How Can We Help Adolescents? Tools for Parents on Suicide

Suicide is the second leading cause of death among adolescents in Israel. Below is some data about the scale of the phenomenon:

• Approximately 360 out of every 100,000 (ages 10-17) people have attempted suicide according to the official Ministry of Health data.
• According to comprehensive surveys and studies, approximately 20% of adolescents have coped with suicidal ideation.
• According to the Ministry of health’s Informatics Division data (Hebrew), suicide was the third largest cause of death among females and the second cause of death among males between the ages of 15-24 in Israel.
• The number of suicide attempts is high among adolescents: in 2019, females between the ages of 10-24 comprised approximately half (45%) of all women who attempted suicide while males between the ages of 10-24 comprised 37% of all males who attempted suicide.
• The attempted suicide rate is highest between the ages of 18-21.
• Suicide comprises approximately one percent of all deaths in people aged 15 and older.

It is important to emphasize that some suicide attempts are not reported, particularly those who do not arrive at the hospital for treatment, in most cases due to a desire to conceal the circumstances. The same holds true for suicide attempts that end in death, so these data are based on the cases that were actually reported. People who attempted suicide who were not treated in hospital, were treated in the community, were not treated at all or who committed suicide are not included.

Suicide during adolescence

Adolescence, which occasionally begins as early as the age of 10, is a tumultuous period that involves many physical, social and mental changes. During this time, adolescents develop their own identity as well as their core system of values and beliefs. They deepen social ties and sometimes experience difficulties in this area. In addition, this is an exciting period of sexual maturation and first experience in romantic relationships. They are in competition, subject to incessant self-comparison as well as to pressures and expectations regarding academic, community (for example, in the youth movement) and other achievements. In many cases, they experience complex conflicts around issues such as freedom, boundaries and values.

These are just a few examples of challenges and struggles that combine to make the period sensitive, challenging and sometimes dangerous, in which there is increased chance of a serious emotional crisis or onset of mental health disability. The lack of a supportive family and social environment, coupled with exposure to risk factors, may exacerbate the situation.

• Depression and mental health disability: depression, anxiety, eating disorder and other mental health disabilities increase the risk of suicide. It is important to know that depression is not despondency that disappears after a few hours or days but lasts for more than two weeks.
• Emotion regulation: in terms of development, adolescents have a more difficult time than adults in regulating behavior and emotions, tending to strongly react to events that trigger strong emotions in them. Adolescents who are diagnosed with ADHD may particularly suffer from difficulties in emotion regulation, based on the developmental stage they are in.
• Drug and alcohol use: Addiction to drugs and alcohol during adolescence is a significant factor in suicide and linked to impulsive behavior and impaired ability to cope with or adapt to difficult situations.
• Stressful life events: parents' divorce, loss of a loved one, teasing and bullying, termination of a relationship, sexual orientation and identity, sexual or physical trauma and more can be a trigger for suicide during adolescence.
• Poor self-esteem: Many teenagers suffer from poor self-esteem, a sense of lack of belonging and loneliness, which may lead to an increased risk of suicide.
• Social influence: the involvement of close friends in suicidal thoughts and behaviors may affect other teenagers in their environment, particularly a friend's suicide.
• Social media: cyberbullying, as well as the influence of social media on self-esteem, are significant stress factors during adolescence.
• Lack of family and emotional support: despite the occasional tendency towards distancing and rebellious behavior during adolescence, teenagers need emotional and family support. Lacking this support, they may experience severe crisis.

Is my child suffering from depression?

If you suspect that your teenager is depressed or at minimum that he or she is experiencing something, it is important to pay attention to the common warning signs, to know the characteristics of clinical depression and, in particular, to pay attention to the differences between the manifestations of depression in adults and teenagers. For example:

• While depression in adults mainly manifests as profound sadness, in teenagers it manifests as anger, irritability, restlessness, hostility towards the world as a whole and those close to them in particular. They feel frustrated and disappointed in the world, and particularly in themselves.
• Declining academic achievement and avoidance of social involvement may be a concerning indication of depression.
• Negative, pessimistic thoughts, hopelessness and despair.
• Behaviors that indicate distress, including high sensitivity to criticism, poor hygiene, isolation, screen addiction, sleep problems, violent behavior.
• Physical symptoms that may occur include as stomachache, headache, unexplained chronic pain. Physical complaints may occasionally be the adolescent’s way of seeking help from the parent and communicating his distress that he is unable to explicitly express.
• Running away from home - common among teenagers and may reflect distress. In general, it is important to remember that distress can manifest itself among adolescents (but not only) as rebellious and oppositional behavior, self-risk and more. It is therefore important that as parents, we are pay attention to the way the teenager's behavior reveals his experience, even if it is not described to us in words.
• Suicidal thoughts.

Thoughts about death during adolescence

It can be extremely frightening to hear that your child is thinking about death, but reality shows that such thoughts are extremely common at this age. The thoughts come in waves and it is important to distinguish whether these are general and passive thoughts that are just thoughts or whether these are active suicidal ideations.

Adolescent mood swings

Adolescent mood swings can blur the significance of suicidal expressions. Mood swings, which are common during adolescence, may mislead and result in not noticing the signs. Therefore, on the one hand, it is important to be aware of the range of fluctuations, and to pay attention to whether during the "low" moments the depression is severe, and whether thoughts of death or suicide also appear. On the other hand, it is important to not assume that momentary relief means the absence of distress, "that the problem has been solved". The distress may appear again later, so we must continue to monitor.

Concealing emotional distress during adolescence

Many teenagers manage to function and conceal the emotional distress they are experiencing. They occasionally express distress through anger, resistance or defiance. There is an occasional tendency to consider these behaviors as typical of adolescence and that nothing can be done about them. That’s not true. Expressing interest in a warm and loving way, without judgment and an open and enabling conversation about feelings and thoughts will, in most cases, cause your teen to honestly share what they are going through. It frequently turns out that underneath the concealment, resistance and anger is a strong desire for attention, for someone to see them, talk, listen and understand.

A question that can save a life

It may not be easy to ask your teen if they are having any suicidal intentions, but you must talk and you must ask. In many cases, just asking can save lives. In most cases, a direct question will open the doors to a candid conversation that will alleviate the situation and facilitate help.

You can, for example, ask “I noticed that you have withdrawn, are you thinking about harming yourself?” Or “I see that you are bothered by something, have you thought that it would be better if you died?” If you have any concern due to the myth that says that discussing the topic may ‘put thoughts into their head”, it is important that you know that this has been refuted by research. Studies show that when teens are directly asked about suicide, not only does it not raise the risk of suicide but does the opposite! A lower level of distress was found among teenagers who were asked about suicidal ideation.

It is important to talk, question and seek help

Because suicidal action is often impulsive, if you learn that your teenager is contemplating suicide, it is important to act immediately and without delay. It may be that due to certain behavioral characteristics, it seems to you that he will not be ready to talk, for example if he walks around nervously or locks himself in his room for hours. This is not necessarily the case. This unusual behavior is frequently an attempt to hide the distress and while he actually needs and wants someone to talk to him, listen to him and understand him.

It is possible that following the referral to the emergency room or the police, the professionals will determine that there is no immediate danger, but this does not mean that there is no need for further supervision and treatment, and it will still be important to continue to help your child and find out the predicament they are facing.

Mandatory reporting

If a person discloses to you their intent to commit suicide, you must report. The reporting may cause you some discomfort, particularly if the person who disclosed this to you trusts you and may have asked to not reveal his intentions. But against these you have a responsibility. It is important to know that the act of reporting is occasionally considered a betrayal of trust by the person but after some time passes and after his life was saved, he appreciates the act and forgives it.

Help for parents of suicidal teens

When discussing suicide, the assistants may also need help. It is possible that as you are reading these lines, you identify feelings of shame and even a desire to hide the subject. Suicidal thoughts and even behaviors are common among adolescents, and many parents in your environment encounter suicide in their children. You will have to find a way to deal with these feelings and above all, focus on the urgent task at hand- to save the lives of the teenagers, to find them help. It is recommended that you not be left alone with these feelings: share them with another person, a professional: a psychologist, an educational consultant or call one of the mental health hotlines.

Written in conjunction with the National Suicide Prevention Program. Written with the assistance of Dr. Shira Barzilai, Clinical Psychologist, Senior Lecturer in Community Mental Health, Haifa University, and Nadav Horovitz, Clinical Psychologist.