SUICIDAL THOUGHTS THAT TURN INTO SUICIDE ATTEMPTS

Suicide is a leading cause of death for adolescents.  A recent article in JAMA Psychiatry by Nock, Ph.D.,et. al. decribes research investigating what factors lead to suicidal behavior in adolescents.  Lifetime rates of: suicidal thoughts = 12%; suicidal plan = 4%; suicidal attempts = 4%.  Importantly, 60% of adolescents who are suicidal with a plan, attempt suicide within one year of the onset of having suicidal thoughts.  For most [55%] of suicidal adolescents they started psychiatric treatment before they became suicidal.  Suicidal behavior rates were  highest in females and lowest in non-Hispanic blacks.   Females attempt more and males complete more as they use more lethal means [guns].  Adolescents are less likely to have suicidal attempts if they live with both their biological parents and have siblings.  Psychiatric diagnoses that predict progression from suicidal thoughts to plan to attempt include: major depression; dysthymia; eating disorders; ADHD; conduct disorders. Symptoms of anxiety, agitation and poor behavioral control, predict suicide attempts.  

This research points out how important it is to take suicidal thoughts seriously and especially suicidal plans. More than half of adolescents who are suicidal with a plan will attempt suicide within a year of the onset of their suicidal thoughts.  If you know an adolescent who is suicidal, talk to them and tell an adult about it.

RISK OF SUICIDE AND OF SUICIDE ATTEMPTS

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.