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Understanding Teen Suicide

What causes someone to go from thinking about suicide to attempting it? Dr. David Shaffer, the director of child and adolescent psychology at Columbia University and a leading expert on suicidal behavior, says that the causes may be complex, but the patterns are usually straightforward.

In recognizing the early warning signs, it may be possible for family and friends to help prevent suicides. Dr. Shaffer explains the risks and what you can do.

At what age do people begin to have suicidal thoughts?
We don't have a lot of information about the frequency in pre-high school kids, but I think that suicidal thoughts probably begin just before puberty or around puberty. But you do get very young kids saying that they wished they were dead or that they are going to kill themselves and things of that kind. But it's very, very rare for young kids to act on those thoughts.

What prompts this type of suicidal thinking?
Suicidal thinking, obviously, is a very mixed bag. There are kids who just say it for effect. There are kids who say it when they're feeling low. There are kids who say it when they really mean it, and so on. And because it's so common, it's not necessarily very indicative of what goes on underneath.

Do these thoughts often lead to suicide attempts?
Suicide attempts are very common, and in depressed kids, who are the kind of kids who end up in treatment, you're getting about 40 to 50 percent who will have thought about suicide and about 30 percent will have made a suicide attempt.

Who is most at risk for committing suicide?
First of all, kids are more likely to commit suicide as they grow older. So, the teenagers who are most likely to commit suicide are 18- and 19-year-olds. They account for half of all teen suicides. Secondly, most suicides occur among boys. It's about five times more common in boys than girls. Thirdly, family history may be important. Suicide is about twice as common if there's a history of suicide on one side of the family.

The kind of person who's at greatest risk is a kid who is very impulsive, loses their temper quickly, is prone to very extreme emotions and who may also have some depression or substance abuse. There are two emotions that seem to underlie suicide: one is the inability to control your emotions, feelings and acts, and the other is hopelessness.

What causes a teenager to go from thinking about suicide to attempting it?
The events themselves are of two kinds. They're not very special, and they're events which are experienced by tens of thousands of kids every day and hardly ever result in suicide. Usually, it's getting into trouble and being found out: maybe they are found cutting classes, cheating or stealing something from another kid. The death will usually take place very shortly after the discovery, before the person knows what the consequences are going to be.

And during that period of uncertainty, there's probably a great deal of fear and anxiety and that seems to be what drives the suicide. They just want to get away from that very bad feeling.

Other triggers are probably common teenage experiences, including breakups with a boyfriend or girlfriend or some kind of public humiliation like a losing fight or being insulted in front of others.

Parents and friends should be on the lookout for what warning signs?
The most important things to look for are really the features of depression. Some of the classic things that you're taught are warnings such as writing a will and giving your possessions away. These are very, very infrequent, and they hardly ever occur before a suicide.

But the classical features would be a change in which the kid becomes less sociable with their friends, preferring to stay at home and more self-critical. A kid may be really passionate about a particular kind of sport or something else and then they just stop doing it. Sometimes the kids will say that the work they've done is lousy or that people don't like them or that they're ugly. Sometimes the kids just get very irritable and snappy and, if their parents question them, they'll snap back.

Can teenagers grow out of this suicidal behavior?
Suicide attempts are much more common in adolescents and then they decline. Once you get into adult ages, the meaning of a suicide attempt is quite different.

How can parents and friends help prevent a potential suicide?
I think that you prevent it by increasing awareness of depression. Most adolescents don't know what depression is; they just feel that they're bad people. They don't think they're depressed, and most of their parents think that the kids are just being teenagers, so it's very, very under-identified. The thing that you can do to help is to routinely try to educate kids about the warning signs.