“The things that make them (youth) vulnerable are where they stand socially and where they stand developmentally” -- Dr. Carl Fleisher, UCLA Child and Adolescent Psychiatrist
When I became a parent just over five years ago, I felt so untethered. Here I was a practicing mental health professional for 20 years and I was scrambling for information on “infant sleep” and “what to do if you’re struggling with breastfeeding.” Fast forward to the early school-age period, and I now anxiously seek out information on power struggles and managing tantrums. Apparently, knowing a lot about child development doesn’t actually prepare you when it’s your own child. Like so many other parents and caregivers, I have been wondering, Where’s the Parenting Manual? Unfortunately, there isn’t one. Instead, we do our best and seek out help from friends, family members, online blogs, and professionals when we need it. I can only imagine how desperate I would feel if I found myself encountering a situation related to my child's mental health, especially suicidal thinking and behavior.
Multiple organizations have placed suicide as the second or third leading cause of death for the 10-24 year old age group (CDC, 2022b; NAMI, n.d.). Suicide rates are fortunately relatively low in 10-14 year old youth, at 2 (female) or 3.6 (male) per 100,000 deaths, but then jump significantly in the 15-24 year old population, especially among males where it accounts for 22.4 per 100,000 deaths (NIMH, 2020). As we examine diverse groups of youth and young adults, we see even greater rates of suicide among those who identify as American Indian/Alaska Natives or a sexual minority (LGBTQ). The military dependent rate of suicide (under 23 years of age) is comparable to that of the civilian population (DSPO ASR, 2021). Further, the primary method of suicide death in military youth parallels that of suicide in a civilian youth population, use of a firearm.
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Data aside, the suicide death of any youth makes suicide a problem of importance. In the next section, I consider what might go into the proverbial “Manual” for parents of a youth who is struggling with suicidal thoughts or behaviors. Because I will only be able to give a high-level overview of some key factors to consider, I urge you to seek out additional information and assistance if this topic is important to you, your family, or someone you support. Beginning in July 2022, a new mental health and suicide prevention lifeline was initiated and can be reached by calling 988.
Contributors to Youth Suicide: Development & Social Factors
The Manual would probably start with some understanding about what’s happening developmentally that contributes to youth suicide. Most youth progress into adulthood with some bumps and bruises, but often develop resiliency along the way and do just fine. However, there are some key aspects of development that can make youth more vulnerable relative to suicidal ideation and behavior. For instance, it is now well known that the human brain continues developing well into the mid-20s. For youth and young adults below about age 25, this means that their judgment and decision-making are not fully developed (Cohen, 2022). This complicates a young person’s ability to reason through both the risks and consequences of suicidal thinking, and their ability to manage behavioral impulses to reduce the likelihood of taking action on these thoughts. Additionally, one’s ability to manage emotions at these younger ages can be quite a challenge as it relates to brain development. Without solid coping strategies in place to deal with big emotions that surface, it’s easy to understand why impulsive suicidal thoughts and behaviors might surface.
In the field of suicide prevention, we widely know the value of relationships as a protective factor to suicide. When a person is suffering, having frequent and positive social interactions can bring a great source of hope and desire to live. It’s clear that social connections for young people are categorically different than those of adults (Cohen, 2022), and even different from youth relationships of 20 years ago. I don’t know about you, but as I look at relationships for young people these days, it’s a completely different social landscape than when I was growing up - and it seems like so many areas where youth may benefit socially also come with serious risk. For example, technology has increased accessibility to connections both nearby and across the globe (which is protective against suicide), but it also has contributed to greater rates of bullying (and now cyberbullying) and greater isolation for some youth.
What Might that Manual Say to Do?
Now that we know some of the reasons why youth might be impacted by suicidal thinking and behavior, let’s shift to exploring what the Manual might say about what you should do when you believe a young person is struggling in this way.
Care for yourself & practice self-compassion. While it might be a very strange way to start this discussion, I think the most fitting place is to take care of yourself and generously apply self-compassion. Any adult, whether they be a parent, caregiver, therapist, teacher, or any other support person, can best serve the youth in their lives by being at their best. So, follow that long-held metaphor and just like when you’re flying in an airplane, put your own oxygen mask on before assisting the youth in your life.
Connection is key! Take heart in knowing you are making an impact just by showing up. Whether they say it or not, most youth are craving connection. Not any old kind of connection, but interactions that are positive and happening often (Wenzel et al., 2009). They need to know that they are seen, heard, and that they matter. Engaging youth who are in distress can be quite challenging, so remain persistent and caring when youth reject help or trend toward isolating. Also, remember that research suggests that talking about suicide has not been shown to increase suicidal thinking or behaviors (Cohen, 2022), so have the difficult conversations.
Distress doesn’t always look the same. While many youth that experience suicidal thinking and behavior will meet criteria for a mental health diagnosis, some do not. In suicide prevention work, we often talk about how suicide is transdiagnostic, meaning it is not attached to one particular mental health condition and may exist even in the absence of a mental health disorder. While most youth exhibit behavioral changes representative of their level of distress, there are some who internally struggle and are less prone to verbalize their difficulties (Cohen, 2022). Youth may suddenly experience suicidal thinking and behaviors in the midst of a suicidal crisis (Wenzel et al., 2009), often brought about by a stressful external event (i.e., relationship loss or discord, social isolation, bullying, etc.). For adults with suicidal thinking and behavior, we often discuss the fluidity of suicide risk; however, the quick shifting of suicide risk in youth may be even more rapidly occurring and also dissipating. Additionally, youth who are experiencing suicidal thinking and behavior may be more prone to engage in non-suicidal self-directed violence such as cutting, burning, head-banging (Wenzel et al., 2009), or behavior that is self-defeating (such as stopping homework, skipping practice, or avoiding situations where praise may occur). Asking about these behaviors is also very important in understanding overall risk.
There is so much more the Manual could say about youth suicide, as well as about various other challenges that accompany the journey of growing up. I think another important question to ask is, why might parents wish for a Manual anyway? Parenting and supporting youth are a treasured role for most in a caregiving capacity. I can only speak for myself, but my biggest fear is that the mistakes that I make as a parent (and let me tell you, there have been plenty) will contribute to or cause lasting negative impact on my child. During the course of my work, I’ve heard the saying from Dr. Steve Hayes (ACT developer), “we hurt where we care”. In the role of parenting, nothing could be truer.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Erin R. Frick, Psy.D., is the Assistant Director, DoD Child Collaboration Study, for the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences at Bethesda, Maryland.
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Cohen, S. (2022, March 15). Suicide rate highest among teens and young adults.
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Department of Defense, Under Secretary of Defense for Personnel and Readiness (2021). Annual
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September 13, 2022, from https://www.nami.org/Your-Journey/Kids-Teens-and-Young-
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September 13, 2022 from https://www.nimh.nih.gov/health/statistics/suicide
Wenzel, A., Brown, G. K., & Beck, A. T. (2009). Cognitive therapy for suicidal patients:
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