarding mental health care. Supporters of the health law recognize mental health care as an important part of physical health care. As such, the ACA makes it easier for young people to afford health insurance and expands Medicaid to help more people that struggle daily with mental health issues. The law also ensures that certain mental health services and treatments that may have traditionally been declined by private insurance companies or Medicaid must now be covered.

Confidentiality is also a major roadblock discouraging people from seeking out the mental health treatment they need. Even though mental disorders are becoming more understood and accepted by the public-at-large, students may still feel embarrassed of their own mental health issues. Everyone should understand that the professional mental health community employs many safeguards to help keep information about your mental health confidential and only shared when coordinating a patient’s care.

While the Affordable Care Act should ensure that all young Americans have access to affordable, high quality health care, there are still many young people today that remain uninsured. Young people who find themselves uninsured, however, should remain vigilant about obtaining mental health care the minute they need it. To help uninsured people find proper mental health treatment, Mental Health America has compiled an extensive list of options that should be kept handy in the event of a mental health crisis.

As the inclusion of mental health treatment becomes the rule and not the exception for health plans across the nation, college students will finally have the resources and support needed to help maintain both their physical and mental well-being while on-campus.

Note:  This page is for information purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified provider, prior to making any decision about your health.

Copyright 2001-2011 Youth Suicide Prevention Program All Rights Reserved

This information was obtained from the American Academy of Child and Adolescent Psychiatry (AACAP) website.