If you're worried about your child's risk for suicide, you are not alone.

In January 2019 I was worried about my son’s risk. Conall had been struggling with depression off and on for a few years. Even at 17, he wasn’t able to find the sweet spot of medication and therapy to keep him feeling consistently good. But just after the new year, I thought he was finally in a better place. Academically successful, he was able to finish high school early and was preparing to leave on a world tour with a famous band. He was an audio engineer and loved his work. A week or so before they were scheduled to leave, my fear became a reality and Conall took his own life.

I will never fully understand the "why" behind Conall’s death but as a pediatrician and parent I will forever wonder if an adult in his life had intervened, seen a sign, asked just the right question, that perhaps things may have turned out differently. My mission now is to make sure everyone knows what to look for and what to say to teens who they are concerned about.

In 2021, emergency departments across the U.S. noted a sharp rise in 12- to 17-year-olds needing treatment for suicidal thoughts or actions. And in a recent report, 4 in 10 high school students reported feeling "persistently sad or hopeless," while 1 in 5 said they'd thought about suicide.

Suicide occasionally comes without warning, but if you understand risk factors for suicidal thoughts you can be better prepared to start a conversation. Here are some important risk factors to recognize:

Family experiences

There are many family issues that can affect youth suicide risks. For example, research shows that when one family member dies by suicide, others in the same family are more likely to end their life. Kids who live with abuse, violence and other forms of trauma are also at greater risk of suicide. Even milder challenges like separation from loved ones due to death, divorce, deployment, deportation, incarceration and other factors can cause mental health struggles that may contribute to suicide risks, as can the loss of stable housing.

Social pressures relating to sexual orientation or gender identity

Young people who identify as lesbian, gay, bisexual, transgender, queer or two-spirit are 4 times more likely to attempt suicide than their straight (heterosexual or cisgender) peers. However, sexual orientation and gender identity themselves are not directly linked to suicide. Rather, youth who identify as LGBTQ2S+ may experience discrimination, hostility and rejection, which can lead to suicidal thoughts and actions. One study found that when kids experience negative family and social reactions to coming out, this can raise suicide risks.

Racism

Racism, discrimination and related systemic bias are extremely harmful to mental health. Also, a history of systemic racism limits children's ability to access developmentally and culturally responsive mental health services in communities and schools. Racism and discrimination have led to significant differences in suicide risk and rates based on race and ethnicity. One study of Black and Latinx youth showed that even subtle discrimination is linked with suicidal thinking. As the American Psychological Association notes, race-related stress threatens the inner resources people need to cope with everyday life. The APA offers tools and insights for parents who, along with their kids, need strategies for overcoming the erosive effects of racism. Suicide attempts and death rates are growing at the fastest pace among Black youth, Indigenous youth, Latino youth, Asian American youth, and youth from other communities of color.

Depression

Adolescents who experience depression are more likely to attempt suicide. Parents may notice depression symptoms such as sadness, irritability, hopelessness, boredom and the tendency to feel overwhelmed most or all the time. But some kids are good at hiding their feelings or don't know how to share them. Since 1 in every 5 adolescents and teens will face depression at some point, the American Academy of Pediatrics recommends that all kids aged 12 and over be screened for depression and suicide risks in yearly health checkups. This way you can understand whether your teen is "just moody" or at risk.

Alcohol and substance use

Substance use is a factor in roughly 1 in 3 youth suicides. Young people may intentionally take large doses of drugs as a way of ending their lives. Alcohol and drug use can also cause a break from reality, or psychotic episode, that causes hallucinations or delusions that lead to suicide.

Previous suicide attempts

Young people who have already tried to take their lives face higher risks for suicide. Risks remain high for at least one year after a suicide attempt, so follow-up care is crucial. One study shows that the stigma and shame people feel after trying to end their lives may drive them to try again.

Behavior problems

Young people who experience extreme anger or have a history of aggressive, impulsive behavior face higher suicide risks. Strong feelings themselves aren't the sole cause, since most children and teens experience intense emotions and moods. But youths who act out feelings in destructive ways may end their lives, especially if they are socially isolated, using drugs or alcohol, or consuming media in excessive, unhealthy ways.

Knowledge of other suicides, especially close to home

One study showed that when young people learn about the suicide of someone they know, they are more likely to consider or attempt suicide. Parents should pay close attention when suicides happen, especially when losses involve family members, friends or school peers. Children and teens may need extra support, including professional counseling, to cope with strong feelings they are experiencing.

Easy access to guns

Firearms are the top cause of death for teens 15-19 years old who die by suicide. Even when guns are locked up, studies show that teens who live in homes with firearms are more likely to kill themselves than those in homes without guns. Teens, whose brains are still developing, tend to be more impulsive than adults. A momentary decision to attempt suicide with a gun often leaves no chance for rescue. The safest home for children and teens is one without guns. If guns are kept in the home, they should be stored safely: locked and unloaded, with ammunition stored separately in a locked location. Family members should make sure the child does not know the codes to the locks or the location of keys.

Bullying and cyberbullying

Kids who are bullied―and those who bully others―face higher risks of suicidal thoughts and actions. This is true whether bullying happens face-to-face or online (cyberbullying). A 2021 study found that adolescents who were bullied online were roughly 12 times more likely to have suicidal thoughts than peers who were not.

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Suicide is the second leading cause of death among young people 10 to 24 years old, so families should know the warning signs and be ready to help their children.

It's OK to ask about suicide. If you are concerned about your child, ask them directly if they are thinking about suicide. Studies have shown that asking about suicide will not "put the idea into their head." Raise the topic in a calm, non-judgmental way to help them feel safe sharing their thoughts and feelings.

Describe what you have noticed in a way that expresses empathy rather than worry or blame: "I noticed you don’t seem to have the energy to see your friends lately. I’m sorry! That must be hard. Do you ever feel so tired that you wish you just wouldn’t wake up?" or "You seem so angry all the time. That must be hard for you! Do you ever feel like that anger builds up and you want to hurt yourself?"

Don't wait to seek professional help. If you see signs that your child might be considering suicide, get in touch with your family pediatrician right away to find mental health resources and support. If you need immediate support, call the National Suicide Prevention Lifeline at (800) 273-TALK or contact the Crisis Text Line by texting "TALK" to 741741 in the United States or Canada.

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Molly O’Shea, MD, FAAP is both a practicing pediatrician and independent practice owner. Her practices, Birmingham and Campground Pediatrics, have behavioral health integration and serve families in southeast Michigan. Dr O’Shea has been involved in the American Academy of Pediatrics throughout her career as a journal editor, national CME planner, and faculty member. She is now one of the Academy’s official spokespeople; writing op/eds and providing media interviews on various topics including suicide prevention.

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