Navigating the difficult topic of suicide with kids and adolescents

Despite efforts to return to a version of “post-pandemic normalcy,” the reality is that youth in the United States are still struggling, concerningly so, with their mental health. It's no question that the height of COVID-19 took a social, emotional and mental toll on school-aged kids who went through a uniquely isolating experience.

What pediatric psychology experts continue to clarify, and what a study by Lurie Children's physicians revealed, was that the youth mental health crisis was serious long before their worlds changed in spring of 2020. According to the study (www.luriechildrens.org/en/news-stories/er-visits-among-youth-with-suicidal-thoughts-had-already-spiked-in-fall-2019), there was a surge of emergency visits related to youth suicide ideation from 2016 to 2019.

“These problems were happening before the pandemic,” said Dr. Audrey Brewer, co-author and general pediatrician at Lurie Children's. “This has been an issue for so long, and it's getting worse.”

While it can be a scary and daunting subject for families to surface with kids and adolescents, what experts have learned is that communication about suicide can make all the difference in potential outcomes. Mallory Hilliard, clinical social worker at the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children's, sheds light on who suicide ideation is impacting and the importance of raising these hard conversations at a time when suicide is the second leading cause of death for individuals ages 10-14 (CDC, 2020).

“Teens are particularly at risk for developing suicidal ideations or attempting suicide due to several factors, including puberty and increase in hormone development as well as ongoing brain development,” Hilliard said.

Parents and caregivers should be observant of their child's behavior and know that risk factors can include things such as:

• School stress

• Community violence and trauma

• Lack of access to medical and mental health care

• Peer difficulty (i.e., difficulty with friendships, difficulty with romantic relationships)

• Bullying/interpersonal violence

• A history of mental health diagnoses, such as depression or anxiety

• Substance use

• Feelings of hopelessness

• A history of suicidal thinking or suicide attempts

Hilliard says there can be additional risk factors dependent on gender, race and ethnicity, and being a member of the LGBTQIA community. Young people who identify with the BIPOC (Black, Indigenous, and People of Color) communities and with the LGBTQIA communities are at greater risk of mental health conditions and suicide attempts.

If families suspect their loved one is struggling with their mental health, one of the most important and encouraged actions to take is to inquire about suicide.

“Myths suggest that by asking young people about suicide that it will 'plant' a thought in their head; however, data consistently suggests this is not true and continues to support the critical importance of asking young people directly about suicide and suicidal thinking,” Hilliard said.

Hilliard believes it's important to create a safe space for young people by not only hearing and validating whatever feelings they might bring up but thanking them for trusting you with the vulnerable details in the first place.

“In talking with a young person about suicide, whether they know anyone who has attempted suicide or if they themselves have ever had these thoughts, it can also be helpful to keep questions as open-ended as possible,” Hilliard said.

She suggests follow-up questions that are rooted in empathy and that create trust, such as “I want to understand this thought and feeling a bit more. Tell me more about what was causing this stress and what the thought felt like.”

In addition to creating open lines of honesty and communication, ensuring safety is vital when a young person reports suicidal thinking, a history of suicide attempts, or other mental health related concerns.

For parents, this may look like:

• Restricting access to all lethal means, including firearms and other weapons

• Reaching out to the child's medical provider for further guidance

• Seeking an emergency psychiatric evaluation in an emergency department or through a community mental health agency

For peers and other individuals, this may look like:

• Talking to a school counselor about their concerns

• Providing friend(s) with crisis hotline numbers such as 988 and encouraging them to call

“There is never a wrong time or reason to seek help for yourself or for someone you care about,” Hilliard said. “If someone reports they're experiencing suicidal thoughts, it's important to seek help immediately.”

While navigating a mental health crisis can be tricky, it should never be ignored or assumed that it will resolve itself. Discussing scenarios and treatment options without shame and judgment helps reduce the stigma of mental health difficulties and creates emotional safety for children, adolescents and adults alike.

If immediate safety concerns become apparent at any time, it's always recommended to go to the nearest emergency department where a psychiatric assessment can be provided, or to access crisis resources such as the National Suicide and Crisis Hotline (text or call 988) or the crisis line through the Trevor Project, 1-(866) 488-7386.

• Children's health is a continuing series. This week's article is courtesy of Ann & Robert H. Lurie Children's Hospital of Chicago. For more information, visit www.LurieChildrens.org.