According to the Centers for Disease Control and Prevention (CDC), one in 25 Americans is diagnosed with a serious mental illness, such as bipolar disorder, major depression or schizophrenia. WebMD estimates that nearly 5 million children in the United States live with some form of serious mental illness that significantly interferes with their daily lives.
Mental illnesses, ranging from mild to severe, are among the most common health conditions in the United States. While some mental illnesses, such as anxiety, mood disorders, substance use, borderline personality and psychotic disorders, are associated with higher suicide rates, difficult life situations increase the risks of suicide as well, such as:
- Relationship issues
- Family history of suicide
- Death of a loved one
- Loss of a friendship or employment
- School failure
- Legal problems
- Chronic illness or pain
Suicide Among the Young
A growing concern in preteens, adolescents and young adults, suicide is the third-leading cause of death in the 10 to 24 age group, accounting for 14% of all suicides nationwide. What’s more, suicide is the second-leading cause of death for children ages 10 to 14. Even more alarming, the CDC cites suicide as the eighth-leading cause of death in children ages 5 to 11.
Young people who have attempted suicide often express feelings of hopelessness or helplessness. A common thread is that they experienced ongoing emotional pain with no perceived solution. The emotional distress they experience points to various environmental situations, such as:
- Feeling rejected, hurt, unloved or victimized
- Facing a relationship breakup
- Experiencing bullying or cyberbullying
- Suffering from physical or emotional abuse
- Having a troubled home life
- Feeling like a burden to others
- Grieving the death of a loved one
Suicide is not the result of a single factor. Rather, it’s generally sparked by a combination of emotional and environmental factors. As children grow, they face various social, emotional and physical changes at various stages that heighten their emotional sensitivity. Add one or more environmentally driven hardships, and the risk of self-harm increases. Combining these issues with mental illness creates the perfect storm for suicidal ideation and attempts.
Prevention Driven by a Community Effort
Parents, guardians, friends, family members, teachers, clinicians, counselors and numerous people in direct contact with someone who may be susceptible to suicidal tendencies have an opportunity to help.
Understanding the warning signs is essential, and some are more prevalent than others. Making statements about dying, such as, “I should have never been born,” “Nobody will miss me when I’m gone,” “The world would be a better place without me,” or “I wish I were dead,” are among the most obvious signs indicating a child should receive immediate evaluation by a medical professional.
Other common warning signs include:
- Frequently asking questions about death or searching for ways to die
- Changes in eating or sleeping habits
- Psychosomatic or somatic symptoms (frequent unexplained physical symptoms, such as headaches, indigestion or shortness of breath)
- Withdrawing from friends and family
- Loss of interest in daily activities
- Changes in academic interest, performance and attendance
- Severe mood swings
In addition to watching for common warning signs, increasing protective factors is critical in helping reduce the risks associated with suicidal ideation and other self-destructive behaviors. There are numerous ways families, friends and communities can provide support and help eliminate the feelings of hopelessness, such as:
- Helping boost self-esteem
- Assisting with developing good coping and problem-solving skills
- Promoting engagement with peers, school activities, athletics, employment or religion
- Providing structure, limits, rules and guidelines
- Helping build stronger bonds with family members
- Proving mentoring and tools for developing skills and interests
Equally imperative to suicide prevention is reducing access to lethal means for people at risk, such as properly storing firearms and ammunition, poisons and medications.
“It is vitally important that teens and preteens and, in fact, all children, should not have access to weapons, sleeping pills and narcotics, or any other means to carry out a suicide threat,” said Dianna Brozyna, M.D., a pediatric hospitalist with Pediatrix® Medical Group. “Although this isn’t the only line of prevention, it’s important to make it difficult for a child to get these things into their hands.”
The Role of Medical Professionals
To help address this critical public health crisis, on March 2, 2022, the American Academy of Pediatrics (AAP) released new recommendations that call for pediatric health providers to screen all patients age 12 and older for suicide risk annually.
The AAP suggests that health care visits present an opportunity to connect with children and adolescents to “assess for suicide risk or protective factors that can be associated with increased risk of suicide and to provide life-saving care.” It recommends using the “ABCD approach,” which involves:
- Assess — Screen for suicide risk and assess risk level
- Build hope and reasons for living
- Connect — Strengthen connections with protective adults
- Develop a plan for keeping youth safe — Restricting access to lethal means and developing a safety plan for coping in the future
The AAP suggests several tools pediatric clinicians can use for effective screening, including:
- Patient Health Questionnaire-9 (PHQ-9)
- Columbia-Suicide Severity Rating Scale (C-SSRS)
- Ask Suicide-Screen Questions tool
“It would be beneficial for pediatricians to ask a short series of questions during well child visits,” said Dr. Brozyna. “These questions should include topics like whether a child is happy, involved in activities with friends and family, has a good appetite and so forth. These are some of the general questions that should be asked of children as young as 8 or 9, as this population has shown an increase in psychosomatic disorders, eating disorders and actual suicide attempts, particularly during COVID.”
Are You or Someone You Know at Risk of Suicide?Please contact the 988 Suicide and Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support.
Visit the 988 Suicide and Crisis Lifeline for more information at 988lifeline.org.