Most teens interviewed after making a suicide attempt say that they did it because they were trying to escape from a situation that seemed impossible to deal with or to get relief from really bad thoughts or feelings. Like Ethan, they didn’t want to die as much as they wanted to escape from what was going on. And at that particular moment dying seemed like the only way out.
Some people who end their lives or attempt suicide might be trying to escape feelings of rejection, hurt, or loss. Others might be angry, ashamed, or guilty about something. Some people may be worried about disappointing friends or family members. And some may feel unwanted, unloved, victimized, or like they’re a burden to others.
We all feel overwhelmed by difficult emotions or situations sometimes. But most people get through it or can put their problems in perspective and find a way to carry on with determination and hope. So why does one person try suicide when another person in the same tough situation does not? What makes some people more resilient (better able to deal with life’s setbacks and difficulties) than others? What makes a person unable to see another way out of a bad situation besides ending his or her life?
The answer to those questions lies in the fact that most people who commit suicide have depression.
Depression
Depression leads people to focus mostly on failures and disappointments, to emphasize the negative side of their situations, and to downplay their own capabilities or worth. Someone with severe depression is unable to see the possibility of a good outcome and may believe they will never be happy or things will never go right for them again.
Depression affects a person’s thoughts in such a way that the person doesn’t see when a problem can be overcome. It’s as if the depression puts a filter on the person’s thinking that distorts things. That’s why depressed people don’t realize that suicide is a permanent solution to a temporary problem in the same way that other people do. A teen with depression may feel like there’s no other way out of problems, no other escape from emotional pain, or no other way to communicate their desperate unhappiness.
Sometimes people who feel suicidal may not even realize they are depressed. They are unaware that it is the depression — not the situation — that’s influencing them to see things in a “there’s no way out,” “it will never get better,” “there’s nothing I can do” kind of way.
When depression lifts because a person gets the proper therapy or treatment, the distorted thinking is cleared. The person can find pleasure, energy, and hope again. But while someone is seriously depressed, suicidal thinking is a real concern.
People with a condition called bipolar disorder are also more at risk for suicide because their condition can cause them to go through times when they are extremely depressed as well as times when they have abnormally high or frantic energy (called mania or manic). Both of these extreme phases of bipolar disorder affect and distort a person’s mood, outlook, and judgment. For people with this condition, it can be a challenge to keep problems in perspective and act with good judgment.
Substance Abuse
Teens with alcohol and drug problems are also more at risk for suicidal thinking and behavior. Alcohol and some drugs have depressive effects on the brain. Misuse of these substances can bring on serious depression. That’s especially true for some teens who already have a tendency to depression because of their biology, family history, or other life stressors.
The problem can be made worse because many people who are depressed turn to alcohol or drugs as an escape. But they may not realize that the depressive effects alcohol and drugs have on the brain can actually intensify depression in the long run.
In addition to their depressive effects, alcohol and drugs alter a person's judgment. They interfere with the ability to assess risk, make good choices, and think of solutions to problems. Many suicide attempts occur when a person is under the influence of alcohol or drugs.
This doesn’t mean that everyone who is depressed or who has an alcohol or drug problem will try to kill themselves, of course. But these conditions — especially both together — increase a person’s risk for suicide.
Suicide Is Not Always Planned
Sometimes a depressed person plans a suicide in advance. Many times, though, suicide attempts happen impulsively, in a moment of feeling desperately upset. A situation like a breakup, a big fight with a parent, an unintended pregnancy, being outed by someone else, or being victimized in any way can cause someone to feel desperately upset. Often, a situation like this, on top of an existing depression, acts like the final straw.
Some people who attempt suicide mean to die and some don't. For some, a suicide attempt is a way to express deep emotional pain. They can’t say how they feel, so, for them, attempting suicide feels like the only way to get their message across. Sadly, even when a suicide attempt is a cry for help and the person doesn’t mean to die, there’s no way to control it. Many people who really didn’t mean to kill themselves end up dead or critically ill.
Warning Signs
There are often signs that someone may be thinking about or planning a suicide attempt. Here are some of them:
- talking about suicide or death in general
- talking about "going away"
- referring to things they "won’t be needing," and giving away possessions
- talking about feeling hopeless or feeling guilty
- pulling away from friends or family and losing the desire to go out
- having no desire to take part in favorite things or activities
- having trouble concentrating or thinking clearly
- experiencing changes in eating or sleeping habits
- engaging in self-destructive behavior (drinking alcohol, taking drugs, or cutting, for example)
What if This Is You?
If you have been thinking about suicide, get help right away. Depression is powerful. You can’t wait and hope that your mood might improve. When a person has been feeling down for a long time, it's hard to step back and be objective.
Talk to someone you trust as soon as you can. If you can’t talk to a parent, talk to a coach, a relative, a school counselor, a religious leader, or a teacher. Call a suicide crisis line (such as 1-800-SUICIDE or 1-800-999-9999) or your local emergency number (911). These toll-free lines are staffed 24 hours a day, 7 days a week by trained professionals who can help you without ever knowing your name or seeing your face. All calls are confidential — no one you know will find out that you've called. They are there to help you figure out how to work through tough situations.
What if It’s Someone You Know?
It is always a good thing to start a conversation with someone you think may be considering suicide. It allows you to get help for the person, and just talking about it may help the person to feel less alone and more cared about and understood.
Talking things through may also give the person an opportunity to consider other solutions to problems. Most of the time, people who are considering suicide are willing to talk if someone asks them out of concern and care. Because people who are depressed are not as able to see answers as well as others, it can help to have someone work with them in coming up with at least one other way out of a bad situation.
Even if a friend or classmate swears you to secrecy, you must get help as soon as possible — your friend's life could depend on it. Someone who is seriously thinking about suicide may have sunk so deeply into an emotional hole that the person could be unable to recognize that he or she needs help. Tell an adult you trust as soon as possible.
If necessary, you can also call the toll-free number for a suicide crisis line or a local emergency number (911). You can find local suicide crisis or hotline numbers listed in your phone book or check out the ones listed in the resources tab. These are confidential resources and the people at any of these places are happy to talk to you to help you figure out what is best to do.
Sometimes, teens who make a suicide attempt — or who die as a result of suicide — seem to give no clue beforehand. This can leave loved ones feeling not only grief stricken but guilty and wondering if they missed something. It is important for family members and friends of those who die by suicide to know that sometimes there is no warning and they should not blame themselves.
When someone dies by suicide the people who knew them can be left with a terrible emotional pain. Teens who have had a recent loss or crisis or who had a family member or classmate who committed suicide may be especially vulnerable to suicidal thinking and behavior themselves. If you’ve been close to someone who has attempted or committed suicide, it can help to talk with a therapist or counselor — someone who is trained in dealing with this complex issue. Or, you could join a group for survivors where you can share your feelings and get the support of people who have been in the same situation as you.
Coping With Problems
Being a teen is not easy. There are many new social, academic, and personal pressures. And for teens who have additional problems to deal with, such as living in violent or abusive environments, life can feel even more difficult.
Some teens worry about sexuality and relationships, wondering if their feelings and attractions are normal, or if they will be loved and accepted. Others struggle with body image and eating problems; trying to reach an impossible ideal leaves them feeling bad about themselves. Some teens have learning problems or attention problems that make it hard for them to succeed in school. They may feel disappointed in themselves or feel they are a disappointment to others.
These problems can be difficult and draining — and can lead to depression if they go on too long without relief or support. We all struggle with painful problems and events at times. How do people get through it without becoming depressed? Part of it is staying connected to family, friends, school, faith, and other support networks. People are better able to deal with tough circumstances when they have at least one person who believes in them, wants the best for them, and in whom they can confide. People also cope better when they keep in mind that most problems are temporary and can be overcome.
When struggling with problems, it helps to:
- Tell someone you trust what’s going on with you.
- Be around people who are caring and positive.
- Ask someone to help you figure out what to do about a problem you’re facing.
- Work with a therapist or counselor if problems are getting you down and depressed — or if you don't have a strong support network, or feel you can’t cope.
Counselors and therapists can provide emotional support and can help teens build their own coping skills for dealing with problems. It can also help to join a support network for people who are going through the same problems — for example, anorexia and body image issues, living with an alcoholic family member, or sexuality and sexual health concerns. These groups can help provide a caring environment where you can talk through problems with people who share your concerns. Check out your phone book to find local support groups, or ask a school counselor or a youth group leader to help you find what you need.
Reviewed by: Matthew K. Nock, PhD
Date reviewed: March 2006
Child and Adolescent Mental Health
Teen Suicide
What is suicidal behavior?
Suicidal behavior is defined as a preoccupation or act that is focused on causing one's own death voluntarily. An intent to cause one's death is essential in the definition. Suicidal ideation refers to thoughts of suicide or wanting to take one's own life. Suicidal behavior refers to actions taken by one who is considering or preparing to cause his/her own death. Suicide attempt usually refers to an act focused on causing one's own death that is unsuccessful in causing death. Suicide refers to having intentionally caused one's own death.
What causes adolescents to attempt suicide?
Adolescence is a stressful developmental period filled with major changes - body changes, changes in thoughts, and changes in feelings. Strong feelings of stress, confusion, fear, and uncertainty, as well as pressure to succeed, and the ability to think about things in new ways influence a teenager's problem solving and decision making abilities.
For some teenagers, normal developmental changes, when compounded by other events or changes in their families such as divorce or moving to a new community, changes in friendships, difficulties in school, or other losses can be very upsetting and can become overwhelming. Problems may appear too difficult or embarrassing to overcome. For some, suicide may seem like a solution.
As many as 12 to 25 percent of older children and adolescents experience some form of thoughts about suicide (suicidal ideation) at one time or another. When feelings or thoughts become more persistent, are accompanied by changes in behavior or specific plans for suicide, the risk of a suicide attempt increases.
What is known about teen suicide?
Suicide is the third leading cause of death in 15 to 24 year olds. According to the National Institute of Mental Health (NIMH), reliable scientific research has found the following:
- There are as many as eight to 25 attempted suicides to one completed suicide - with the ratio even higher in youth.
- The strongest risk factors for attempted suicide in youth are depression, substance abuse, and aggressive or disruptive behaviors.
The Centers for Disease Control and Prevention (CDC) reports the following:
- Males are four times more likely to die from suicide than females.
- Females are more likely to attempt suicide than males.
- Firearms are used in over half of youth suicides.
What are the risk factors for suicide?
Suicide risk factors vary with age, gender, and cultural and social influences and may change over time. Risk factors for suicide frequently occur in combination with each other. The following are some suicide risk factors that may be present:
- one or more diagnosable mental or substance abuse disorders
- impulsive behaviors
- undesirable life events or recent losses (i.e., death, parental divorce)
- family history of mental or substance abuse disorder
- family history of suicide
- family violence, including physical, sexual, or verbal/emotional abuse
- prior suicide attempt
- firearm in the home
- incarceration
- exposure to the suicidal behavior of others, including family, peers, in the news, or in fiction stories
Warning signs of suicidal feelings, thoughts, or behavior:
Many of the warning signs of possible suicidal feelings are also symptoms of depression. Observations of the following behaviors by parents and care givers may be helpful in identifying adolescents who may be at risk of attempting suicide:
- changes in eating and sleep habits
- loss of interest in usual activities
- withdrawal from friends and family members
- acting out behaviors and running away
- alcohol and drug use
- neglect of personal appearance
- unnecessary risk-taking
- preoccupation with death and dying
- increased physical complaints frequently associated with emotional distress such as stomach aches, headaches, and fatigue
- loss of interest in school or schoolwork
- feelings of boredom
- difficulty concentrating
- feelings of wanting to die
- lack of response to praise
- indicates plans or efforts toward plans to commit suicide, including the following:
- verbalizes "I want to kill myself," or "I'm going to commit suicide."
- gives verbal hints such as "I won't be a problem much longer," or "If anything happens to me, I want you to know ...."
- gives away favorite possessions; throws away important belongings
- becomes suddenly cheerful after a period of depression
- may express bizarre thoughts
- writes one or more suicide notes
Threats of suicide communicate desperation and a cry for help. Always take statements of suicidal feelings, thoughts, behaviors, or plans very seriously. Any child or adolescent who expresses thoughts of suicide should be evaluated immediately.
The warning signs of suicidal feelings, thoughts, or behaviors may resemble other medical conditions or psychiatric problems. Always consult your child's physician for a diagnosis.
Treatment for suicidal feelings and behaviors:
Specific treatment for suicidal feelings and behaviors will be determined by your child's physician based on:
- your teen's age, overall health, and medical history
- extent of your teen's symptoms
- seriousness of the attempt
- your teen's tolerance for specific medications or therapies
- expectations regarding future suicide risk
- your opinion or preference
Any adolescent who has attempted suicide requires an initial physical evaluation and treatment until he/she is physically stable. Mental health treatment for suicidal feelings, thoughts, or behaviors begins with detailed evaluation of events in the adolescent's life during the two to three days preceding the suicidal behaviors. A comprehensive evaluation of the adolescent and family contributes to decisions regarding treatment needs. Treatment recommendations may include individual therapy for the adolescent, family therapy, and, when necessary, hospitalization to provide the adolescent a supervised and safe environment. Parents play a vital supportive role in any treatment process.
Prevention of suicide:
Recognition and early intervention of mental and substance abuse disorders is the most effective way to prevent suicide and suicidal behavior. Studies have shown that suicide prevention programs most likely to succeed are those focused on identification and treatment of mental illness and substance abuse, coping with stress, and controlling aggressive behaviors.
According to the American Foundation for Suicide Prevention (AFSP), it is important to learn the warning signs of teenage suicide in order to prevent an attempt. Maintaining open communication with your teenager and their friends provides an opportunity for helping as needed. If a teen is talking about suicide, he or she must receive an immediate evaluation.
- Warning signs for teen depression:
- feelings of sadness or hopelessness
- declining school performance
- loss of pleasure/interest in social and sports activities
- sleeping too little or too much
- changes in weight or appetite
- nervousness, agitation or irritability
- substance abuse