James' World 2

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I have a patient named “Alex.” He is 15. He feels alone, down almost every day. He tells me he’s having trouble with schoolwork. He worries about his future. He struggles to make friends and keep the ones he has. He says it’s hard to get out of bed, to shower, and brush his teeth. He doesn’t find joy in things he used to love, like painting. I met him in our emergency department; he was in the middle of a crisis and came to us for help.

Alex has depression and anxiety, and these feelings had been going on for about one year. Recently, he told me he’d been thinking about hurting himself or overdosing on medication. These thoughts were becoming more frequent. He talked a lot about wanting to die.

The teenage years are difficult. Our kids carry huge emotional burdens, and more youths than ever face anxiety, depression or have trouble regulating their emotions. Unfortunately, suicide is now the second leading cause of death in youth ages 10 to 24. Among this age group, suicide rates have risen more than 60 percent in the last 20 years. Chronic physical health issues, abuse or other traumatic events, substance use, bullying or negative experiences with social media, family history or past history of contemplating or attempting suicide are huge risk factors.

I’ve sat beside far too many children who’ve told me they don’t want to live anymore. Some whisper it. Others say it with tears streaming down their cheeks. It doesn’t have to come to this. And parents are key to prevention.

So why was I, a child psychiatrist, particularly concerned about Alex? He initially had a hard time opening up and minimized concerns his family had about him. His parents knew something was off but attributed it to teenage angst until the changes became more pronounced. His struggles and the progression of his symptoms were seriously concerning. We needed to act.

There are many things that I and others think has led to the rise in suicide risk. Our teens constantly question their self-worth, struggle to cope with distressing situations, or feel disconnected and unvalidated. Family, school, and community can make these feelings worse, and the risks worsen alongside other mental or physical health problems.

Getting Alex treatment, establishing a clear safety plan, limiting access to things that could pose harm (like medications or firearms), finding friends and family to build a support network, and making sure he was getting support at school, home and within the community would be important in reducing his risk. But this goes for all children at increased risk of suicide.

Having a child at risk can be scary and uncertain. Even if everything looks okay on the outside, it may not be. It’s the last thing any parent ever expects to hear. But you’re in a powerful position. You can protect your child by knowing what leads to suicide, picking up on warning signs, and getting help.

You are not alone in this. There is hope. Your child can get through it. Here’s how:

Warning signs vary, and some are less obvious than others. Alex complained that he was tired on school days, that he had a stomachache,e and didn’t want to eat. Of course, these can be symptoms of physical health concerns or, if brief and transient, they may be related to typical teenage behavior. When it’s vague, persistent, impairing, however, and there is no clear medical cause, it could very well be a symptom of anxiety, depression, chronic stress or general emotional distress.

Recognizing when your child is acting differently and uncharacteristically may be a subtle sign that there is something wrong. For you, here’s the opportunity to be curious and check in. “I noticed you have been having more bellyaches before school. I wonder if there is something about school or something else that is bothering you. I am here to listen and want to understand how I can help.” Acting early can help reduce overall risk.

But there are some warning signs that are more obvious: Making statements about wanting to die or not be around, expressing intense guilt or shame, saying things like they feel like a constant burden to family or others, are all red flags. Others include talking about feeling empty, trapped, or hopeless; or isolating themselves, or, like Alex, no longer doing activities they enjoyed. Mood matters too. Some children are irritable, sad, or constantly worried. Others talk about unbearable emotional or physical pain. You might see significant changes in eating or sleep patterns, and involvement in risky and uncharacteristic behaviors, including substance use.

Alex told his primary care doctor and his family how high his risk had gotten; he told his family how trapped he felt. A mental health screen affirmed concerns about worsening depression, anxiety, and more frequent thoughts about hurting himself. The emergency visit confirmed he was in crisis.

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