Suicidal thoughts are fairly common in adolescence, and physicians can play an important role in making sure that at-risk teens get treatment, according to Pittsburgh psychiatrist Alan Axelson, MD, and Erie psychiatrist Mary Anne Albaugh, MD.
Nearly 14 percent of high school students have seriously considered suicide, while almost 11 percent have made a suicide plan, according to the 2009 Youth Risk Behavior Surveillance from the Centers for Disease Control and Prevention (CDC). Suicide is the fourth-leading cause of death among youth and young adults.
“Because of adolescent impulsiveness and lack of a long distance perspective, in a very short period of time you can go from a kid that appears to be fine to somebody who makes a serious suicide attempt, sometimes with an intended or unintended fatal outcome,” Dr. Axelson says.
One factor driving these numbers is the speed at which hurtful information can be spread via new technologies like Facebook and text messaging, Dr. Albaugh says.
Warning signs
Some signs to watch for include consistent depression or social isolation. In teenagers, Dr. Axelson says depression in children and adolescents is manifested as irritability and the inability to experience good feelings rather than actual sadness.
“What often happens with adolescents is that they’re depressed around the house but parents are reassured when they are in a pretty good mood around their friends. Depressed mood, lack of communication, and isolation from family can be a cause for concern,” Dr. Axelson says.
“Other warning signs are if the child used to go out with his friends, and now his friends call and he doesn’t go out, or if he doesn’t look forward to things. Everybody else is looking forward to going on the band trip but he is not,” he adds.
In addition, Dr. Albaugh recommends looking at sleep patterns, appetite, grades, and substance abuse and other risk-taking behaviors.
Screening methods
Identifying teenagers at risk of suicide isn’t always easy since they aren’t likely to discuss depressed feelings with their physician.
“I was just seeing a young man in the inpatient unit. Even with his family bringing him there and sharing all the turmoil in his life, the amount of denial and his ability to say ‘That’s not the case’ was amazing to me,” Dr. Albaugh says.
One key is to see teenagers alone, rather than with their parents. Ease into any questions related to suicide.
“I’m amazed at what kids will tell me if I approach them in a gentle way and invite them to tell me rather than demand they tell me,” Dr. Axelson says.
Dr. Axelson recommends something similar to this line of questioning:
- “A lot of kids have trouble with down moods. Are you having any difficulty with your mood?”
- “Have you ever felt down so far that you thought you might hurt yourself?”
- “Does the feeling get so intense that are you afraid that you might hurt yourself seriously or commit suicide?”
Even before you get to these questions, routinely ask questions to identify warning signs like disturbed sleep habits or pressure to abuse substances.
“Let them know that it’s important to be open so the family physician can do the best by them and help them,” Dr. Albaugh says. “If you ask these things routinely, you’ll be able to get to these other harder pieces over time.”
A screening questionnaire can be helpful since teens and adults alike are sometimes more likely to reveal something on paper than bring it up in person. Dr. Axelson recommends a questionnaire created by the Teen Screen program at Columbia University.
Sometimes, just the interest of a physician can help alleviate a troubled teens’ sense of isolation and reduce their risk of attempting suicide.
“You can’t underestimate the power of the physician-patient relationship,” Dr. Axelson says.
If you identify a child who is at immediate risk of attempting suicide, try to get them in to see a psychiatrist or, if one is unavailable, a psychologist, social worker, or mental health crisis team in your area. Both physicians recommend keeping a list of who you can contact in your area in case you identify a patient at high risk of attempting suicide.
For more information on this topic, visit the
American Academy of Child and Adolescent Psychiatry and the
American Academy of Pediatrics.