Many teens think about suicide. Parents: you need to take an inventory of your child’s habits and address problems with diet, sleep, and exercise.
If you hear from your teen daughter — or her therapist — that she thinks about suicide, the natural response is terror and guilt.
You won’t be alone. More than 22 percent of American high school girls think about attempting suicide, according to 2013 teen suicide rate data from the Centers for Disease Control and Prevention. That’s a terribly big number. But it should help — a bit — to hear that only half of them made an attempt, and only 3.6 percent did something that made them need medical attention.
The numbers were roughly half for boys: nearly 12 percent considered suicide, more than 5 percent made an attempt, and 1.8 percent made an attempt that resulted in an injury, poisoning, or an overdose that required medical care.
Is your daughter (or son) eating consistently? A teen who loses her appetite is at much greater risk of hurting herself in some way, according to a study in Japan of more than 18,000 teens. What she eats counts as well. In a separate study, researchers following more than 7,000 teens found that not eating enough vegetables and fruits and sticking to a limited repertoire — typically meat and bread — can drag down mood.
Insomnia is also a danger sign. Sleep deprivation is strongly linked to depression in teens. It may be worth the battle to insist that your teen stay away from computers and smartphones for an hour before bedtime. Many teens do their worrying lying in the dark. You might suggest writing in a diary or scheduling a “worry period” just after dinner, along with a talk about why worrying at night makes things worse. Especially poor decision-making skills is another risk factor.
You might think your child isn’t in danger as long as she’s going to school and not doing drugs or otherwise acting out. But teens who skip or can’t sleep, focus on electronic gadgets, and don’t exercise may be in trouble — even if they’re generally well behaved, according to a large 2014 study.
Teen suicide prevention
You might be tempted to take a “wait and see” approach. That may make sense for a few months, but not longer: research concludes that treatment within the first six to 12 months after the suicidal thoughts begin is most effective. Schools run suicide-prevention programs that help teens recognize the signs in each other, but other studies indicate that these programs don’t stop suicidal thoughts or attempts.
So don’t delay: have your child evaluated by a psychotherapist. You’ll hear contradictory tales about antidepressants — that they’re necessary or ruled out for teens. Neither may be true for your child. You’ll also hear that the gold standard treatment is a combination of talk therapy and antidepressants. But a 2014 review from the prestigious Cochrane Review has concluded that the effectiveness of this approach remains unproven.
The bottom line: It’s not clear how antidepressants or therapy alone or the two together affect suicidal thinking. Your best move is to get a professional opinion, talk to your daughter, see what she prefers, and keep paying close attention. There are many treatment options, and trying many is a good idea.
Community-based creative activities — local theater or art programs, for example — can improve self-confidence in teens. Exercise improves self-esteem and dampens depression, though research suggests it won’t substitute for therapy. Even computer-based interventions can be helpful, some research shows.
If you call the police reporting that your child has threatened suicide, in some areas she will be required to enter a standard program with a hospital stay, sometimes followed by a requirement that your child attend group therapy. Studies do suggest that groups led by a specialist that allow teens to talk with each other about their emotions can be effective.
Make your home safe. Practice gun safety — keeping them unloaded and locked up with ammunition elsewhere. A depressed teen also shouldn’t have access to alcohol or vials of painkillers or sleeping pills in your home. Any practice that buys time is essential — the time between the decision to commit suicide and the action may be short — from five minutes to a day. But you can take comfort in the fact that many people who have attempted suicide say they spoke to friends, family, and partners during the decisive interval. Be sure your child has someone to talk to who is both loving and calm.
March 30, 2017
Christopher Nystuen, MD, MBA