Teen's Suicidal Threats

Threats of suicide or attempts at suicide are usually the most difficult crises for families of depressed children. It's important to remember, however, that although thoughts of self-harm are almost universal among depressed children, attempts are far fewer. About 20 to 25 percent of teens with major depression attempt suicide at some point before age 20. Children or teens who actually die by suicide are rare (less than 4 percent of teens with major depression, most of these in the late teens). These figures are still much higher than in the general population, though, so threats of suicide must be taken seriously. Depressed girls are more likely to attempt suicide, but depressed boys more often complete suicide (they often use more lethal methods).

Some books have long lists of "signs" to look for in assessing children's suicidality. Unfortunately, these create the false impression that you can evaluate this risk yourself. This is simply not true. Even experienced professionals have difficulty predicting who will attempt suicide and who will not, and even the correct predictions are rarely accurate for more than the next 24 to 48 hours. Trust your instincts. Go to the nearest hospital emergency department if you be­lieve your child is at risk. Be extra suspicious if:

Your child has a friend who talks about suicide or has recently engaged in suicidal behavior (in this case, there is potential for a suicide "pact" among peers);
Your child starts to give away her possessions; or
There has been a recent loss of a close relationship or a source of pride (for example, losing a major competition or failing an examination).

Conversely, if your child has a habit of threatening "I'll kill myself if you don't give me what I want," recognize this for what it is: an expression of anger. On its own, this means little. If there are other recent changes in your child's behavior, however, it may be worth checking with a professional.

Also, beware of the impulsive child who takes a handful of pills in front of you to "make a statement." Depending on the pills, they could result in an inadvertent fatality (for example, Tylenol can destroy the liver). Following up with an emergency visit is often a good idea. The experience of being made to swallow charcoal (to neutralize stomach contents) or having a tube inserted down the throat can also be noxious enough to deter children and teens from repeating this behavior.



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