How prevalent is teen suicide, and has the rate changed over time?

The most recent national data we have is from 2017 and nearly 3,000 teens died by suicide that year. Each of these suicides is a tragedy that cuts short a life and leaves many loved ones, friends, and community members struggling with an unfathomable loss. With young people, suicide may be especially painful because there's so much life unlived, and I think we, as adults, feel a strong responsibility to protect our youth and prevent such outcomes.

Teen suicide gets a great deal of media attention and is the focus of my research program, but teens are not more vulnerable to suicide than other populations. As context, it’s important to keep in mind that the suicide rate is higher among adults than it is among teens. There are certainly more people in their twenties, in middle age, and in their older years who die by suicide. Every suicide is a tragedy, no matter when it occurs.

But despite increased national attention, suicide awareness activities, and increased research on preventive interventions and treatments, the overall suicide rate and the teen suicide rate have been going up in our nation. This is a major public health concern. There is an urgent need to develop and implement effective suicide prevention strategies. Suicide is, ultimately, preventable. A public health model that combines preventive strategies, such as improving coping and resilience for all youth, making sure effective treatment is available, providing crisis intervention services for those most at risk, and safely storing firearms will likely be needed to achieve this goal.

What are some of the factors that make teens vulnerable to suicide, and are there things we can do to counteract them?

Several of the primary psychiatric risk factors for suicide, such as depressive disorders and frequently co-occurring conditions such as anxiety and post-traumatic stress disorders, become increasingly prevalent during the teen years. Depression certainly occurs in younger children, and sometimes it just hasn’t been recognized or diagnosed. But large-scale studies indicate that onset is more common in adolescence.

The teen years also come with greater independence and the freedom to make more choices, including choices about alcohol and drug use, which can often become more accessible with more independence. If you combine depression or another psychiatric condition with alcohol and drugs, they tend to exacerbate each other and increase risk for suicide. In addition, adolescence is associated with new interpersonal stresses in the realms of relationships, sexuality, competition, identity development, and finding one's place in the world. Some teens are victimized because they identify as a minority. Some have histories of sexual or physical abuse. These types of interpersonal factors may further exacerbate suicide risk.

We also often work with teens that might be in a school or in a family where there are substantial problems that appear to be unresolvable. I think it’s sometimes harder for young people to appreciate that things may change or that problems may resolve when they are able to change environments. As we leave our families of origin and graduate from high school, we may have more opportunities to choose our environments, and we may have more life choices and options available to us than when we do when we're adolescents.

Are there warning signs that can help us identify suicidal teens?

I was part of a group that worked to develop a clinical consensus of warning signs that are consistent with research evidence. We developed a short list of signs, which you can see on the Youth Suicide Warning Signs website.

One warning sign is that the teen is talking about suicide, saying they want to die by suicide, or sharing that they're having suicidal thoughts. Sometimes they are even making plans or preparing for a suicide attempt.

A second sign is severe, overwhelming emotional pain, despair, or hopelessness about the future.

A third sign is worrisome changes in behavior. For example, a  teen who used to be engaged in social activities now withdraws from them. They don’t want to go to the mall when they used to love going to the mall. They've quit the soccer team. They're refusing phone calls from friends. They've stopped using social media, they are no longer getting up for school, or they’re sleeping a lot more or less than usual. They might be angry or hostile in a way that seems out of character or out of context. They’re more agitated or more irritable. There may also be an increase in the use of drugs or alcohol in an effort to dull pain or to harm themselves, or engagement in reckless behavior. These behaviors are especially worrisome when they’re combined with suicidal thoughts and overwhelming emotional pain. There is more information on the Youth Suicide Warning Signs site. I also highly recommend the Suicide Prevention Resource Center, which has excellent information pertinent to suicide and suicide prevention.

If we know a teen is suicidal, how can we help them?

If concerned about a teen’s possible suicide risk, it is important to show that we care by asking them directly if they are having thoughts of suicide, of killing themselves.  This can be part of a conversation about their well-being and noted distress, and asked in an understanding manner.  For instance, “Given all you’re dealing with now and the distress you’re experiencing, I’m wondering if you’ve had thoughts of hurting yourself in some way or thoughts of suicide?” You should tell them that you appreciate their honesty and courage in sharing something so painful and difficult. It is important to stay calm and listen to why they feel this way, and to really make an effort to understand.

The goal is to ask, listen, and facilitate taking the next step to get the help they may need to resolve their feelings of extreme pain or distress (or link them directly with someone who can). If a teen is planning a suicide attempt, is taking preparatory actions, or is struggling with recurring or severe thoughts about suicide, an immediate professional evaluation is recommended. This may mean involving your local emergency department or your local government’s crisis services.

You are credited with creating what is believed to be the only intervention shown to be associated with a reduction in self-injury mortality among teens. Can you describe the intervention?

The intervention is called the Youth Nominated Support Team Intervention or YST. We developed it for adolescents between the ages of 13 and 17 years who had been psychiatrically hospitalized for suicide risk. In YST, youth are asked to nominate up to four adults they would like to be more involved in their life. The adults are people they trust and think could be helpful to them when they leave the hospital.

The YST intervention takes place with the youth-nominated adults. The adults come in for what we call a psychoeducation session to learn about the teen’s current problems (and strengths) and their treatment plan. They’re not asked to function as mental health professionals, and we emphasize to them that they are not responsible for the teen’s behaviors. Their role is to be a caring adult in the teen’s life. We want the adults to feel they understand the treatment and issues well enough to be helpful in encouraging treatment adherence, providing support, and facilitating positive behavioral choices. We provide them with education and support by offering the psychoeducation session and following up with them weekly by phone for the next three months to help them support the teen.

To the extent that YST is effective, I think there are two key components to the intervention’s success. One is that the teens nominate the adults. Usually in treatment and intervention, we assign treatment providers. Here, the teens choose who they want to be involved. The second key part is that the adults are not left on their own in the intervention.  We provide them with substantial information and support.

Why haven’t there been more studies about the kinds of interventions that save lives?

It takes a very long time to study mortality outcomes. Each suicide is a tragedy, but it's actually relatively rare – even with the higher rates we’re seeing. If you’re working with even a fairly large study sample, such as the 446 teens in our YST study, the number of deaths from any cause will be, hopefully, very small. It takes time and substantial funding to examine mortality outcomes.

The Youth Nominated Support Team Intervention was designed as a supplemental intervention rather than a stand-alone intervention. Most teens who are psychiatrically hospitalized for suicide risk will leave the hospital with recommendations for psychotherapy and for medication. Our intervention was included as an addition or supplement to these more traditional or usual treatments. Our positive findings related to mortality outcomes came from a secondary, post hoc analysis. As a clinical scientist, I strongly believe that these findings need to be replicated, and this is my current goal.


If You Know Someone in Crisis

Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week.