How can you tell if your son or daughter might be developing suicidal tendencies or a self-destructive mind-set? Are there any specific risk factors or warning signs to keep in mind?

Potential Risk Factors

If you think about it for a moment, you’ll realize that just about everything we’ve talked about in the first five parts of this book has something to do with risk. Our purpose has been to build up, brick by brick and stone by stone, a thorough and systematic understanding of the many developmental, psychological, and social factors that can feed into the growth and development of a suicidal mind-set.

We’ve talked about attachment, child discipline, and the importance of good self-care. We’ve considered the effects of worldly values, significant losses, domestic violence, anxiety, depression, addictions, personality disorders, mental illnesses, social media, and a host of other potential problems. Without rehashing that information here, we can summarize its significance as follows: if your child has issues in any of these areas, you need to remain vigilant. And if you see a combination of these factors, it’s time to heighten the alert status.

A short list of specific identifiable risk factors for suicide among young people would include the following: mood disorders, substance abuse, certain personality disorders, low socioeconomic status, childhood abuse, parental separation or divorce, inappropriate access to firearms or prescription drugs, and interpersonal conflicts or losses. Pay special attention to the following predictors of suicidal thoughts and behaviors:

• A previous suicide attempt
• A family history of suicide
• The presence of chronic pain, degenerative disease, or some serious psychiatric condition such as bipolar disorder
• Other mental health issues, such as clinical depression, anxiety, OCD, or OCPD
• Several of the adverse childhood experiences (ACEs)
• Traumatic brain injury
• Suicide among other adolescents in your community
• A sudden, major loss or humiliation, such as bullying or a dramatic boyfriend-girlfriend breakup

The presence of any of the factors listed above doesn’t necessarily constitute cause for immediate concern. It doesn’t prove your child is likely to commit suicide. It merely indicates that he might be more prone to think about suicide than people who aren’t struggling in these areas. If these factors are part of your child’s background or personality, be aware of the implications and stay on guard. But there’s no need to jump to unwarranted conclusions.

Watch Out for Depression

Of the several mental health issues cited above, depression, again, comes in for special mention. Why? Because statistics indicate that depression is the most common cause of teen suicide. Though depression doesn’t always lead to suicide, it must be taken seriously on its own account. If you suspect your child might be clinically depressed, see our definition of this term in chapter twelve on depression, and seek appropriate help immediately. You may want to contact your primary care physician for advice or a referral. Even if a present threat of suicide doesn’t seem to be part of the picture, you’ll want to take definite steps to deal with the depression.

Warning Signs

Up to this point we’ve been talking about tendencies and theoretical possibilities. A risk factor is not necessarily a problem: it’s a weakness that could lead to a problem. A bald tire is not a flat tire, but it might become a flat tire under the right conditions very easily. When that starts to happen, there are usually some warning signs: wires sticking through the treads, for instance, or a bulge, or a slow loss of air. It’s the same, metaphorically speaking, with people considering suicide.

Studies show that four out of five teen suicide attempts have been preceded by clear warning signs: changes in behavior or attitude indicating a dangerous psychological shift. An important part of averting a teen suicide is staying involved in your child’s life—especially if she’s at risk for some reason—and watching for these signals:

• Sudden changes in behavior, attitudes, or social habits
• Expressions of intense guilt or hopelessness
• Declining grades and other problems at school or work
• Behavioral issues
• Difficulty concentrating or paying attention
• Increased boredom
• For boys, sudden outbursts of anger and violence
• Substance abuse, unsafe sexual activity, and other risky behaviors
• Lack of positive response to praise
• Physical complaints (fatigue, aches, pains, migraines) resulting from emotional distress
• Loss of interest in favorite extracurricular activities
• Changes in sleep patterns: too much or too little
• Changes in eating habits
• Withdrawal from family and friends
• Threatening, talking, or joking about suicide
• Sudden interest in procuring potential tools for suicide (firearms, pills, poisons, etc.)
• A teen who has been struggling with depression, stress, anxiety or deep disappointment suddenly seeming happier and calmer; this may be a sign that he has made up his mind to end his life
• “Cleaning house”: a sudden impulse to give away personal possessions
• Neglect of hygiene and other matters of personal appearance

Not all of these signs will be present in every case. There have been instances in which a seemingly well-adjusted teen committed suicide for no apparent reason. But vigilance is always important, especially if two or three of the signs listed above appear in combination.

It’s always better to err on the side of caution. In particular, any talk about suicide on the part of your child needs to be taken seriously and given full attention. If your kid says something such as, “I’d be better off dead,” or “Maybe life would be easier for you if I wasn’t around,” take action.

Assessing the Danger

On an even more serious level, the following behaviors may indicate that your child is actually in the process of putting together a suicide plan:

• Open declaration: “I’m thinking of committing suicide,” or “I wish I could die.”
• Verbal hints that could point to suicidal thoughts or plans; for example, “I want you to know something in case anything happens to me,” or “I won’t be troubling you anymore.”
• Suicide notes or diary entries
• Verbal expression of bizarre or unsettling thoughts

What Now?

If you become aware of any of the warning signs listed above, sit down with your child and have a heart-to-heart talk. Don’t be afraid to get pushy. Press your son or daughter with some direct questions. You might begin by asking, “Where are these negative feelings coming from?” or “What is it that’s causing you to talk so much about ending your life?” It could be especially helpful and revealing to ask, “Exactly what would have to change for you to feel better?” You may also want to get an official psychiatric diagnosis so you can find out what’s behind the depressive behavior and talk of suicide.

The important thing is to take action now—before it’s too late.

In the next two chapters, we’ll take an in-depth look at strategies for dealing with a suicidal teen or young adult.