Suicide Prevention Includes Talking About Suicide
Adolescence is too frequently described in popular culture as a period of intense suffering and psychopathology. Think of some of the most popular coming-of-age films that Generation X parents loved as teens (The Breakfast Club, Heathers) and the films that our own teens love (Mean Girls, Thirteen, Little Miss Sunshine). Constant bombardment with movies, television shows, books and music that depict teens as angry and depressed can cause caring adults to misinterpret real symptoms of depression as just a passing phase.
When I teach medical students, I remind them that 80% of teens show no evidence of emotional or behavioral disturbances throughout the course of their development, so the 20% need to be taken seriously. Doctors need to look for the signs and treat them, instead of taking the “wait and see” approach of previous generations. In reality, 2% to 3% of teens meet the symptom criteria for depression and 18% of teens report at least one two-week period when they were clinically depressed.
About Teen Depression: How it Looks and Feels.
What does depression look like in a teen? In many cases, depressed teens may appear profoundly sad, like adults with depression. They may be irritable, crabby or explosive. The psychological symptoms of depression in adolescents include feeling inadequate, guilty, empty or bored; not feeling excited by anything; feeling hopeless or helpless; and most alarmingly, feeling suicidal. Suicide is the third-leading cause of death among adolescents, behind accidents and homicides, making the identification and treatment of teenage depression a significant public health concern.
The brain illness that we call “major depression” also exhibits physical symptoms including:
- sleep problems (too much or too little)
- appetite changes (too much or too little)
- lack of energy
- decreased ability to concentrate
- headaches or stomachaches not accounted for by other illness
Teens with depression are also at higher risk than their peers for problems like substance use (especially alcohol and marijuana), school failure, unplanned pregnancy and legal intervention.
Medical Findings and Treatments.
For too long, families have been ashamed or embarrassed to bring a teen with depression for professional treatment, erroneously thinking that such symptoms are a sign of weakness or poor parenting. Only recently has medical research begun to demonstrate that major depression is a medical illness like any other. Like asthma or high blood pressure, depression can be inherited and exacerbated by life stressors, but it is treatable.
The most important study to date demonstrating the benefits of treatments for teen depression was designed by the National Institutes of Mental Health, and titled the Treatment of Adolescent Depression Study (TADS). In the TADS protocol, teens with depression were randomly assigned to either:
(1) talk therapy,
(2) treatment with fluoxetine medication (Prozac),
(3) talk therapy combined with fluoxetine or,
(4) placebo treatment groups.
The best outcomes—defined as the fastest and most complete recoveries—appeared in the talk therapy combined with fluoxetine group. This landmark study has given thousands of doctors new tools for the safe and effective treatment of youths with depression, and it has helped save an untold number of lives through early identification, treatment and recovery. Across the country, researchers are working to improve talk therapies, medicines and methods of depression prevention in high-risk teens. Every day, thousands of teens benefit from these efforts, which is exactly why good research benefits all of us.
How To Discuss Suicide: Start the Conversation
Beginning a discussion about teen depression and suicide can be difficult. Moreover, not every parent will approach the conversation in the same manner. Two different expert sources suggest different approaches.
Pat Lyden of Suicide Prevention Education Alliance of Northeast Ohio suggests that parents ask the question directly. If your child seems hopeless or depressed, ask the suicide question, Are you having thoughts of suicide? You will not be putting ideas in their head.
If the answer is no, they may still need treatment for depressive illness or bipolar disorder.
The Youth Suicide Prevention Program of Washington State offers some opening lines that may effectively engage your teen in a dialogue about teens and suicide.
- Comment on their behavior without judgment: “I’ve noticed that you have been looking sad for several days.”
- Invite your teen to talk about their feelings: “Tell me what’s going on.”
- Allow your child to do most of the talking.
- Avoid unkind words: “You get everything you want; what do you have to be depressed about.”
- Ask one question at a time and wait for the answer; be comfortable with silence.
- Offer reassurance. “I’m on your side. we’ll get through this together.”
- Inform your teen about resources in the community, i.e. the school nurse, school counselor, teacher, the family doctor, or a church group leader.
- Develop a plan of action. What does your child agree to do? What are you committed to doing? When will the two of you talk again? Do you need to seek professional help?
- Communicate love and acceptance of your teen’s feelings and acknowledge the courage that it takes to talk about hard things. Share your willingness to talk again.
Where to Seek Help
If you suspect a teen you know is depressed, there are many ways you can help. The best point person to assess evaluation and treatment for a depressed adolescent is the primary physician, whether pediatrician or general practitioner. However, if you are concerned about safety, especially suicidal threats, suicidal talk, or any other concerning behavior, call 911 or your local suicide prevention hotline, or go to the nearest emergency room. In Cuyahoga County Ohio, the Child Mobile Crisis Team is available 24 hours a day, 7 days a week, at (216) 623-6888. The National Suicide Prevention Lifeline is 1-800-273-TALK (8255)
Cleveland’s Case University Hospitals Medical Center is proud to support such research through the Discovery and Wellness Center for Children, which can be reached at (216) 844-3922 or by visiting www.case.edu/med/psychiatry.