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Teen Suicide: Awareness, Risks, and Prevention

We express our deepest sympathies to the families who recently lost their teenagers to suicides in San Diego. There have been 3 suicides and 1 attempt in the last one month in high schools within a 5 mile radius. The community is shocked and grieving with the families, and parents, clinicians, and educators are working hard to map the steps to teen suicide awareness, risks, and prevention.

The public and private high schools the 4 students attended are academically competitive, high achieving, and prominent schools in an affluent and professional neighborhood. But these are not unique contributing factors. KPBS reports, “In addition to the overall rise in suicides, suicide rates for people under 18 continued to trend upward, mirroring rises in the state and national suicide rates for children and teenagers. San Diego’s under-18 suicide rate has climbed from roughly 0.75 deaths per 100,000 people in 2007 to two per 100,000 in 2016.” Stan Collins with the San Diego County Suicide Prevention Council states, “About 20 percent of youth consider suicide and about 10 percent of youth attempt suicide.” In essence, suicides in San Diego have risen by 5% from 2016 to 2017 as reported by the San Diego County Suicide Prevention Council.

In 2014, the Center for Disease Control and Prevention stated that suicide was the second leading cause of death for children between the ages of 10-24 years. Suicide continues to be a significant cause of concern for parents and schools. The series, 13 Reasons Why, has also raised alarm amongst clinicians, teachers, and parents. The San Diego Union Tribune interviewed Dr. Maker on the 2017 shooting/suicide at Torrey Pines High School, and the pros and cons of the series 13 Reasons Why.

In February 2015 there was a flurry of suicides among high school students attending the local school in Palo Alto, which is similar to other affluent, well educated communities. The NY Times published two very important pieces on the suicides in Palo Alto to reveal that there had been a history of teen suicides in the community.

The articles identified risk factors of high academic pressure, intense expectations of attending top-notch colleges, immersion in high achievement oriented families and social/support groups, and elevated expectations of performance and success in multiple domains. Welcome to a successful high school from a teen’s perspective, as poignantly described by a Palo Alto student in an interview published in the Almanac News. A significant question raised by teen suicides is why parents, schools, and society are pressuring children to such an extent?

This is a critical question, as living in a society that clearly espouses success, wealth, and achievement, and with San Diego being a powerful hub of all three characteristics, one begins to wonder what price our children are paying to meet these expectations? Are children really thriving when their primary focus is achievement and performance? Is it healthy for us to be pushing our children to measure themselves primarily through wealth and educational status? Shouldn’t we also be being paying close attention to and encouraging multiple forms of development, such as play, creativity, social relationships, giving to others, family time, sleep, nutrition, and rest and recreation?

In working with teenagers and families, my first questions focus on what I consider are the 4 pillars of healthy development:

  • How much sleep are you getting and what are your sleep habits?
  • What is your daily nutrition and what are your eating habits?
  • How much daily exercise are you getting?
  • How much time do you spend with friends and having fun?

If teens are not healthy, successful, and balanced in these four critical areas, schools and parents need to pay attention and encourage their teenagers to develop, implement, and sustain healthy habits in basic self-care.

The above characteristics and behaviors are supremely important in child and adolescent development to foster thriving, well-balanced, and happy human beings. In today’s climate, parents and schools need to be mindful of whole child development, emotional happiness, and balanced life-styles, in addition to academic and athletic achievement. It is essential that we simultaneously emphasize these cornerstones of self-care so that our children can continue to be children, in all aspects of the word.

“Suicide continues to be a serious concern in our region,” said Dr. Michael Krelstein of San Diego county’s Health and Human Services Agency. “We must do all we can to prevent people from taking their lives and it starts by knowing the warning signs of suicide.” We need every adult and teenager to know the warning signs of suicide, including stress, self-harm, substance abuse, mood swings, withdrawal, and isolation. We need to train every teacher and the students about risk assessment, and to not be afraid to have complicated conversations with students, family, and friends.

Lythcott-Hains, the Dean of Stanford from 2002-2012, has published an informative book, How To Raise An Adult, which explores the drawbacks of excessive expectations and overachievement for children. An excellent movie that also goes into depth regarding the pros and cons of academic pressure and rigor, the need for children to engage in balanced socio-emotional development, and the high price children and college students may be paying for achievement and success – including suicide – is The Race To Nowhere. This movie is now well shown in schools across the country. I strongly recommend that all of us as parents, educators, and clinicians review these resources and reflect on their powerful messages.

Given the high rate of teen suicide, it is imperative that parents and schools focus on prevention and early assessment if we are to make a change. Here are some suggestions of what adults can do to identify early warning signs:

  • Check in frequently with your teenage about their socio-emotional functioning – not just their grades, tests, and school performance.
  • Ask your teen how much fun they had in school that day or week.
  • Although teenagers are private, ask them how their friendships are going: are they having lunch with others, playing sports with friends, being invited to birthdays, sleep-overs, get-togethers, etc.
  • Ask your teen how he/she is feeling about school, friends, grades, college, the future, and the family.
  • Have FUN with your students and teenagers. Spending weekly high quality time doing some fun and exciting activities with your students and teens is a highly effective way to get to know your teenagers, and to build a healthy and positive relationship with them.
  • Teachers can check in more frequently with the quiet teen, the isolated teen, the teen who is struggling with grades and friendships, and the new kid in the classroom.
  • Parents, teachers, and counselors should collaborate frequently when they may have concerns about a teenager. Early discussions, feedback, and interventions at home and at school could have a huge impact on the child.
  • If you have concerns, take your teenager in to see a professional for an objective and expert assessment. Prevention and early detection is key to helping your child.
  • Provide training for teachers, parents, and students to learn the facts and steps for suicide awareness, assessment, reporting, and prevention. Specialized appropriate training can be provided to students focused on positive psychology, coping, and empowerment, so that teenagers feel confident and proactive in seeking help and reporting.
  • Publicize clearly identified confidential venues and targeted adults for students to share concerns, report incidents, and seek support related to self and peer mental and behavioral health issues.
  • Schools consistently perform standardized academic testing for all students every year. It would be an excellent and cost-effective intervention to conduct annual or bi-annual socio-emotional wellness checks with standardized mental health screening questionnaires with all students in middle and high schools.

Teen suicide is a complicated and painful issue. As a community, we will continue to work together to reach out to teenagers, with a focus on prevention and early intervention. It is key to successfully prevent further tragedies amongst this very vulnerable population.