Increasing Awareness and Prevention of Youth Suicide

It’s a sobering fact. Suicide is a leading cause of death among young people in the United States. The topic is difficult to talk about – but it is one that can save lives.

Every year, approximately 2 million adolescents attempt suicide. According to the Children’s Hospital Association’s Pediatric Health Information System, suicide attempts, ideation and self-injury among children from ages 5-18 have become the most common behavioral health condition seen in children’s hospitals’ emergency departments nationwide.

Experts say several factors are behind these numbers. “During the COVID-19 pandemic, access to outpatient health care was extremely limited. This led to a significant increase in children and adolescent visits to the emergency room for mental health emergencies across the United States that may have been prevented with careful outpatient management,” said Bonnie Mackenzie, MD, attending physician and medical director of the Pediatric Emergency Department at Lawrence + Memorial Hospital.

“There is also evidence to support the idea that exposure to social media may be making more children and adolescents depressed and anxious,” said Kirsten Bechtel, MD, a pediatrician in the emergency department at Yale New Haven Children’s Hospital (YNHCH) and professor of Pediatrics and Emergency Medicine at Yale School of Medicine.

“The increased use of social media among children and adolescents has also led to an increase in cyberbullying. Research shows that 97 percent of adolescents report using at least one form of social media, so the effects are far reaching,” Dr. Mackenzie added.

Other risk factors include a family history of suicide; stressful life events, the presence of mood disorders with no behavioral health treatment, substance use, poor parent-child communication and school problems.

Warning signs of suicide 

How can a parent know if their child is struggling with a mental health issue? Various behaviors should raise concern.

“It's very important for parents to monitor their child's mental health, because it can be very dangerous if certain symptoms like anxiety and depression are left unattended,” said Shanthi Mogali, MD, a psychiatrist with Northeast Medical Group and assistant professor of Clinical Psychiatry at Yale School of Medicine. Dr. Mogali treats patients at L+M and Westerly hospitals. 

Immediately call 911 if you observe someone:

• Saying they want to kill themselves or threatening to hurt or kill someone else
• Looking for ways to kill themselves, such as seeking access to pills, weapons or harmful activities 
• Talking or writing about death, dying, or suicide, either verbally, in a note or on social media postings

Additional warning signs include:

• Feelings of hopelessness
• Increased substance use
• Withdrawal from friends, family
• Inability to sleep or sleeping all the time
• Drastic mood changes (rage, sadness)

“Children often present with physical symptoms, yet sometimes it's all related to whatever they’re feeling emotionally. This is why it’s important to check in with a mental health provider or a primary care provider to help determine if there is a psychological component to their symptoms,” Dr. Mogali said.

What should you do if you see warning signs?

Address the situation directly and don’t be afraid to be blunt. “The first step is to acknowledge that you see the signs and that you are concerned about the person. Ask the child or adolescent if they are thinking about hurting or killing themselves,” Dr. Mackenzie said. “Don’t be afraid to ask. It does not increase the risk of death by suicide, and may actually help to save that person.”

Mackenzie said. “Don’t be afraid to ask. It does not increase the risk of death by suicide, and may actually help to save that person.”

If you are worried that a child or adolescent is suicidal, you should just ask and not wait for warning signs to occur, said Dr. Bechtel.

In 2022, a national hotline was created to provide free and confidential support for anyone in a crisis. That includes those who need support for a behavioral health crisis, or who are in emotional distress. Anyone—the person in crisis, or someone supporting a person in crisis—can text or call 988 in the United States through any land line, cell phone, and voice-over internet device.

The 988 Lifeline provides easy access to behavioral health care. It differs from 911, which dispatches emergency medical services, fire, and police. A 988 call may lead to activation of the 911 system if there is imminent risk to someone’s life.

Connecticut residents can also call 211 to be connected with essential services and resources, including support for health evaluation, intervention and suicide prevention.

Strategies for risk reduction

Experts advise to put time and space between someone who is experiencing suicidal thoughts and their access to lethal items. Firearms, for example, are used in almost half of suicides among adolescents and children, according the Centers for Disease Control.

“It’s important to consider the presence of guns in the home. While it’s safest to have a gun-free home to decrease the risk of suicide, if a firearm is present it should be unloaded and locked up separately from the ammunition. Ammunition should also be locked away,” Dr. Mackenzie said.

Other potentially dangerous items to secure include medications, knives and ligatures.

Dr. Bechtel also recommends QPR training, which teaches you how to recognize the warning signs of a suicide crisis and how to “question, persuade, and refer” someone to get help.

“Children and adolescents should be appropriately screened for mental health disorders as part of a holistic approach to health and well-being. If a mental health or substance use concern is brought to light, referrals to community resources and mental health providers can be lifesaving,” she said.

“I encourage parents to work closely with the people in your child’s life and to listen carefully if they have information about how your child is behaving,” added Dr. Mogali. “Teachers, coaches, therapists and other family members may be able to offer insights that even parents are not aware of, and listening to others can sometimes help with early diagnosis of a mental health issue or disorder.”