At what age do suicidal thoughts first take root in a child’s mind? Can talking about suicide encourage the act itself? Are there signs that a child or adolescent is at high risk for suicide? Given the increasing prevalence of suicide among young people, it is crucial for parents to understand as much as possible about suicide prevention in children and adolescents.
A study by American researchers found that suicidal thoughts emerge early and, surprisingly, that in over 75% of cases where children reported suicidal thoughts or suicide attempts, their caregivers knew nothing about these experiences.
According to experts, although some parents may not recognise the warning signs, they are present almost every time, and spotting them can be crucial for the well-being of children and adolescents going through this crisis.
Rising suicide rates
According to a study by British researchers, approximately 7% of British youth have attempted suicide by the age of 17, and nearly a quarter have engaged in self-harm in the past year.
A study published in 2019 showed that the number of children in Australia who intentionally poisoned themselves with medication had risen by 98% over the course of a decade. The researchers identified 33,501 cases of deliberate poisoning involving commonly found household medications among children aged 5 to 19. The study concluded that this generation is engaging in self-harm more frequently, which could predict rising suicide rates in the future.
Globally, suicide is the fourth leading cause of death among young people aged 15–19.
Among the 41 high-income countries that are members of the Organisation for Economic Co-operation and Development (OECD) and the European Union, New Zealand ranks second in adolescent suicide rates (with 14.9 deaths per 100,000 adolescents).
In the United States, the suicide rate among children aged 10 to 14 nearly tripled between 2007 and 2017, and suicide is the second leading cause of death in the 10–24 age group, according to a 2019 report. Between 10 and 15% of students have suicidal thoughts during middle and high school, according to the Centers for Disease Control and Prevention (CDC).
A study by researchers at Washington University in St. Louis, published in 2020, found that suicidal ideation appears quite early, as early as ages 9–10. Between 2.4% and 6.2% of the nearly 12,000 nine- to ten-year-olds who participated in the study reported suicidal thoughts ranging from a desire to die to formulating a suicide plan. Additionally, 0.9% of the children said they had attempted suicide, while 9.1% reported non-suicidal self-harm behaviours.
The study’s findings aren’t all that surprising, believes psychology professor Deanna Barch. She explains that the high proportion of middle and high school students who report having had suicidal thoughts shows that these ideas don’t just appear out of the blue. However, Barch adds that children are having suicidal thoughts at an even younger age than reported by researchers at the University of Washington, and she has encountered such thoughts in her work even among preschoolers.
Young children also commit suicide. Although the number of cases of suicide at such young ages has always been small, it has risen steadily over time.
The belief that young children lack the capacity to plan their own death has influenced even specialists, which is precisely why there is little data on suicide among children under 12, writes psychologist Marilyn Mendoza. However, young children do commit suicide and, although the number of cases has always been low, it has risen steadily over time, Mendoza warns.
According to the American Foundation for Suicide Prevention (AFSP), there is an average of one suicide every five days among young children, but Mendoza believes this number inaccurately reflects reality because failed attempts go unreported and some suicides may be mistakenly classified as accidents.
Navigating the risk factors for suicide in children and adolescents
No matter how young the children are who come into her office at Jefferson Elementary School in Cape Girardeau, Missouri, to discuss their suicidal thoughts or self-harming behaviours, counsellor Olivia Carter takes them seriously. The school has a protocol for helping students who have expressed a desire to harm themselves or have actually done so. In her first year at Jefferson Elementary School, Carter used the protocol once or twice, but now things have worsened; every month, she meets a student who says they wish they were dead. And these are elementary school students.
Statistics show that suicide among children aged 10 or younger is rare, and this age group is not included in the survey conducted every six months by the CDC on risky behaviours among children and young people. However, specialists who work directly with children say they encounter preschool-aged children in need of support.
Factors that predict suicidal thoughts in young children include online bullying, early use of social media, late-night mobile phone use, family conflicts, and financial difficulties.
Previous suicide attempts (the risk of suicide remains high even one year after an attempt), self-harm, a family member’s suicide, abuse or parental mental health issues, and a history of adoption or foster care are other factors associated with an increased risk of suicide among adolescents and younger children.
Depression is one of the signs that adults look for when assessing suicidal ideation in children. However, psychologist Lisa Boesky says that mood swings and depression are common among adolescents who attempt suicide, whereas younger children are more likely to have attention-deficit/hyperactivity disorder (ADHD).
According to a 2015 study led by researcher Susan Dickerson Mayes, bulimia, anorexia, autism, intellectual disabilities, and oppositional defiant disorder (ODD) are among the mental disorders that can increase the risk of suicide in children and adolescents aged 6 to 18. The study found that bulimia appears to be a greater risk factor for suicide at younger ages than depression.
It is more difficult to predict suicide in young children, but Boesky recommends that caregivers watch for increased sadness, irritability, anger, isolation, and loss of interest in usual activities.
So, what can parents do to prevent suicide in children and adolescents?
Dr Gregory Fritz of Warren Alpert Medical School of Brown University says that adults must take a child who talks about suicide—directly or indirectly—seriously. He is commenting on a study led by researcher Arielle Sheftall which shows that even children aged 5–11 are at risk of suicide.
Emphasising that suicide at such young ages “happens. Not every day, but not that infrequently”, Fritz notes that helping these children is challenging because of how quickly their thoughts change from one day to the next. However, he recommends that adults initiate a discussion about possible suicidal thoughts and intentions when warning signs are present, such as visible unhappiness, impulsive behaviour, or self-harm. Although parents believe that such discussions may encourage suicide, open communication can actually help to keep the child or adolescent safe, Sheftall adds.
Parents should pay attention to changes in their children’s behaviour and not dismiss statements such as: “I wish I were dead,” “I wish I could go to sleep forever,” “You won’t have to take care of me much longer,” and others that convey the same message, either explicitly or indirectly. Such statements are not normal in a child’s speech, notes Boeski, who advises parents to talk about these feelings with their children and to seek help from specialists if things seem to be getting worse.
When helping a child with suicidal thoughts, family members and specialists must respond calmly, without yielding to pressure from the child to remove healthy boundaries, and aim to keep them safe, says Professor Francheska Perepletchikova. She argues that “there is always a balancing act of ensuring safety in the short-term versus decreasing suicidal behaviors in the long-term”.
There are general and specific measures that parents can take to prevent the tragedy of suicide. While some are recommended for the teenage years, other suggestions from the list below are also applicable to younger children.
Learn about warning signs and risk factors.
An informed parent is better able to spot the signs of suicidal thoughts and knows how to intervene and whom to turn to if the situation cannot be managed by the family alone. Parents also need to be knowledgeable about factors that prevent suicide. According to research, these factors include the ability to solve problems and manage conflict non-violently; strong relationships with family and friends; limited access to lethal means; easy access to support services; community support; and cultural and religious beliefs that discourage suicide.
Build and maintain a good and trusting relationship.
Although adolescence can be turbulent, most teenagers want a harmonious relationship with their parents. Good communication can provide an outlet during turbulent or highly stressful periods.
Providing an emotionally and physically safe family environment, wisely choosing when to address conflicts openly (especially during periods of teenage rebellion), and spending quality time together helps build a good, strong relationship between parent and child (as clichéd as the phrase may sound, parents and teenagers often engage in negative interactions, such as criticism or arguments).
Listen carefully to what the child/teenager says, even beyond the explicit message.
Experts say that parents should pay close attention to contradictory or confusing messages and try to decode what their child is feeling from verbal and non-verbal cues. Adolescents need parents who support them, show empathy, and set clear rules—not intrusive parents from whom they hide their problems.
Researchers have found that approximately half of adults who commit suicide reveal their intentions to others.
Studies have shown that, since suicidal thoughts are associated with communication difficulties in the parent–child relationship, good communication is a significant factor in reducing suicidal thoughts in adolescents.
Researchers have found that approximately half of adults who commit suicide disclose their intentions to others. Any hint or explicit statement of suicidal intent in children and adolescents must be taken seriously; in this situation, it is better to overreact than to ignore a potential danger.
Monitor social circles and leisure activities.
It is of the utmost importance for parents to know where their child is when they are not at home and who their real-life friends are. It is also beneficial to stay in touch with their friends’ parents. Parents should learn how to use social media to stay informed about their children’s concerns and more easily spot signs of trouble or distorted thinking.
Collaborate with educators.
As children and adolescents spend a significant portion of their day at school, supervision by school staff and the creation of a positive school environment are important suicide prevention factors. It is crucial for educators to familiarise themselves with risk factors and warning signs. There should also be a psychologist or counsellor on staff who can manage crisis situations, assess suicide risk, and inform parents. They should also be able to provide recommendations for accessing other support services when necessary.
Specialists in mental health and suicide prevention among children and adolescents
The existence of a wide range of risk factors makes it difficult to identify reliable predictors of suicide attempts. However, children and adolescents with suicidal behaviours appear to be more influenced by circumstances than adults, according to Guy Diamond, PhD, professor emeritus at the University of Pennsylvania School of Medicine and associate professor at Drexel University. He emphasises the need to focus intervention on circumstantial factors as well as improving adaptive skills.
Although psychotherapy has proven to be an effective tool, experts are still exploring the most appropriate treatments for children. While hospitalisation is generally considered the best strategy, it may not be suitable for children, according to specialists at the American Psychological Association (APA). Studies highlight an increased risk of suicide in adults after discharge, with the risk remaining high for a year or more. Additionally, hospitalisation can cause anxiety in children, says Megan Schott, director of psychiatric emergency services at Children’s National Hospital in Washington, D.C. She notes that approximately 30–40% of patients presenting with psychiatric emergencies are elementary and middle school-aged children, and that the number of such services for young children is limited.
Many specialists prescribe antidepressants, but studies show that there is insufficient evidence to suggest that they reduce suicidal thoughts. In fact, some studies even suggest that they increase the risk of suicide in certain groups of children, writes David Jobes, a clinical psychologist and professor at The Catholic University of America, who advocates the development of therapy approaches tailored to children.
Cognitive behavioural therapy, which helps to change thinking patterns and thereby influence emotional and behavioural aspects, is one of the forms of therapy that has proven useful for children contemplating suicide. Dialectical behaviour therapy, founded by psychologist Marsha Linehan, has also shown promise in treating young children.
Parents’ active participation in this process, from identifying risky behaviours to treatment, is crucial for recovery. In some cases, the family is part of the problem and is responsible for resolving the situations that caused the child’s stress and suffering. In other cases, parents fail to understand and accept the situation their child is in.
The way parents react can make things better or make them a thousand times worse, says Professor Guy Diamond.
When a child expresses a desire to die, they are actually conveying the depth of their emotional suffering, says counsellor Renée Turner. No matter how challenging managing this pain and anticipating children’s actions may be, experts say that parents should not feel powerless in this process.
There is always a way to convince a child or teenager that emotional suffering is just a phase that can be overcome, and that suicide is a permanent solution to a temporary problem. There is always hope that parents (and the specialists they turn to) will find a way in time.
Carmen Lăiu is an editor at Signs of the Times Romania and ST Network.
