How to Help When Adolescents Have Suicidal Thoughts

The New York Times

By Perri Klass, M.D.

Feb. 6, 2021

Even when rates of suicidal ideation increase, there are ways to keep kids safe.

With some evidence suggesting that more adolescents have been reporting suicidal thoughts during the pandemic, experts and parents are looking for ways to help.

One issue is that the Centers for Disease Control and Prevention has not yet compiled and released statistics on suicide deaths, so it’s not clear whether the problem is worse than usual. But there are questions about whether suicide risks are increasing — especially in particular communities, like the Black and brown populations that have been hit hardest by the pandemic.

Even during normal times, many mental health problems tend to emerge in adolescence, and young people in this group are particularly vulnerable to social isolation. In Las Vegas, an increase in the number of student suicides during the pandemic spurred the superintendent’s recent decision to reopen schools.

“We don’t have the data to know the relationship of suicidality in children and youth and the Covid epidemic,” said Dr. Cynthia Pfeffer, a professor of psychiatry at Weill Cornell Medical Center who has worked extensively on grieving and bereavement in children and adolescents. “The tremendous stress for families might make a child feel like they need to get out, or feel depressed.”

During the early months of the pandemic, there may have been some sense of common purpose — the kind of spirit that can increase people’s resilience after a disaster. In a research letter published on the JAMA network in late January, researchers compared internet searches related to suicide during the two months before and four months after March of 2020, when the United States declared a national pandemic emergency. Searches using the term “suicide” went down significantly in the 18 weeks after the emergency was declared, compared with what was predicted.

In a new study in the journal Pediatrics, researchers looked at the results of more than 9,000 suicide screenings that had been performed on 11- to 21-year-olds who had visited a pediatric emergency department in Texas. Everyone coming in, for any reason, was asked to complete a questionnaire which asked, among other things, about suicidal thoughts or suicide attempts in the recent past.

The researchers compared the responses from the first seven months of 2019 with those from the same months in 2020. They wanted to see if there was evidence of more suicide-related thoughts and behaviors between March and July of 2020 as the pandemic took hold. Ryan Hill, an assistant professor of pediatrics at Baylor College of Medicine who was first author on the study, said that his team expected that while in January and February, the pandemic would not have been on people’s minds, “we expected to see some differences later — and we did see some, but they were not consistent.”

Dr. Hill and his team found higher rates of suicidal thoughts in some, but not all, months of 2020. “In March and July, the rate of ideation was substantially higher than in 2019,” Dr. Hill said. “Something’s going on — we interpret it as due to the pandemic, though other things were going on in 2020.”

Dr. Christine Moutier, the chief medical officer at the American Foundation for Suicide Prevention, emphasized that even when rates of suicidal ideation increase, suicide rates do not have to rise.

“I think it is terrific that there is more universal screening going on; it represents an opportunity to employ some of the evidence-based strategies that we know can help,” she said.

In a comment published in JAMA Psychiatrylast October, Dr. Moutier wrote about how important it is to prioritize suicide prevention during the pandemic. She included several strategies for health care providers, communities, government, and also friends and family to do just that, with some designed to improve social connections by taking advantage of technologies for virtual check-ins and visits. Her foundation also recently released a statement on what parents can do to protect children’s mental health during remote learning.

“Now more than any other time is a time for parents, for any adults who work with adolescents and youth, to be paying attention to the well-being of all adolescents,” Dr. Moutier said. “It’s really a time to be checking in.”

Parents should think about the different ways adolescents might respond to stress, said Dr. Rebecca Leeb, a health scientist at the Centers for Disease Control and Prevention who led a team on emotional well-being and mental health in the pandemic. Perhaps they are withdrawing and sleeping more; eating more or less; or trying drugs, alcohol or tobacco.

Parents can encourage their teenagers to get out of the house and to use the right safety measures — masks, hand-washing, distancing — so that they can spend time outside with friends. She emphasized that “social interaction” is important, whether that’s “exercise or drawing or hiking or taking the dog for a walk.” Kids take cues from their parents, she added, so adults should do those things as well.

It’s also important to make sure that your own mental health is taken care of before you “jump in and start checking in on your kid’s mental health,” Dr. Moutier said. Find moments to relax and laugh, she said, and make sure to talk about how you’re maintaining your own wellness and resilience, so that you can acknowledge and model the importance of those coping strategies for your kids.

Checking in with your kids might also give them an opportunity to open up, said Dr. Moutier, which, for many families, is something that they used to do in the car.

“Our children will feel loved and cared for if we’re practicing that kind of dialogue,” she said. “Do not shy away from asking the deeper, harder questions.” Dr. Moutier recommended being curious about your teenager’s world, asking things like, “How is that situation at school affecting you and your friends?”

Laura Anthony, a child psychologist at Children’s Hospital Colorado and an associate professor at the University of Colorado School of Medicine, said that one common mistake that even she sometimes makes is trying to solve a child’s problems. “What I need to do is just listen,” she said.

She works as the co-leader of the hospital’s youth action board, and teenagers with mental health histories compiled suggestions about how they would like their parents to help. One suggestion: Don’t assume that your kids are struggling all the time, Dr. Anthony said. Instead, consider questions like, “What’s taking up your head space?” Or, “What are you grateful for?”

Another suggestion: Parents should not discipline kids by taking away their phones. “Our teens say, this is not the time for a lot of punishment, you need to give us encouragement, help us have fun,” Dr. Anthony said, “and taking away the phone is really like taking away a lifeline.”

We need better data on mental health, Dr. Leeb said, and on well-being and quality of life. “We are learning a great deal,” she said. “I personally am hopeful for the future,” adding that she’s had several discussions with her children (who are 11, 15 and almost 18) about what the future looks like.

Ask teenagers, “How is this time affecting you?” Dr. Moutier said, and if they are experiencing any kind of struggle. And make it clear that no challenges are insurmountable, she said, “those are really important words for parents to say.”

Giving kids a sense of agency is also vital, said Dr. Sarah Vinson, an associate professor of psychiatry and pediatrics at Morehouse School of Medicine. “Think how kids can be part of the solution,” she said, whether that’s encouraging them to do volunteer work, or helping them understand that concrete steps, like wearing masks, can play a vital role in “reclaiming our day-to-day lives from this pandemic.”

If you’re concerned that your child is depressed or anxious, or if an adolescent talks about feeling overwhelmed, Dr. Anthony suggested asking directly, “Are you having any thoughts of suicide?” You don’t need to ask them every day, but if you’re having any concerns, you should definitely ask.

“Help is out there and it works,” Dr. Anthony said, pointing to the increased availability of virtual mental health services. “Suicidality is partly not being able to see the future,” she said. “If we can change that, we can see remarkable changes.”

Much as the hardships of the Great Depression and World War II forged what is known as “the Greatest Generation,” she said the challenges of the pandemic could strengthen today’s young people.

“I think we are going to have a generation of really remarkably resilient kids and teens who grow up to be really remarkable human beings as adults.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.