Most of us would rather not think, let alone talk, about youth suicide. Yet the reality is that along with the rise in mental health issues among young people, there’s an accompanying increase in all forms of suicidality: suicidal thoughts, making suicide plans, and attempts to take one’s own life. That means no matter how difficult it is, talking about youth suicide is imperative. September is Suicide Prevention Awareness Month, and as a new school year gets underway, now is the time to ensure this topic is on everyone’s radar.

How prevalent is suicide among America’s kids? Suicide is now the second leading cause of death among teenagers (led only by road accidents). The suicide rate in teens has been on the rise for roughly the last fifteen years. A report issued in 2020 noted that the suicide rate among young people between the ages of 10 and 24 remained stable between 2000 and 2007 but then increased by 57.4% between 2007 and 2018.

The pandemic only exacerbated these trends. In a 2021 survey conducted by the CDC, 22% of high school students reported that they had seriously considered killing themselves within the past year. That number was up from 16% in 2011. Eighteen percent said that they had made a suicide plan, and 10% said they had attempted suicide at least once. The increases were evident across all demographic groups, but some have seen sharper rises than others. The rise has been higher in girls than in boys. Black and LGBTQ kids have also fared worse.

Why the Increase in Suicide Ideation and Suicidality?

Most experts agree that the underlying causes of this increased suicidality aren’t well understood, and there are likely a number of factors affecting different populations and individuals. One exception, however, is the pandemic, which has had a clear and observable impact on mental health and wellbeing among people of all ages. It’s now well understood that the disruptions, isolation, and other hardships that arose during the pandemic led to surges in depression, anxiety, and suicidality among children and teens.

But because the numbers were rising before the pandemic, it’s apparent that other factors are also at work. Many experts agree technology likely plays some role, though just how much remains unclear. Yet as the psychologist and researcher Jean Twenge has noted, the increase in youth mental health issues, including suicidality, has occurred in tandem with the rise in smart phone use, so there’s clearly a correlation. One of her research findings is that among teens, the heaviest users of social media (more than five hours a day) are twice as likely to be depressed as those who spend a day or less online.

Technology has also given rise to new forms of bullying. Bullying of course has been around forever, but the way it’s carried out has changed in the internet age. While physical bullying and intimidation still occur, cyberbullying can be relentless, far-reaching, and can give rise to extreme distress. One study found that physical bullying had comparatively little association with mental distress but that “identity bullying” — behavior that targeted sexual orientation or gender identity — was much more likely to lead to feelings of sadness or hopelessness and suicide attempts. Cyberbullying and social bullying — excluding someone or turning peers against them — was also associated with great distress and suicidal feelings.

Importantly, research has shown that the bullies themselves are also at risk for depression and suicidal thinking and behavior. And one study found that young people who were both bullies and bullied — “bully-victims” — are more at risk than either bullies or victims alone. So, does bullying cause suicide? As a report by the CDC emphasizes, we know that bullying and suicide are closely related, but we can’t say with certainty that bullying directly causes suicide-related behavior. And while the association is clear, most young people who are involved in bullying don’t engage in suicidal behavior.

Who’s at Risk?

The majority of young people who attempt suicide are dealing with significant mental health challenges, depression in particular. In addition to depression, other risk factors include:

• A family history of suicide attempts
• Exposure to violence
• Impulsivity
• Aggressive or disruptive behavior
• Bullying or being bullied
• Feelings of hopelessness or helplessness
• Acute loss or rejection
• Access to firearms

Because suicide is often an impulsive act, having access to a means, such as pills or a firearm, can make suicide more likely. About 40% of children’s suicides involve guns, and suicide rates among young people who live in homes with guns are four times higher than among those in homes without them. Other factors contributing to suicidal behavior include social and academic pressures and a history of abuse and neglect.

As the research on bullying suggests, LGBTQ youth are at an especially high risk for depression and suicidality. The American Association of Suicidality notes that being LGBTQ is not itself a risk factor, but the stressors that LGBTQ youth experience — such as discrimination and harassment — are directly associated with suicidal behavior.

Though the reasons aren’t entirely understood, Black kids are also increasingly vulnerable. The suicide rate among Blacks has historically been lower than for whites, but death by suicide has been rising among Blacks, primarily among young people. And according to the 2021 CDC report, girls continue to be at higher risk for suicidal thoughts and behaviors than boys: “Three in 10 females (30%) said that they seriously considered attempting suicide in the past year, and nearly a quarter (24%) had made a suicide plan. This represents a 60% increase in both measures over the past decade. During the same period, suicide attempts by female students increased by 30%.”

Crisis Intervention: How to Recognize Someone Who May Be Suicidal

A young person thinking about suicide will often exhibit subtle, or not so subtle, signs and behaviors, so it’s important to know what to listen and look for. Suicidal youth may make openly suicidal comments such as, “I wish I was dead,” or “I don’t want to be here anymore.” Statements like these are meaningful indicators that should be taken at face value. But there are also other less direct warning signs to watch for:

• Frequent or pervasive sadness
• Changes in eating or sleeping habits
• Withdrawal from friends, family, and regular activities
• Increased use of alcohol or drugs
• Giving away prized possessions
• Statements such as “I won’t be a problem much longer,” or “If anything happens to me, I want you to know . . .”
• A drop in grades or school performance
• Comments about feeling hopeless, trapped, or being a burden to others
• Talking about suicide or wanting to die

These behaviors don’t necessarily mean a young person is thinking about ending their life. But paying close attention and investigating when there’s concern could make all the difference.

What Can We Do? Suicide Prevention That Works

Suicide is preventable. As noted above, young people thinking about suicide frequently show warning signs through their words and actions, which is why knowing what to watch for is so important. Below are interventions that we know are effective.

Ask. If parents, educators, health care professionals, or others in a child’s life suspect that a young person might be considering suicide, the best thing to do is ask: Are you thinking about killing yourself? Asking this question directly may seem counterintuitive. Many people report they’re afraid to raise the topic of suicide for fear it will make the young person more inclined to harm themselves or that it will put the idea in their head when it wasn’t there before. But research makes clear that this isn’t the case. In reality, asking demonstrates your care and concern, and these can be lifelines to a young person who’s depressed and who may feel their life doesn’t matter or that no one truly cares about them.

If a young person says they are thinking about harming themselves or feel consistently sad or hopeless, ask if they have a suicide plan and the means to carry it out. If they are actively suicidal, it’s important they get help immediately. If they have a therapist or psychiatrist, call them. If they don’t have a therapist, take the youth to the hospital for an evaluation.

Targeted Mental Health Screenings. Universal mental health screenings in schools and at routine preventive medical visits can identify students who may be at risk for suicidal behavior. In fact, brief mental health screenings that specifically ask about self-harming can effectively identify students who might otherwise fall through the cracks and who might not raise red flags on other tests for depression. A study conducted by researchers at Penn State College of Medicine found that by administering a simple nine-question screening tool, they were able to identify high school students who were at risk for suicidal behavior. Eight of the questions were part of a standard mental health questionnaire, but the ninth question specifically addressed suicidal ideation, asking: “How often have you been bothered by thoughts that you would be better off dead, or of hurting yourself in some way?”

In the Penn State study, half the students were asked this question, and the other half were not. The students who were asked about harming themselves were seven times more likely to be identified as being at risk for suicide. And, importantly, they were more likely to receive treatment. It turns out that even kids who don’t come out and say, “I need help,” can share what they’re feeling when they’re given the chance.

Peer Support. Teens can support their friends by asking questions, giving them the space to talk, and listening nonjudgmentally. If the person confesses that they’re thinking about harming themselves, peers should encourage them to reach out for help. The friend might stay with the person while they call their therapist or the Suicide & Crisis Lifeline at 988. Teens might feel they should keep a friend’s suicidality secret. But it’s important that teen let the person know this is not something they can keep secret, and they should share the information with a trusted adult.

What Can Schools and Districts Do to Enhance Suicide Prevention Efforts?

Schools can play a part in suicide prevention in teens. A first step is to strengthen the Tier 1 capacity within the Multi-Tiered Systems of Support (MTSS) framework. This might include building or expanding universal screening activities, making sure your screening tool includes a question about self- harm. It’s critical to have steps and personnel in place to intervene effectively when students need a higher level of care.

Other important steps include offering professional development to ensure staff have the skills to talk to students about suicide. Offering workshops for parents can help parents and caregivers build the skills and confidence to identify vulnerable youth and assist in seeking help. And more generally, schools can create a healthy, supportive culture that puts academic achievements into proper perspective, promoting a balanced approach to growth and education.

The National Suicide Prevention Lifeline is 988. More information can be found on the website for the American Foundation for Suicide Prevention.

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