Talking with your child about suicide

For three weeks in late spring of 2018, it seemed like suicide dominated the media. On May 18, the second season of the controversial series 13 Reasons Why began airing on Netflix. Eighteen days later, fashion designer Kate Spade died by suicide, followed three days later by celebrity chef Anthony Bourdain.

Such news came on the heels of an equally troubling report in the May 16 issue of Pediatrics, which found that the number of children and teens who were hospitalized for attempting suicide or having suicidal thoughts nearly doubled between 2008 and 2015. The reasons for this increase aren’t entirely clear, says Kimberly O’Brien, PhD, a clinical researcher in psychiatry at Boston Children’s Hospital who studies suicide. “More kids may be suicidal than in the past,” she explains. “But it’s also possible that parents are more likely to ask about or pick up on signs of suicidal thoughts and take them more seriously.”

In fact, it’s important to talk with your child or teen about mental health and suicide, says O’Brien. Here, she offers tips for making those difficult conversations a little less challenging.

Consider your child

There are plenty of ways to talk about suicide with your child, particularly if you don’t have specific concerns about their mental health and just want to get ahead of the game — the key is to be open and honest. You might start by saying something like, “I’ve seen a lot about suicide in the news lately. What do you think about that? Have you ever had thoughts about killing yourself?” Keep in mind that your child isn’t necessarily going to respond honestly, says O’Brien. In fact, they may groan and roll their eyes. But you’ve shown them that you’re comfortable talking about the issue, and they’ll remember that.

If you’ve noticed that your child seems depressed or anxious, you’ll want to take a more direct approach. You might start by asking, “I’ve noticed you’re feeling more down lately. Is anything going on?” That can lead to your next question: “Sometimes when people feel down, they think about dying a lot. Is that something you think about?” If they say yes, ask them specifically about suicidal thoughts: “Has it ever felt so bad that you’ve thought about killing yourself?.”

Make it age appropriate

Match your conversation to where your child is developmentally, advises O’Brien. For example, if you’re
really worried about your 10-year-old, you could say, “Sometimes kids feel like they want to die. Sometimes they want to do something to make themselves die.” Use the language you normally would use with them. “Parents underestimate their ability to talk about this, but it’s more powerful coming from you,” she says. Just like talking about sex, this isn’t a comfortable conversation, but it’s an important one.

Be prepared for the next steps

If your child says they feel suicidal and you’re not sure what to do next, you can contact Boston Children’s and ask to page psychiatry on-call, where a clinician can help you determine the next steps and if you should bring your child in for an evaluation. Likewise, all towns have a mobile crisis team that you can access. “Don’t feel guilty or ashamed to ask for help,” says O’Brien. “If you’re concerned, go with your gut and know that you’re not alone.”

Know the warning signs

People who are thinking about suicide usually exhibit one or more of the following warning signs. Keep an eye out for these signs in your child or teen and take them seriously.

• talking about wanting to die
• looking for a way to kill oneself
• talking about feeling hopeless or having no purpose
• talking about feeling trapped or in unbearable pain
• talking about being a burden to others
• using alcohol or drugs
• acting anxious, agitated or reckless
• sleeping too little or too much
• withdrawing or feeling isolated
• showing rage or talking about seeking revenge
• displaying extreme mood swings

It’s also important to know that exposure to certain fictional portrayals or media coverage of suicide can be harmful — and appears to result in an increase in suicidal behavior in people at risk for it, particularly teens and young adults. This phenomenon, known as suicide contagion, may occur when reports or portrayals suggest oversimplified explanations for suicide, glorify or glamorize it as a vengeful act, or include graphic descriptions of the method used.

Such details can increase the likelihood of identifying with the victim and choosing the same method, says O’Brien. “This isn’t just a theory,” she explains. “We’re seeing this in action at Boston Children’s, where kids are coming in and telling us they want to kill themselves just like the character Hannah Baker on 13 Reasons Why.” She recommends discouraging your child from watching the series or watching it and discussing it with them if they insist.

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.