Dear Dr. Wes and Julia: How can I tell if my teen is thinking about suicide?

Julia: If you’re looking for signs as a precautionary measure, know the basics: radical change in behavior, which includes sleeping, eating and general disposition; drug and alcohol use; and withdrawal from usual friends and activities. If you’re worried that your teen is planning to commit suicide soon, look for verbal hints such as, “I’m not going to be here much longer”; giving away possessions; and dramatic mood swings, such as becoming calm and happy after being depressed. These are signs listed by the American Academy of Child & Adolescent Psychiatry.

I’d say that everyone thinks about suicide at least once in his or her life. For some, it’s a fantasy way out or a means to enact revenge. Most of these thoughts are sudden, fleeting and have no consequence. The people who think or fantasize about suicide and the people who follow through with their thoughts differ greatly in number and mindset. Adolescence is obviously an extreme set of years with all of the stresses that plague people who are simply trying to find themselves. It’s easy to dream of a way out when loneliness, hormones and school take their toll. It’s easy to confuse the fine line between the overly stressed, genuinely depressed person and one who has decided there is no other option than suicide.

To teens out there, remember that everyone goes through periods of feeling completely overwhelmed. Part of maturing is learning how much you need to do and how much you can get away with not doing. These times pass and, by going through them, you’ll learn what you are capable of. However, feeling genuinely hopeless and miserable is more than just stress, and you should consider seeing a doctor or therapist to determine if you could be depressed. If your thoughts begin to turn to suicide, by all means reach out. Someone cares and someone will listen, and it should not be up to you to decide your fate based upon the inaccurate reasoning that there are no other options or that no one cares.

To parents, know that “thinking about suicide” is sometimes only thinking, and give yourselves a pat on the back for being concerned enough to ask.

Dr. Wes: This question comes up almost every year, and every year I find it difficult to answer. Unfortunately, in the three years we’ve been doing this column, the rate of teen suicide has increased by 8 percent. While the number of successful suicides is still comparatively low in the 10- to 24-year-old age group, the current upward trend comes after 13 years of downward movement and is, thus, quite disturbing. Many believe this increase comes from a decrease in prescription drug rates after the FDA “black-boxed” antidepressants for teens. Others believe there has been a dramatic increase in life stress in that age group. There’s really no way to know because controlled research can’t be ethically performed.

What makes this a difficult question is the fact that any list of warning signs can miss individuals who do not show those particular symptoms, while many of the symptoms also apply to numerous other issues. Moreover, many teens have occasional thoughts of self-harm, and deciphering when to worry can be excruciatingly difficult. I typically use three lists drawn from the American Academy of Pediatrics. The first includes the most serious signs – but also the most obvious:

¢ Any history of previous suicide attempts or strong ideations.

¢ Inexplicable gift-giving or giving away valued possessions.

¢ Talk of suicide, even in a joking way.

The next list is more ambiguous. It’s most useful when you see several signs, when the teen is also exhibiting a symptom from the first list or she or he has undergone some of the stressors I’ll list later.

¢ Writing or drawing pictures about death. This almost belongs on the first list, but in today’s age of anime and video games, it can create a lot of “false positives.”

¢ 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.

¢ Difficulty getting along with others.

The final list comes from research on teens with known suicidal tendencies and needs to be interpreted carefully. If one or more of these conditions is present in your teen’s life and symptoms from the above list are emerging, you should raise your level of concern. These include:

¢ A history of violence in the family.

¢ Breakdown of the family unit (e.g., divorce, separation, etc.).

¢ High demands to perform and achieve in school, sports, etc.

¢ Substance abuse.

¢ Loss of a family member, romantic partner or other significant figure.

¢ School failure.

¢ Diagnosis of bipolar disorder.

¢ Close relatives or friends having committed suicide.

¢ Family alienation, the feeling that one’s family does not understand him/her – that parents have denied or ignored attempts to communicate feelings of unhappiness, frustration, or failure.

¢ Uncertainty about sexual orientation or having identified oneself as gay.

Beyond any list of symptoms, successful identification of suicidal feelings requires communication. This is the opposite of family alienation because it represents the necessary lifeline that helps teens share these thoughts and get help. I realize that for many families the teen years seem distant, but research is clear on the importance of family involvement in teen life. The key to understanding any issue, including self-harm, is having a solid, rational and meaningful conversation with your child – and making that a matter of routine, not something that comes at them from out of the blue when they turn 13.

Finally, kids often fear discussing suicidal feelings because they believe they will be locked up, ridiculed or unsupported. If you believe your child is at risk, I suggest hooking him or her up with a therapist who is used to dealing with these issues and seeing if that process can open the lines of communication for you and your child. It’s certainly an issue to take seriously.

Next week: The secret life of girls. A local theater production by some talented teenagers sparks Double Take to revisit the issue of bullying.

– Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Julia Davidson is a Bishop Seabury Academy junior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues (limited to 200 words) to doubletake@ljworld.com. All correspondence is strictly confidential.