Subtle warning signs of suicide in kids

More than 48,000 people die by suicide in the United States each year. And while the suicide rate is higher for adults, it’s the second-leading cause of death for children ages 10 to 14, and the third leading cause for kids between 15 and 19 years old. Suicide claims the lives of at least 2,500 children and teens annually.

While kids’ suicide rates may rise or fall slightly from year to year, they’ve increased overall by more than 50 percent since the mid-2000s. Official numbers may underestimate actual incidence, however. That’s because suicide—particularly those involving drug overdoses—may be underreported.

“This is a growing trend that does not appear to be slowing down,” says Franklin Drummond, MD, a psychiatrist in Nashville, Tennessee. “I think it’s part of the reality of being a child today, and that’s a new concept for a lot of people.”

To prevent these terrible tragedies, it’s important to understand the factors contributing to suicide in children, warning signs to look for, and what to do if you think a child is in trouble.

Factors that contribute to suicide in children

Risk factors for suicide in children and teenagers include the following:

• Mental health issues including depression, anxiety and substance abuse
• Neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism, and learning disabilities
• Previous suicide attempts
• Family history of suicidal behavior or mental health issues
• Gay, lesbian, or bisexual orientation or transgender identity
• History of physical or sexual abuse
• Exposure to violence

Other signs in children and teens that suggest a suicide attempt may be imminent include:

• Thoughts of suicide or self-harm
• Feeling trapped, hopeless, or purposeless
• Excessive anxiety, worry, fear, or anger
• Withdrawal from friends, family, and society
• Reckless behavior
• Mood changes

And the following factors may increase the likelihood of a suicide taking place:

• Access to weapons or other means of self-harm, such as medications or poisons
• Alcohol and drug use
• Exposure to suicide of a family member or friend
• Social stress and isolation

Warning signs in younger children are often subtler than those seen in adolescents and teens. “I always try to alert people for a change in a child’s behavior that involves some sort of withdrawal or a change in attitude about other people,” Drummond says. Crying spells, becoming less verbal, and displaying a lack of interest in familiar activities are also signals.

“These signs should be noted,” he says, “and there should be an intervention at that point.”

What to do if you see signs

The first thing to do if you detect warning signs of suicide is to talk directly to your child about it, Drummond advises. “Be open and try to make it non-threatening,” he says.

If you continue to suspect a risk of suicide, Drummond says it would be appropriate to reach out to a family therapist or counselor who focuses on children, or a child psychiatrist.

Communication and staying engaged with your child are key. “The way that families manage feelings and the more support that families provide can definitely help manage some of these stressors,” Drummond says. “Isolation of the individual is one of the big risk factors for a suicide.”

Your child’s healthcare provider (HCP) may be enlisted to help, too. They can help identify warning signs and refer your child to a psychiatrist or other mental health professional.

Educators have a role to play, too. “Kids can present a different face at school than they do at home,” Drummond says, “and teachers can help identify acute behavioral changes.”

For example, teachers may be able to discern changes in a child’s interaction with peers or self-isolating behavior, which may be more obvious at school than at home. “Changes in academic or sports performance—when something suddenly becomes difficult for a child or when a child suddenly loses interest—are other signs that teachers should tune into,” Drummond says.

If a teacher detects signs like these, he or she can refer a student to a school counselor. “That will trigger a child psychiatrist visit or a mental health intervention,” he says.

If a child displays suicidal behavior—that is, an attempt in the moment to inflict self-harm—don't wait to see a psychiatrist or therapist. Seek emergency help. Dial 911 right away. Let the operator know it’s a mental health emergency and request that responders are trained in crisis intervention or suicide prevention, specifically. While you wait for help, the child should be kept under close watch in a safe environment without the means to hurt themselves.

If you're confident the child isn't in immediate danger, you can reach out to a mental health professional or access 24/7 help by calling, texting, or chatting 988 to reach the 988 Suicide and Crisis Lifeline.

Why children face unique pressures today

Research suggests the frequency of hospital visits for suicide attempts and ideation appeared to follow the school schedule: lowest during the summer months and highest in the fall and spring.

“It could be that it’s more stressful to be in school than it used to be,” Drummond says. “While academic standards and expectations have gone up, kids are being exposed to other stressful things—including violence, negativity, and bullying.”

And though technology and culture are not the only contributors to suicide in children, they are factors that have been evolving and accumulating rapidly in recent years.

“Social media opens up a different world, so kids are exposed to the idea of suicide at a much younger age,” Drummond says. “There’s a lot of content out there that uses language like, ‘You should kill yourself.' Unfortunately, that seems to have an impact on children.”

There is also evidence that bullying may contribute to the observed increase in hospital visits related to suicide. Drummond emphasizes that children, parents, and educators need to be clear-eyed about its dangers.

“Bullying used to be much more observable because it was out in the open, on the playground,” Drummond says. “Now, it can be silent, virtual and a lot of parents have no idea that this level of negative pressure is going on.”

Here, too, teachers can also play an important role, because even if they don’t witness overt acts of bullying, they will often be the first ones to observe its effects on students.

“I think these factors have a lot to do with these disturbing trends we see in mental health in our younger kids,” says Drummond.

His takeaway? “Don't underestimate their seriousness. And address them as effectively as possible so that we can come together to do our best on behalf of our children.”