Clinical Reference Systems: Pediatric Advisor 10.0

Suicides among young people nationwide have increased dramatically in recent years. Each year in the U.S., thousands of teenagers commit suicide. Suicide is the third leading cause of death for youths 15 to 24 years old, and the sixth leading cause of death for youngsters 5 to 14 years old.

Teenagers experience strong feelings of stress, confusion, and self-doubt. There also may be pressure to succeed, financial uncertainty, and other fears while growing up. For some teenagers, divorce, the formation of a new family with stepparents and stepsiblings, or moving to a new community can be very unsettling and can intensify self- doubts. In some cases, suicide appears to be a solution.

Depression and suicidal feelings are treatable mental disorders. The child or adolescent needs to have his or her illness recognized and diagnosed, and appropriate treatment plans need to be developed. When parents are in doubt whether their child has a serious problem, an examination by a mental health care professional can be very helpful.

Many of the symptoms of suicidal feelings are similar to those of depression. Parents should be aware of the following signs of adolescents who may try to kill themselves. If one or more of these signs occur, parents need to talk to their child about their concerns and seek professional help when the concerns persist:

• change in eating and sleeping habits
• withdrawal from friends, family, and regular activities
• violent actions, rebellious behavior, or running away
• drug and alcohol use
• unusual neglect of personal appearance
• marked personality change
• persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
• frequent complaints about physical symptoms often related to emotions, such as stomachaches, headaches, and fatigue
• loss of interest in pleasurable activities
• intolerance of praise or rewards.

A teenager who is planning to commit suicide may also:

• complain of being "rotten inside"
• give verbal hints with statements such as: "I won't be a problem for you much longer," "Nothing matters," "It's no use," or "I won't see you again"
• put his or her affairs in order (for example, give away favorite possessions, clean his or her room, or throw away important belongings)
• become suddenly cheerful after a period of depression.

If a child or adolescent says, "I want to kill myself," or "I'm going to commit suicide," always take the statement seriously and seek evaluation from a child and adolescent psychiatrist or other physician or mental health professional. People often feel uncomfortable talking about death. However, asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than putting thoughts in the child's head, such a question will provide assurance that somebody cares and is willing to give the young person the chance to talk about problems.

With support from family and professional treatment, children and teenagers who are suicidal can heal and return to a healthier path of development.