Where we are and reasons for optimism
Youth suicide has become a national emergency. It was the second leading cause of death in youth aged 10-14 in 2021.1 3.3 million youth aged 12 to 17 had serious thoughts of suicide, 1.5 million made suicide plans, and 892,000 attempted suicide within that year.2
Racial disparities are a big factor, as the suicide rate in Black youth aged 13 and younger is twice that of White youth.3
LGBTQ+ youth also experience a much higher suicide risk. In 2021, more than a quarter (26.3%) of LGBTQ+ high school students reported attempting suicide within the previous year. This rate was five times higher than the rate reported among heterosexual students (5.2%).4 According to the Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health, 45% of LGBTQ+ youth had seriously considered suicide in the past year.5
However, the launch of 988 has shown great promise in increasing youth access to immediate support. “Most individuals using 988 chat and text services are under the age of 25,” states Ms. Farmer. “We’ve learned that many of them are currently experiencing or have recently experienced suicidal thoughts.”
SAMHSA confirms that texting has been a very popular way for people younger than 25 to reach 988, who have tended to be in more acute distress when contacting the hotline.6
Text and chat answer rates overall continue to trend considerably upward, with rates having reached 96% or higher in December 2022, compared with 24% for chats and 52% for texts from the previous year.7
Causes behind the emergency
Over 8% of youth who made a suicide plan or attempted suicide cited the COVID-19 pandemic as a driving factor.2 The pandemic added to or intensified challenges that youth faced, given the implementation of remote schooling, and the shutting down of social opportunities in youth communities.
The most vulnerable youth experienced the pandemic’s impact the most, due to additional challenges. They endured disruptions in access to health care, social services, food, housing, and the stresses their caregivers were facing. These youth include LGBTQ+ individuals, low-income youth, and youth of color.8 Suicide rates among Black individuals aged 10–24 years old increased over 36% from 2018-2021.9
Warning signs to watch for
Primary care providers have an opportunity to notice potential early warning signs of youth suicide because of patient access and knowledge of their patients’ medical history. Providers can look for changes in a youth’s mood or behavior that might indicate something is wrong. Examples include a youth not participating in activities they typically enjoy, changes in eating, or disruptions to sleeping.10
Additional warning signs include a youth talking about wanting to die, expressing feelings of hopelessness, believing they have no reason to live, feeling trapped, seeking revenge, becoming increasingly isolated, or using alcohol or drugs.11
How providers can talk to youth about suicide
Primary care providers can start addressing the subject with their youth patients by creating an open dialogue and asking open ended questions. If the youth expresses thoughts of suicide, the provider can ask if it makes them feel worried, scared, or overwhelmed, or whether the youth has discussed the subject with anyone before, prior to the provider taking any next steps.
Engaging the youth in a non-judgmental manner, taking the time to understand them and their background, can help to earn the youth’s trust. A provider should also be mindful of adapting their follow up questions to the patient’s family and cultural background. The provider and youth can work together on building a safety plan and follow up care.10
Providers should use trauma-informed care principles, centered around safety, trustworthiness, transparency, peer support, collaboration, empowerment, humility, and responsiveness. They should use language that avoids stigma and engages the youth and their family, eliminating the myth that individuals who talk about suicide do so for attention, are crazy, or that talking about suicide puts the idea in someone’s head.10
Preventing youth suicide
Youth can contact 988 via phone, chat or text if they are in immediate distress, in crisis, or need someone to talk to. The youth section of the 988 website also contains valuable resources for youth, including ways to ask for help, a guide on making a safety plan, how to build healthy relationships, and additional resources.
The site also contains tips for loved ones and caregivers, such as active listening, validating the youth’s feelings, learning the warning signs, and informing someone who can help.11
“If people are concerned that their child may be thinking of suicide, the most important thing they can do is ask the question,” advises Ms. Farmer. “It is not easy, but most of the time individuals in such great pain are relieved that another person is willing to talk about such a difficult subject.”
The American Academy of Pediatrics also recommends that providers work with schools, community organizations, and youth groups to partner on prevention strategies and programs.12
Ultimately, people should remind their loved ones they are not alone, and that reaching out for help shows courage. “The most important thing a person can do to help their child is to help them get the care they need,” Ms. Farmer concludes.