In the first installment of our series on teen suicide, we addressed the resounding silence that often surrounds this rising public health crisis. Because of the shame and fear that envelope the subject, teen suicide lurks in the shadows of our consciousness while other pressing public health issues like substance abuse and anti-bullying campaigns take centerstage. We discussed the need to force the issue out into the open, to remove the stigma that surrounds honest discussion, to better equip ourselves to confront it when we see the warning signs and risk factors, whether in those around us or in ourselves.
But what are the warning signs and risk factors? And how can we differentiate between a person who's just having a bad day and one who is desperately crying out for help? Does it matter or should we simply make it our business as human beings to reach out when we see others in need?
In this installment, we do our best to outline the warning signs. But before we do, a few thoughts about how to contextualize these perceived warnings.
Contextualizing the Warning Signs
Youth counselor and speaker, Jerry Johnston, in his book Why Suicide? summarizes the suicidal mindset as “helpless and hopeless.” While every individual is susceptible to the occasional bout of depression, and each of us must sometimes carry the burden of challenging personal circumstances, these forces alone will not inevitably lead one down a path toward suicide.
While we all endure pain in life, Johnston suggests that those most vulnerable to suicide typically feel helpless in the face of that pain and hopeless that this pain can ever be diminished to the point of being bearable. Those in danger of suicide don't choose death because it looks attractive or because they don't fear it. For most, death simply seems like the only viable option. When continuing to endure pain seems scarier than even death, suicide may appear like the only true release.
Adolescence and young adulthood can be exciting times, but they can also be terrifying. These years are filled with heartbreak, uncertainty, disappointment, and darkness. Many young people are truly hurting, and their proximity to suicide, either by way of the news, the media or even personal exposure can threaten to transform this pain into serious suicidal contemplation.
So as you look for warning signs in a loved one, or attempt to better understand your own feelings, consider that the core cause for suicidal thoughts is a persistent pain, magnified by a sense of helplessness and hopelessness. Also consider that each of these conditions—pain, helplessness, and hopelessness—can be inflated by the social pressure, hormonal instability, and underdeveloped impulse control that characterize adolescence and young adulthood.
Taken in terms this simple, it isn't difficult to understand the root causes of suicide, or perhaps even relate to them. A far more complex problem, though, is how to recognize somebody who might be experiencing these feelings. How can we know that an individual who appears full of life in outward appearance is not masking a deep-seated pain? Certainly, the shocking 2014 suicide of comedian Robin Williams should give us pause if we think the symptoms are so readily detectable.
On the other hand, how can we know that an individual who appears to be emotionally distressed isn't simply having a bad day? Who hasn't felt depressed occasionally? Surely, we can't simply presume that every person who looks a little sad is at risk of taking his or her own life. Compassion compels us to intervene when someone is at risk, but in the interest of respecting privacy, we also tend not to meddle unless we're invited. How do we tell the difference between an occasional bad mood and a symptom of something darker?
Well, when in doubt, ask.
You won't always know when somebody is actually battling suicide, expressing healthy grief, or just having a really crummy day. But when you do see somebody hurting, you can respectfully ask if they'd like to talk, or if there is anything bothering them. Just be gentle, clear, and sincere. Try not to assume too much, but ask open questions that allow them to fill in the details if they want.
If you yourself are contemplating suicide, the same advice applies. Don't be afraid to speak up to a friend, a classmate, a teacher, a guidance counselor, or any trusted adult. Know that those around you want to help alleviate your suffering and you are not alone.
And as you look more closely at these warning signs, remember that the risk of inaction is far greater than the risk of intrusion.
Feeling Depressed? Worried about Someone? Need help? Call The National Suicide Prevention Lifeline 1-800-273-TALK
Warning Signs and Risk Factors
The single most common warning sign is depression. There is a difference between feeling occasionally down in the dumps and experiencing clinical depression. Clinical depression, also known as Major Depressive Disorder, is marked by prolonged sadness, despair, irritability, and apathy.
The Mayo Clinic notes that an individual suffering from depression may exhibit any combination of the following symptoms:
- Sadness, emptiness or hopelessness
- Angry outbursts, irritability or frustration, even over small matters
- Loss of interest or pleasure in most or all normal activities, such as hobbies or sports
- Sleep disturbances, including insomnia or sleeping too much
- Tiredness and lack of energy, so even small tasks take extra effort
- Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
- Anxiety, agitation or restlessness
- Slowed thinking, speaking or body movements
- Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren't your responsibility
- Trouble thinking, concentrating, making decisions and remembering things
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
We tend to presume that depression will be evidenced by a visible and profound sadness. But it isn't always that easy to detect. A person may feel depressed but hide it behind a smile. And one who is suffering from clinical depression may not even fully understand the condition or realize that this is the cause of their prolonged feelings of despair.
In the first installment of our series, we learned about suicide clusters—spates of suicides concentrated in single communities. We found that in many cases, especially during adolescence, depression can be hidden behind popularity, friends, good grades, and a well-respected family. Those who are suffering may not only be doing so in silence, but in full and inconspicuous view of their loved ones.
The cause for this depression may be clear and tangible. It may stem from feelings of failure, undisclosed abuse, addiction, overwhelming life transitions, or personal loss. In many cases, however, depression cannot be traced to any specific experience. Instead, it may be the consequence of irregular behavior in the brain's neurotransmission of the chemicals effecting mood. There is also some evidence that clinical depression may be inherited, suggesting that some have a genetic predisposition to the disorder.
The variety of possible causes, and the fact that any number of these causes may overlap, makes depression a difficult condition to diagnose and treat. Just as its causes may be overlapping, so are its symptoms. This means that, on a case by case basis, its severity can be dramatically underestimated or even overlooked altogether. But depression is the leading cause of suicide. Its intensity is often magnified for teens and young adults who may not know how to articulate their feelings or recognize that they suffer from an illness.
This is why it is incumbent upon parents, teachers and classmates not to take signs of depression lightly. And if you feel that you may be suffering from depression, do not be afraid to ask for help. Turn to a parent, teacher, or a doctor and tell them what you're going through. The condition is not always easily treated, but reaching out is the very first step.
Feeling Depressed? Worried about Someone? Need help? Call The National Suicide Prevention Lifeline 1-800-273-TALK
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that alcohol-related incidents claim the lives of 5,000 young people yearly, 300 of these due to suicide.
And according to Psychiatric Times, individuals living with a substance abuse disorder are nearly six times as likely to report a lifetime suicide attempt than those without substance issues. Drugs and alcohol are highly prevalent in youth culture and directly correlated with teen suicide and various associated risk factors.
However, substance abuse in teens isn't troubling just for the sake of legality, but rather what this substance abuse is indicative of: a desire to escape from reality. Ultimately, most substance abuse stems from an individual's desire to escape from some feeling or circumstance in the real world. The more often someone uses, the more likely it is that their waking reality is unbearable to them. Drugs and alcohol are a means to forget and live in the now. If this is the case, death might eventually seem to them a permanent escape when the drugs or alcohol stop masking the problem, or makes the problem worse.
Not all students use drugs to escape problems, stressors and basic reality. For some students, drinking and drugs are just part of the party culture. Others may simply see themselves as experimenting with drugs. At adolescence, many are still learning about the connection between action and consequence. Unfortunately, when it comes to drugs, the learning curve can be exceptionally sharp. Substance abuse has a long history of consuming kids in their prime.
Peer pressure can also be a powerful effector. Adolescence is the time when we begin to truly forge our own identity, be it in relation to family, friends, or society at large. Students are still figuring out the balance between planning and spontaneity, independence and social acceptance, responsibility and indifference, work and fun. Drugs and alcohol can serve as an easy way to readily identify with a peer group, to declare liberation from parental control, or escape from painful realities.
Of course, while this may tell us a lot about teen behavior, it also means that substance abuse by itself will not always indicate depression or suicidal tendencies. Indeed, while underage drinking at a weekend house-party may be illegal, it should certainly not be taken as evidence of rampant depression. However, substance abuse becomes a more frightening corollary to suicide when multiplied by addiction, binging, escapism, risk-seeking, or a transition into harder drugs. These tendencies may signal deeper issues.
teensuicide.us advises looking out for a few telltale signs of habitual drug abuse, such as increased secretiveness, growing remoteness from family and friends, diminished attention to appearance and hygiene, declining grades, and an eroding sense of responsibility, accountability, or empathy. Like depression—with which it shares many symptoms—substance abuse may lead to all or none of these signs. This is why, once again, you have to be willing to reach out.
The same is true if you are battling an addiction. Be honest with yourself about your dependency and recognize the serious health risks that come with it, including a heightened risk of suicide.
As a parent, teacher or classmate, you should treat habitual substance abuse as a major health risk factor. But you should also take the time to understand what is at the root of this abuse. There may be more at play here. Substance-driven intervention might not be sufficient without the proper psychiatric support.
Feeling Depressed? Worried about Someone? Need help? Call The National Suicide Prevention Lifeline 1-800-273-TALK
History of Abuse
A history of abuse can be a major risk factor for teen suicide. Sexual, physical, or psychological abuse can do untold damage to developing children. These forms of abuse violate the natural trust that a child must develop during those delicate formative stages in order to achieve healthy and functional adulthood. At a young age, children get a sense of self and identify from those in authority around them. That is why they are constantly seeking the attention and approval of their parents, asking them to watch them do a handstand, look at their drawing, or listen to them count to 10. They internalize their worth and security by how they are spoken to and how they are treated. The seeds of being treated as ugly, stupid, bad, or worthless at a young age bloom into the weeds of insecurity and low self esteem as adolescents. Even if the abuse has long ceased, these wounds are still present.
A history of sexual abuse has been found to correlate especially strongly with a risk of attempted suicide, stemming significantly from the shame and secrecy that surround victimhood. Sexual abuse is humiliating and disempowering by nature. This can lead to feelings of fear, self-loathing, and confusion for the victim, especially when this abuse comes at the hands of a trusted adult, which is most often the case.
According to the Childhood Molestation Research and Prevention Institute, children are most at risk [of molestation] from the adults in their own family, and from the adults who are in their parents' social circle. In fact, 90% of abusers target children in their own families and children who[m] they know well. According to the Children's Bureau, 91.4% of abusers are parents.
That this abuse is so often perpetrated by an adult charged with the responsibility of protecting the victim from the world can shatter the victim's ability to trust, to formulate healthy relationships, or to achieve a sense of self-worth. And with greater silence comes a feeling of greater shame.
A Youth and Risk Behavior Survey published in the journal Suicide and Life Threatening Behavior demonstrates the impact of this feeling, noting that between 2009 and 2011, 3.5% of male respondents with no sexual assault history had attempted suicide, as compared to 33.2% who did have such a history. This denotes, at least within the sample of respondents between the ages of 14-18, sexual assault predicated a tenfold risk of suicide. The comparison for girls was 5.8% to 27.1%, also a dramatic ratio.
The study hypothesized that the more extreme ratio among male respondents was likely a consequence of a lower outreach focus on male victims. This underscores the importance of outreach and the role can play in giving victims of abuse an alternative outlet to suicide.
If you are a victim of abuse who is living in secrecy, speaking out about your abuse can be a critical part of healing. Seek out a teacher, friend, or trusted adult and let them know what you've been through. You are not to blame and you shouldn't have to live in silent fear.
Preoccupation With Death
One of the clearest warnings that someone is losing the will to live is a fascination with death.
This preoccupation is more than just an occasional stray thought. Preoccupation with death displays as chronic, foreboding, morbid fascination. Much like substance abuse, preoccupation with death signifies that one might not be coping well with life. If a friend or family member is known to make comments about the attractiveness of death or to imagine out loud how the news of their death might be received, don't take this lightly.
Sometimes stage lights distort our perspective on death. Death is glamourized through camera lenses when young celebrity passings are romanticized, or it is normalized in crime dramas, war movies, action flicks, and an endless stream of violent video games. Young people may think they understand death well enough to take it lightly.
But this preoccupation may signal suicidal thinking. It may be an indication that your child, student or classmate is choosing to become acquainted with the idea of their own mortality. The more normal it seems, the less it scares them. Yet, the fear of death can be a healthy elixir for life.
Morbid fascination may be an indicator that this person has an action plan. Evidence that your child, student, or classmate has imagined and articulated how to carry out a suicide may be a blaring sign that a suicide attempt is imminent. Intervene immediately. Be very clear that their death would change the lives of many of their loved ones for the worse. Don't let them believe the lie that everyone would be better off without them. Explain in detail the pain it would cause you and their friends and family if they were dead. For individuals with healthy relationships, compassion on what their death would do to friends and family can sometimes be the motivation they need to push through the tough times in life.
Unstable Home Life
Nobody's home life is perfect, but when the place that should serve as your warm sanctuary from the rest of the world is penetrated by instability, violence, or abuse, the psychological impact can be devastating. Typically, children bear the brunt of this devastation and the effects can be highly traumatic.
Challenges like deadbeat parenting, parental alcoholism or drug addiction, and patterned abuse all manifest in the home. The connection between these experiences and depression is well-documented. But there may be other, less immediately apparent or insidious factors contributing to a negative home life. Kids can experience disorientation, grief, and trauma over divorce, a family move, a change of school, a broken friendship, or a parent's remarriage. These stressors can add up and for many young people, it can be impossible to perceive a way out.
As commonplace as divorce has become, it may be easy to overlook just how psychologically taxing it can be on children. The fracturing of a household can be a crushing blow to a child's sense of security and structure. This is likely why, according to The Daily Mail, women whose parents divorced during childhood are twice as likely to attempt suicide and men are three times as likely.
These patterns are true even without consideration of the numerous other variables that can heighten the risk of suicide. The Daily Mail says that even when adjusting for variables like socioeconomic status, depression, and anxiety, divorce still proved a strong independent risk factor, especially in men. Though the research still rated adult living conditions such as addiction, delinquency, or unemployment as higher risk factors, evidence suggests that divorce can play a major role in heightening one's vulnerability to suicide.
This means that any child, teen, or young adult who is enduring a parental divorce should at the very least be considered a candidate for outreach. And quite frequently, when divorce or another major disruption to household stability occurs, adults in the house are simply too preoccupied with their own personal traumas to fully comprehend the toll these experiences are taking on their children.
So if you know that a student, classmate or friend is going through a difficult time at home, or simply lives in a state of household insecurity, reach out. Be sure that they are receiving the support they need from caring adults beyond the walls of their broken home.
If you are struggling to cope with a situation at home, find a friend or teacher that you can confide in. Share what you're going through. There are people who care and people who can help.
Dramatic Changes in Mood, Personality, or Lifestyle
In a certain regard, each of us exists on a continuum of constantly shifting emotions. We feel up, down, happy, or sad depending on the day, or even the hour. Teenagers, in particular, are notoriously erratic in their emotional ups and downs, a consequence of the hormonal changes that mark this period of development. However, dramatic and sustained shifts in personality, lifestyle, or mood should raise a red flag.
Such changes could be indicative of an emergent psychological issue or mood disorder. Sudden, extreme, or insistent behavioral change should be interpreted as a cry for help. Even if the risk of suicide is not immediate, noticeable and worrisome changes can be a sign that the individual is unconsciously reaching out for help.
In some cases, these personality changes may be coping mechanisms constructed to defend against the impact of hidden trauma like bullying, physical abuse, or molestation. The Rape Abuse and Incest National Network estimates that 1 in 6 girls, and 1 in 33 boys have been sexually abused. The incidence of domestic violence and bullying is even more common. This means that more people in your midst than you likely realize are carrying a terrible secret burden. That burden is likely to manifest in unpredictable ways.
This combination of irrational behavior and drastic mood swings can be an especially dangerous trigger for those who are at risk of suicide. If you notice a typically outgoing and upbeat person retreating into sullen introversion, a once even-keeled individual behaving manically, or even just a friend diving headlong into a sweeping lifestyle change, take note.
It is fair to acknowledge that teenagers are, as a rule of thumb, in a constant state of finding and redefining themselves. Change is part of puberty and it can come about in ways that are dramatic and sudden. It can be hard to know sometimes when changes in behavior, even defiant ones, are part of the natural process of maturation or signs of something more troubling. Be vigilant. Regardless of the reasons for these changes, open up a healthy dialogue that enables the teen to talk about what he or she is going through.
Along with dramatic mood swings, impulsive behavior can be a highly visible warning sign for suicide. Teenagers tend to be impulsive relative to fully-realized adults to begin with. Situational impulsivity can be a consequence of effectors like fear, anger, insecurity, or even just pure curiosity. However, when you add a stress, anxiety, or depressive disorder to the mix, the stakes of this impulsivity can be heightened significantly.
Findings vary on the empirical connection between habitual impulsivity as a character trait and the risk of suicide. However, the American Association of Suicidology considers impulsivity both a chronic and acute risk factor. This suggests that while an impulsive personality by itself does not inherently make one more prone to the risk of suicide, a fair amount of impulsivity may factor into the decision to attempt suicide.
To this end, the findings reported by the Harvard T.H. Chan School of Public Health suggest that in many cases, disturbingly little forethought is given to an attempt on one's own life. The findings note that less than 15% of surveyed suicide survivors between the ages of 13-34 contemplated their decision for more than a day prior to the attempt. Roughly 25% of respondents said the thought occurred less than 5 minutes prior to the attempt. In spite of the countless reasons one might have to keep fighting for life, impulsivity allows the individual to act before these reasons may be given consideration.
This highlights an important fact when it comes to intervening. We cannot assume that the proverbial window of opportunity for prevention will be open long. Those who exhibit a tendency toward manic and impulsive behavior may be capable of making a snap decision from which there is no going back. If you see these qualities beginning to emerge or intensify, the time for action is now.
If you are having suicidal thoughts, stop and consider the finality of this decision. Most suicide survivors experience an immediate sensation of regret for their actions and an overwhelming sense of relief and gratitude as a consequence of their survival. Do not allow your life to be determined by a snap decision.
Exposure to Suicide
As we saw in the first installment of this series, suicides will sometimes occur in clusters. In a 1997 article from the journal Review of Suicidology, researchers used the phrase “suicide contagion” to attempt a better understanding of why suicide “outbreaks” occur. They examined the impact of geographical proximity and recency of a suicide on the decision by others to do the same. They also observed the impact that media influence plays.
Researchers concluded that while the risk of such exposure may not be as statistically problematic as factors such as depression and substance abuse, the “suicide contagion” is a very real effect. This is what allows self-contained communities to become infected by the spread of suicide, especially among teens.
Sociologists have also noted that the risk of suicide is two to three times greater for people with suicide in their family history. Whether this is attributable to exposure, genetics or some measure of both is not certain. However, it underscores the reality that when a suicide occurs anywhere within a community, it carries the danger of multiplicity.
Since suicide can happen in bursts, communities must be on high alert whenever a suicide occurs. This is especially so within the insular walls of a school community. There is a tightly coiled social tissue connecting all members of a student body. When a suicide occurs, it impacts everybody. Despair breeds despair, and other struggling youths may borrow what they perceive as the victim's courage to take the same fateful step. It is incumbent upon communities that have collectively suffered a loss to speak respectfully but also openly and honestly about suicide. This is a time to honor the departed while decrying his or her actions so that a single tragic act does not become the seed for further loss.
Among warning signs, isolation can sometimes be difficult to spot because, by its very definition, it suggests the individual feels a sense of removal from others. Those enduring isolation may find it difficult to make friends or connect with classmates, may lack a caring familial support system, or may suffer from crippling social anxieties that prevent the formation of meaningful relationships. These conditions sometimes make it especially difficult to even notice, let alone connect with, somebody who is suffering.
More challenging still are those forms of isolation which cannot be detected even as they appear right before your eyes. Feelings of isolation can just as easily occur in individuals with loving families, large circles of friends, and outgoing personalities. In spite of how others perceive these individuals, they may see themselves as incurably disconnected, out-of-place, or lonely. In some cases, the outwardly engaged individual you see may be compensating for a feeling of emotional remoteness.
When it comes to emotions, perception can be indistinguishable from reality. An individual who feels emotionally disconnected from family or peers might have difficulty garnering the positive reinforcement, emotional support, and human warmth that we need from our loved ones.
Isolation, external or internal, portends dangerous behavior. Often those who experience this sense of isolation may believe that few would notice or mourn their passing. This is a delusion that allows the isolated individual to carry out an act that will have a devastating impact on others. Do your best to shatter this delusion by reaching out and drawing those in isolation closer. Let them know they are cared about and that their presence matters.
If you are feeling isolated, recognize that you are not alone. If you are feeling suicidal, recognize that there are those who care about you and those who would never recover from the devastation of losing you.
According to Patient Plus, a previous suicide attempt is the biggest risk factor for suicide. Research indicates that 50% of people who ultimately take their own lives have previous attempts in their history. Those with the inclination and the willingness to act on it are suffering from a pain that they feel is intractable. This means that the threat may never disappear entirely.
This danger makes it especially important to speak openly and honestly about suicide. The shame and fear that surrounds this subject may make friends and family members hesitant to honestly invoke the subject with a loved one who has attempted suicide. Rising above this fear, however, could have life-saving implications. Ignoring or remaining silent on the subject forces the victim to continue carrying this burden alone.
If you know somebody in your family, social circle, or class who has an attempt in his or her past, remain always vigilant, connected, compassionate, and available.
Knowing the warning signs and risk factors is one thing. Truly intervening or speaking out on your own behalf is another matter altogether. As we've advised repeatedly and throughout, when in doubt, ask. A loving inquiry could be the outlet your loved one or you yourself might need. It could just be a comfort to know that somebody cares. A single conversation could be the beginning of a desperately-needed healing process. We don't know until we reach out.
That said, most of us are not licensed therapists or suicide counselors. We know how to help when we see others in need, but depression is a very real sickness that conversation alone may not cure. And the risk factors associated with suicide are numerous and deceptive. We aren't necessarily equipped to understand the profound complexity underlying suicide.
So what then? How can you ensure that somebody gets the help they need? How can you get the help you need? How can you save a life that you know is in danger? That answer isn't always clear but it helps to know the treatment and outreach options available. Keep reading to find out more about how we can best help those in need.