Wes: Several readers asked us to elaborate on warning signs of teen suicide. I must warn that any such list carries two caveats. First, lists can miss individuals who do not show the signs but still harbor suicidal tendencies. Second, most of these items also apply to other issues besides suicide. For this reason, I use two lists drawn from the American Academy of Pediatrics. Clinically, I find the following three indicators to be strong and fairly unambiguous. If any one is present, friends, parents and others should be concerned.

¢ Having a history of previous suicide attempts or strong ideations. As we discussed before, once the door is open it’s easier to walk through again.

¢ Unusual gift-giving or giving away valued possessions.

¢ Talk of suicide, even in a joking way.

The next set of items is more ambiguous. For instance, there are at least 20 reasons for poor schoolwork or rebellious behavior. I find these items useful only when they come in clusters, when the teen is exhibiting a behavior from the first list, or has undergone stressors like family violence or substance abuse.

¢ Writing or drawing pictures about death. This one almost belongs on the first list, but in today’s age of anime and video games, it has become harder to interpret.

¢ Diminished quality in schoolwork. Withdrawal from friends and family members. Running away from home. Appearing bored or distracted. Rebellious behaviors or problems with the law. Changes in eating habits. Dramatic personality changes. Changes in appearance (for the worse). Sleep disturbances. Also difficulty getting along with others.

On a final note, seeking help for suicidal thoughts or behaviors can be scary for teens. Most fear that if they’re discovered, someone will pop them in a hospital as quick as a wink. For most teens that thought is more stressful than anything I’ve listed above. This confounds attempts to get kids to talk about these feelings openly. It may be reassuring to know that the days of hospitalizing all but the most acute cases has passed. In fact, the entire mental health system is set up to avoid hospitalization while maintaining safety through outpatient services and family focused therapy. In short, it’s absolutely better to get these thoughts out on the table and get help rather than keeping them to yourself.

John: Suicide is the third-largest killer of persons ages 15 to 19, but it is not as common as the public assumes. In 2003, the teen suicide rate was 7.3 per 100,000, while accidents claim almost three times as many lives. Suicide gains its notoriety from being a particularly gruesome way to die, and while every suicide is a tragedy, it is important to keep in mind the big picture.

Suicide strikes like lightning, and at times without a reliable warning sign preceding it. Although four out of five persons give warnings before attempting suicide, these are usually recognized only in hindsight. There are certain demographics more likely to commit suicide, for instance: victims of rape or teens who live in poverty. But even among these groups, weeding out the potential suicides from the rest of the population is a strenuous task, since most teens in similar circumstances don’t commit suicide.

The bottom line may sound corny, but there is medical research to back it up: the best thing an individual can do to prevent suicide is to be a friend to those who need friends most. There are numerous accounts of persons who planned to commit suicide, but they changed their minds after finding a concerned friend.

– Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. John Murray is a Free State High School senior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues to doubletake@ljworld.com. All correspondence is strictly confidential.