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Dealing with Suicide

The incidence of suicide in children and adolescents has nearly tripled over the past twenty years. Some suicides are based on impulse, but most are planned and given much thought and long consideration. There is no single answer as to why a young person wishes to end his or her life, but research tends to point to such factors as family problems and pressures, loss of a loved one or important relationship, identity problems, availability of drugs and alcohol, high academic competition, and needs and goals that are not accessible. While it is difficult to say what type of child will attempt suicide because it is prevalent in all types of young people, the child who is isolated, aloof, and no trouble to anyone is more likely to attempt this than others. These children often need attention, but do not get it at home or school because their behavior does not demand it. They do not stand out and are easily overlooked. While it is difficult to provide personality characteristics of the child who will attempt suicide, there are many clues and signs that one can look for. The more symptoms the child shows, the higher the risk.

Danger Signs or Characteristics
The signs or characteristics that will help identify and prevent a possible suicide attempt can be divided into three general areas: verbal, behavioral/feelings, and situational.

Verbal characteristics
All statements revealing a desire to die should be taken seriously.

1. Direct communications:
   "I'm going to kill myself."
   "I want to die."
   "I want to be with Grandpa in Heaven."
   "I wish I were dead"
   "I'm going to shoot myself."

2. Indirect communications:
   "You won't have to worry about me much longer."
   "Everyone would be better off without me here."
   "I'm causing all the problems in the family."
   "I can't take the pressure much longer."
   "I'm a burden to my parents."
   "My friends don't need me. All I do is cause trouble."

Behavioral/feelings characteristics
Changes in behavior or personality and the emergence or presence of certain feelings and attitudes may indicate a suicidal personality.

1. Withdrawal. The child becomes more of a loner and isolates himself from others or activities. Socialization with his peers and verbal interaction with others decreases. He may appear deep in thought much of the time and unaware of others.

2. Depression, crying, unhappiness, and apathy, as well as feelings of hopelessness, helplessness, and uselessness.

3. Anxiety, confusion, agitation, moodiness, or other signs of disturbance.

4. A decline in academic performance.

5. An increase in sleeping or an inability to sleep.

6. An increase or a decrease in appetite.

7. Preoccupation with or questions about death, dying, religion, deceased relatives, Heaven, etc.

8. Making final arrangements or trying to "get [his] affairs in order." This may involve giving away treasured personal possessions (e.g., stereo, baseball glove, CD collection), paying back debts, doing favors for those he has mistreated, keeping a diary or excessive writing, organizing his belongings.

9. Recent involvement with drugs or alcohol.

10. Lack of optimism or hope about the future.

11. Neglect of appearance.

Situational characteristics
Certain situations or environmental conditions are common with children who attempt suicide.

1. Previous suicide attempts or threats.

2. A history of counseling, therapy, or psychiatric hospitalization.

3. Problems or chaos in the family. Disorganized home or breakdown of family structure (e.g., death, divorce, separation).

4. Pressure from the family to be successful. The teenager feels that he must be perfect to please his parents.

5. Dissatisfaction with the home situation, rules, or restrictions, and a feeling that things will not change because his parents' rules, behavior, reactions, and actions are etched in stone.

6. The feeling that the teenager's family does not understand, respect, or appreciate him. The adolescent's feelings of unhappiness, frustration, or failure are unacceptable to the parents. Parental rejection.

7. Physical fights with others and/or family members. Physical and assaultive behavior in family members.

8. Increased tension, pressure, competitiveness, and demands from school and/or peers. Failure in school.

9. Loss of a loved one or close, important relationship.

10. Adolescent identity problems. Transition from adolescence to adulthood.

11. Suicide plans that involve highly lethal or quick methods (e.g., gunshot, hanging, jumping off a bridge). Suicide plans are specific, with the details well worked out.

12. Recent suicide of a friend, relative, or admired person.

While it is difficult to identify a "suicide personality," the more of the above signs or characteristics the teenager shows, the higher the risk. Whether the suicide attempt is impulsive or well thought out, a lack of optimism, a sense of unhappiness, and a lack of hope about the future are usually present.

What to Do?
If a teenager is making verbal comments indicating a desire to die, that situation should get your attention and you should take his threat seriously. The first thing you should do is to identify the situation or circumstances when this feeling is expressed. Does it occur when the child does not get his way (e.g., when you do not buy him something he requests, or when you will not let him go to a dance or concert)? Does it occur after you punish him, or when making you feel guilty will be to his advantage? Is he trying to get a reaction out of you, or make you upset? Can you predict when you will hear him say this? Or does it occur in an unpredictable situation, such as watching TV, riding in the car, or in a conversation about school or his friends? How frequently does it occur and under what circumstances?

Some comments about suicide are manipulative and can be viewed and reacted to in a similar fashion: e.g., "I hate you," "You're mean," "I'm running away," or "I want to live at Grandma's." This would be especially true if the child has a manipulative personality. Have the child express his feelings and discuss them, but stay calm; do not allow the child to manipulate you.

Whether the expression concerning a desire to die is predictable or not, or is seen as manipulative or not, the next step is to look for possible danger signs or characteristics. If you can identify several of the above feelings, behavioral changes, or situations in your child, I would take the remark very seriously. The more frequently you hear the comments, the more seriously you should regard them. Talk to the child about his feelings and about suicide. Do not offer simple answers to serious problems or tell the child all of the reasons he should not feel the way he does. This may increase his feelings of guilt and make him feel more worthless and hopeless. Try to understand his feelings and have him generate other solutions to the problem(s). When in doubt or when you have unanswered questions, get in touch with a mental health professional who specializes in children and adolescents, so that he or she can provide you with assistance.