The American Academy of Pediatrics recently released a report in the journal Pediatrics that further encourages pediatricians to screen teenagers for significant suicide risk factors such as a history of physical or sexual abuse, substance abuse, mood disorders, sexual minority status and bullying.
The goal is to make sure all healthcare providers are consistently and accurately screening adolescents for depression and suicidal thoughts. In encouraging these screenings, it’s important for parents and healthcare providers to know that asking teens about these difficult issues does not increase the risk of them acting on suicidal thoughts. Research has shown that the only external influence that might increase the risk of suicidal thoughts in teens is the amount of media coverage a recent suicide or suicide attempt might get.
If an adolescent is part of a sexual minority such as being gay, lesbian or transsexual, they are at increased risk. Another risk factor is if the teen has had a classmate who has attempted or completed a suicide.
How to ask
No one knows that a teen may be having suicidal thoughts unless a parent or healthcare provider asks them about their thoughts and feelings.
There are several screening tools that healthcare providers use to start the discussion with teenaged patients. If the answers are troubling, the healthcare provider can then have a focused discussion with the teen about what they are feeling in order to see if they need help.
Most pediatricians will start the conversation of talking about depression and suicide with their patients at the age of 11. Around the age of 13 or 14, more advanced screening questions will be used. The questions are always asked in an age-appropriate manner and get a little more personal in nature as the child ages.
Even if your child is healthy, you should still have them seen by a pediatrician or family physician from their teen years to adulthood. If nothing else, because healthcare providers are willing to ask these tough questions on your behalf and can try to find out what kinds of risky behaviors and thoughts your child may be having.
This yearly check-up can be invaluable for some families because healthcare providers can pick up on some things that parents don’t know about and might be able to head them off before they become a crisis. A child or adolescent might find it easier to express their troubling thoughts to a trusted non-family member, such as their physician.
If we notice that the child is at increased risk, or if the child tells a healthcare provider he or she is having suicidal thoughts, it may be appropriate to have a conversation with the teen’s caregiver about removing items that can be used to act upon suicidal thought such as large quantities of medication, weapons or firearms.
Reasons for concern
So what are the signs parents should look for if they are concerned about their teen? If you recognize any of the following, it’s important to talk to your child about what’s going on in their life and whether they feel they might need help:
- Has there been an announcement of a child committing suicide at the child’s school?
- Is the child acting depressed? Teens don’t always show depression as sadness. It may manifest instead as apathy or avoidance of friends and activities that the teen used to enjoy.
- The child is hyper engaged in or hyper avoidant of social media.
- The child is being bullied.
- The child has developed a sudden fascination for medications or guns or other weapons.
How to start the conversation
If you’re struggling with how to start the conversation with your teen here are some tips:
- Ask your child how they are feeling? Tell them you have noticed some concerning changes in their behavior.
- Give the child a chance to explain what’s going on.
- Explain why you are concerned (“those behaviors make me concerned that you might be depressed.”)
If your child confides in you that they are struggling with depression or suicidal thoughts, it’s important to know that you, as the parent, don’t have to have all the answers as to how to help them. You can reach out to your family physician or other community resources who are experienced in these issues. If you are worried your child is actively preparing to harm themselves call 911.
As a pediatrician, I encourage all parents of young children to have the phone number for the Poison Control hotline (1-800-222-1222) programmed into their cell phone, and I encourage all parents of preteens and adolescents to have the Suicide Prevention Hotline (1-800-273-8255) programmed in their phone.