It is difficult to assess the risk of suicide and suicide attempts in children and adolescents although it is possible to identify risk factors.  

One risk factor that seems to be important involves how a parent talks to their child or adolescent.  If statements are mostly negative that are directed to the child or adolescent, this increases the risk of suicidal behavior.  This clearly indicates that children and adolescents are influenced by what and how parents talk to them.  It is also clear that negative communications are damaging and not effective in achieving behavior change.  Being encouraging and supportive with our children and adolescents will lead to positive behavior change and increased self-confidence.  A study looking at what indicates whether a child will be successful as an adult [be able to function successfully independent of their parents] correlated significantly with the amount of positive communication parents directed to their children during their preschool years.  Successful children were talked to more and with a much higher percentage of positive and encouraging comments. It is never to late to start emphazing positive and encouraging statements to our children, yet it is just better if it starts out that way from birth.

Other risk factors related to suicidal behavior in male and female adolescents include: if they disobey their parents; don't talk to their parents; have had a recent argument with their parents; and if there is a family history of depression or substance abuse/alcohol problems. Risk factors for female adolescents include: death of a family member or illness in a family member.  Risk factors for male adolescents include: parents separated or divorced; parent recently lost a job; the adolescent is adopted; or a parent has been jailed.

It is important to pay attention to a child or adolescents statements about suicide and also important to ask your child or adolescent if they are thinking about suicide or have ever thought of it.  If you are concerned about a behavior change in your child or adolescent, ask about suicidal thoughts or impulses. Just talking about suicidal thoughts/impulses will reduce the risk of your child or adolescent acting on them.  In addition, talking about how to handle feelings and stress and offering your support to listen to your child or adolescent, can be very helpful.  Listening without immediately offering suggestions, is very supportive.  Finally, talking about a safety plan with your child or adolescent is important with a focus on ways that your child and adolescent can ensure that they will be safe.



Almost all research involves larger numbers of people and this allows the results to be discussed as the probability that the changes in symptoms was related to the treatment.  This does not tell any individual if the treatment will work for them except that it can be said that there is a probability [% liklihood]  that they will respond.  

So, why is this important?  Everyone of us has to discover if we will respond to a treatment and for blood levels, we need to find out what a normal blood level is for us. This is always important and yet it can be very important for hormone levels. An example is the TSH [thyroid stimulating hormone] that is used to evaluate thyroid function.  It will tell you if it is normal, meaning in the normal range.  That is a statistical average of a large number of people and your normal range may be different.  This diagnosis [hypothyroid] is a clinical diagnosis and this means that the diagnosis is made by the symptoms that you have. Then you can be treated and see if the symptoms go away.  When your symptoms are gone then you can check a blood level and find out what your normal TSH level is.  This is one reason why your input to your physician is very important.  Knowing your symptoms and researching possible diagnoses and sharing these with your physician will help your doctor take care of you.  If your physician does not listen to you, you might consider changing physicians.  Another situation where your input can make a big difference has to do with evaluating your response to medications.  It is helpful for you to know how long it usually takes for the medicine to work and what the possible side-effects are.  If you experience side-effects, that could mean that you need to have the dose lowered.

Be an advocate for yourself with your physician[s].  It is good for you and also for your physician[s].



From a tweet by Cory Booker [Mayor of Newark, N.J.]:" give more than is expected, love more than seems wise, serve more than appears necessary, and help more than is asked."  This was written after the damage from hurricane Sandy.  His encouraging others to share and care about each other is a way to help people cope with the loss of their posessions, their neighborhoods, and unfortunately for some, the loss of their loved ones.  

Philosophers have for thousands of years written that we [humans] are all connected and all in it together. If we are bombarded by negative news, disasters, and dire predictions about the future, it is hard to feel the connection with others and the support that this can bring.  It is interesting that often after a disaster affects us personally, we become reaquainted with our neighbors and realize how many neighbors that we actually have.

I am hoping [and believing] that we won't need disasters to bring us back together.  We can start now. Value yourself and then give more than is expected.



In talking with a number of my younger patients who are living with their girlfriend or boyfriend, I noticed that there was a reluctance to talk to their significant other about their commitment to the relationship and about marriage.  These young people seemed to be waiting for the right time to bring it up and were not sure that he or she was the one to live with for the rest of their lives.  They were hesitating even though it was clear that they were in love and respected and valued each other.  In exploring this with them, I was reminded of research showing the high percentage of people who live together that become depressed.  I was also reminded of the time in the past when there was an abundance of newborn babies up for adoption and to encourage adoption the agencies gave the parents a 6 month return policy.  Yes, they could return the babies within 6 months, no questions asked.  The agencies anticipated that certainly no one would return a baby.  They were wrong.  Many did.  So why did they? One factor seemed to be that the expectation was established that the parents might want to or need to return a baby.  As anyone who has been a parent knows, babies are wonderful and very frustrating. So, having a bad day with your baby can lead you to use your return policy.  Hard to believe?  Well, living with someone can also become like a conditional experience as you decide if they are worthy of a lifetime commitment.  Of course, just as babies can be very frustrating at times, so can our significant others [and so can we be very frustrating to our significant others].  Should that be enough to call off the whole thing?  Of course not.  However, if we and our significant others are not able to look at ourselves and become aware of our own doubts and insecurities then we might be tempted.  Human relationships are too important [precious] to treat like something that is returnable.  Believing in ourselves can help us to trust our feelings and recognize when we have made a commitment to another and let that person know.  

I wonder if uncertainty about relationships and a lack of a recognized and spoken commitment to each other is one reason that marriages have become so dominated by rituals that distract from the opportunity to share the joy of their relationship with their friends and relatives.  These rituals will not act as glue for the relationship.  So, if you are openly commited to your significant other you may end up with a simpler [and less expensive] wedding! Since I have two daughters, I am hoping that this is true.



When some of my patients told me that they were taking baby steps to try to change unhelpful patterns of their behavior. They were making small changes and hoping to gradually makes changes.  They all  told me that it was not working.  I thought that there was something not right about baby steps = small steps.  I then saw a toddler of one of my patients stand up and take some steps.  The toddler was delighted.  It looked like baby steps are actually big steps in that everything changes when you [a baby] have been crawling and then start walking.  So, baby steps really means making big changes in what we do and making it clear to ourselves that we really want to make a significant change in our behaviors/coping.  If we only take small steps, our brains do not recognize this as a committment for a change and so maintains the old pattern of behaviors.  To change patterns of our behaviors we must  make it clear that we want a change and baby steps are the way to go!