The Advice Corner: How do I talk with my teen about suicide?
This month’s question: How do I talk with my teen about suicide?
Nikole Slocum, MS, LPCC, JFCS Therapist:
Talking with your teen about suicide might feel like one of the hardest conversations you’ll ever initiate. In my work with adolescents and families, one of the most common things I hear from parents is, “How do I start this conversation? I don’t want to make anything worse.” However, the truth is your willingness to ask is actually protective. Research shows that talking with your teen about suicide can reduce suicidal ideation, rather than increase it. (Dazzi et al., 2014)
Many teens who experience suicidal thoughts don’t disclose this to anyone unless they’re directly asked.
Why teens think about suicide
Being a teenager is hard. For many of us, being a teenager might feel like a distant memory and we may forget the intense emotions that can fluctuate rather quickly. Teens don’t have the same capacity as adults to regulate their emotions because the part of the brain that is responsible for regulating emotion is still developing.
A teenager’s reward center and emotional processing regions (such as the amygdala) mature much earlier than the prefrontal cortex, which handles long-term planning, problem-solving, and impulse control. (Casey et al., 2010)
All this boils down to the fact that teens feel emotions more intensely, often have a difficult time seeing temporary problems as truly temporary, and can experience “all or nothing” thinking when feeling overwhelmed. When teens think about suicide, it’s often a reflection of emotional pain, feelings of hopelessness, a desire to escape from whatever they’re feeling, or because they feel they are a burden.
Warning signs
Don’t worry parents, you don’t have to memorize a long list of symptoms. What really matters is noticing changes, especially in more than one area. Parents often notice subtle signs before anyone else. I like to break it down into three core areas: Emotional/cognitive changes, behavioral changes, and situational stressors.
Emotional changes:
• Expressions of hopelessness, feeling trapped, empty, extreme sadness, more anxiety, increased agitation, rage
• Statements like, “I wish I could just disappear,” “I just want to die,” or “You’d be better off without me.”
• Unbearable emotional (and physical!) pain
Behavior changes:
• Social withdraw
• Declining from their baseline school performance
• Risky behaviors
• Increased drug or alcohol use
• Displaying extreme mood swings
• Researching ways to die
Situational stressors:
• Break-ups
• Peer conflict and bullying
• Grief and major loss
• Trauma exposure
• Academic pressure and/or perfectionism
How to start the conversation
This part feels pretty scary for a lot of parents because they’re fearful about saying “it” wrong. You don’t need perfect phrasing here. It doesn’t need to be elaborately worded either – you just need honesty, warmth, and non-judgment.
Some conversation starters:
• “I’ve noticed that you seem overwhelmed lately and I care about you. Can we talk about how you’ve been feeling lately?”
• “Sometimes when people feel stressed out, or hopeless, they think about hurting themselves or ending their own life. Have you experienced that?”
• “Are you thinking about suicide?”
• “I want you to know that you aren’t in trouble. I just want to understand what you’re experiencing or feeling. You aren’t alone in this.”
When having these tough conversations, we want to avoid shaming or dismissing with statements like “You’re being dramatic,” “You have nothing to be depressed about,” or the classic, “It’s just teen hormones.” These responses shut down honesty and increase shame, which are major drivers of suicidal thinking.
My teen said “Yes”
Take a breath. It’s ok to pause for a moment. You’ve got this. Your ability to be calm is more impactful than the words you choose. Saying something like, “Thank you for telling me. I’m so glad you trusted me with this,” is one way to show you are there with them and that you’re a safe space to be honest about a tough topic.
Next, gently assess for safety:
• Are the thoughts active or passive?
• Passive: Just thinking about it. This could look like having thoughts like, “I wish I wouldn’t’ wake up.” or “It would be so much easier if I just didn’t exist.”
• Active: Intent, plan, and lethal means to carry out the plan
If the thoughts are passive, but distressing:
• Increase supervision
• If possible, remove medications, sharps, and firearms. If that is not possible, lock up medications, sharps, and firearms.
• Arrange therapy promptly
• Maintain routine check-ins
• Stay emotionally available
If there is intent, plan, and access to lethal means, this is a mental health emergency. Call 988, your local crisis line, or go to the nearest ER.
Final thoughts
You don’t need specialized training to support your teen in suicidal thoughts. You don’t need perfect words. You don’t need to “fix it” or get rid of all their stressors. What’s helpful is noticing change, asking directly, listening openly, staying calm, and knowing when to get professional help.
Conversations around suicide aren’t going to plant ideas of suicide in their head. Conversations around suicide plant seeds of hope, honesty, and support.
Resources for parents and teens
• 988 Suicide and Crisis Lifeline (call, text, or online chat)
• Crisis Text Line: Text HOME to 741-741
• The Trevor Project (LGBTQ+ youth) – (call, text, or online chat)
• Cope: Hennepin County Mobile Crisis Response: 612-596-1223
• Ramsey County Crisis Line: 651-266-7878
References
- Casey, B. J., & Jones, R. M. (2010). Neurobiology of the adolescent brain and behavior: implications for substance use disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 49(12), 1189–1285. https://doi.org/10.1016/j.jaac.2010.08.017
- Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?. Psychological medicine, 44(16), 3361–3363. https://doi.org/10.1017/S0033291714001299