Talking about the tough stuff: Suicide ideation and teens

It was trending on social media and is one of the top-streamed show in the history of Netflix. It’s likely your teen has seen or at least mentioned discussions of the show “13 Reasons Why.” The show portrays an adolescent female’s experience of bullying, harassment, lack of social support and hopelessness that ends in her decision to take her own life. Although the show has received both praise and criticism, there is no denying it has brought the topic of teen suicide into public focus and left many parents wondering, “Should my teen be watching this?”

Understandably, for many parents, the word “suicide” is fraught with anxiety and fear, which can often lead to avoidance of this topic with their teen. However, having open communication is paramount, as suicide is the third-leading cause of death among adolescents ages 15-24. Further, data from a large national survey (YRBS) completed by the Centers for Disease Control and Prevention (CDC), revealed that within the last 12 months, of the adolescents surveyed in grades 9-12: 

  • 17.7 percent reported seriously considering attempting suicide 
  • 14.6 percent noted making a plan of how they could end their life
  • 8.6 percent attempted suicide
  • 2.8 percent attempted suicide that resulted in an injury requiring treatment 

While these numbers are staggering, they highlight just how common thoughts of suicide are and further stress the importance of understanding how to support teens. Some ways to reduce risk include: Allowing for open conversations regarding these thoughts, and increasing access to treatment.  

Trying to answer the question, “Should my teen be watching this?” is complicated and depends on a few factors. There is evidence in the research to suggest that presentations of suicide on TV or in the media can result in cases of “copycat suicides.” It is important to remember these messages can have a powerful impact on the viewer. However, this doesn’t necessarily mean you need to censor your child from viewing shows that may cover this topic. Regardless of your choice to watch this show or shows like it, perhaps what is most important is the personal conversation you have about the topic. Parents and teens would benefit from having open discussions about suicide (and if your child has viewed emotional, triggering content, a conversation will help them make sense of the material and help your child know they have support). Some conversation starters might be:

  • What are your thoughts about that show?
  • Has there ever been a time you felt like that?
  • Has a friend ever told you they had thoughts like this? 
  • Have you ever felt so bad you wanted to disappear? 
  • What keeps you going when things get really hard?
  • You can always talk to me. And if that is too difficult, is there someone you could talk to if you are having a hard time?   

Having said this, there are situations where it might be best to screen content for your teen. One reason you might censor content is if your child is at risk (i.e. feeling depressed, talking about suicide, getting bullied, expressing thoughts of worthlessness, etc.) If your child is at risk, it might be the best idea to reduce exposure to triggering content, at least until risk is reduced and professional support is in place. 

No matter what you and your family decide about viewing shows that cover topics such as suicide, talking together opens lines of communication and can even reduce risk. Having these conversations, in person, with supportive, caring adults is important. There is significant stigma and fear surrounding sharing thoughts of suicide, but research indicates a lessening of the burden and increase in one’s mental health following the open discussion of difficult, personal topics (Frey, Hans, Cerel, 2016; Clement et al., 2015). These conversations help a teen feel understood and build a bridge for healing, communication and coping.

As hard as it may be, don’t be afraid to start this conversation with your teen as an adult who deeply cares for them. Your teen may be experiencing depression, anxiety, fear, suicidal thoughts and pain even if, on the “outside,” your teen seems fine. Sometimes suicidal thoughts can feel too painful to share. Perhaps hidden by a smile that serves to ease the concern of caregivers and friends and cover the pain. Teens may be aware that parents or friends will worry they are over-burdening loved ones and therefore might stay quiet about these feelings. This can create further isolation, silence and increased risk. Teens may have good friends, leadership positions and supportive family members, yet still be thinking about suicide or feeling hopeless, even worthless. A tough exterior with the intent to protect loved ones can disguise the true conflict within, but a listening ear from a caring adult may be enough to begin these conversations, ease the pain and save a life. 

Warning signs someone may be thinking about suicide need to be taken seriously. Signs can include:

  • Substance abuse
  • Sadness and hopelessness (Resource: Teen Depression Blog)
  • Expressed suicidal thoughts or actions
  • Previous suicide attempts
  • Direct statements, such as: “I’ve decided to kill myself,” or “I’m going to end it all.”
  • Indirect statements, such as: “I’m tired of life, I just can’t go on,” or “My family would be better off without me,” or “Who cares if I’m dead anyway.” 
  • Even if the teen sounds sarcastic or joking – it is important to take these statements seriously and check in with your teen.

What can you do if your teen is talking to you about suicide?

  • Ask directly if he or she is considering suicide
  • Be willing to listen with care and concern
  • Offer hope that alternatives are available
  • Take action to ensure his or her safety:
    • This might mean getting help from persons or agencies specializing in crisis intervention and suicide prevention:
    • Mental Health Authority of Harris County: 1-866-970-4770 
    • Teenline: 713-529-8336 
    • National Suicide Prevention Line: 1-800-273-8255 
      • For hearing impaired, contact Lifeline: 1-800-799-4889 
  • Visit a website for more information and support 
  • If your child is expressing a suicidal plan you should go to your local ER or call 911. 

Please consider creating an open space with your teen to have the conversation – even if it is hard. Sharing an ear, shoulder, hug, smile or simple moment of connection today may be the beginning of the support your teen needs. Even if your teen is not thinking about suicide, a friend of theirs may be, or they may just be worried about the topic in general. Knowing the pathways to get help opens the door to healing. Talking about tough topics and offering support opens the lines of communication, reduces risk and can lead to getting the professional help your child may need. 

Citations: 

  • Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ... & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological medicine, 45(1), 11-27.
  • Frey, L. M., Hans, J. D., & Cerel, J. (2016). Suicide disclosure in suicide attempt survivors: Does family reaction moderate or mediate disclosure's effect on depression?. Suicide and Life-Threatening Behavior, 46(1), 96-105.
  • Pae, C. U. (2014). Influence of media on suicide: proper coverage of media on suicide report. Journal of Korean medical science, 29(11), 1583-1585.
  • Phillips, D. P. (1974). The influence of suggestion on suicide: Substantive and theoretical implications of the Werther effect. American Sociological Review, 340-354. 
  • https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_suicide_trend_yrbs.pdf
  • YRBS data extracted from: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_suicide_trend_yrbs.pdf

Post by:

Amy B. Acosta, PhD

As part of the interdisciplinary Adolescent Medicine team, I provide both individual and family therapy to our patients. My primary clinical focus includes working with adolescents with eating disorders and body image issues. I also work with patients who present with symptoms of depression,...

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Dr. Krista Caldwell, Ph.D., Fellow in Adolescent Medicine