Many suicidal children and adolescents have clinical depression alone or in conjunction with another mental illness like anxiety disorder, attention deficit disorder, bipolar illness (manic depression), or child-onset schizophrenia. Each child’s personality, biological makeup, and environment are unique, and depression and suicidal ideation in children are complex issues involving many factors. By recognizing and treating children we can improve the chances a young person with depression can live a longer, healthier, more quality life.
Know What To Watch For
Saying things like:
- "I shouldn't be here."
- "I'm going to run away."
- "I wish I were dead."
- "I'm going to kill myself."
- "I wish I could disappear forever."
- "If a person did this or that... would he/she die?"
- "The voices tell me to kill myself."
- "Maybe if I died, people would love me more."
- "I want to see what it feels like to die."
- "My parent's won't even miss me."
- "My boy/girlfriend won’t care anyway."
Doing things like:
- Talking or joking about suicide.
- Giving away prized possessions.
- Preoccupation with death/violence; TV, movies, drawings, books, at play, music.
- High risk behavior such as jumping from high places, running into traffic, self-injurious behaviors (cutting, burning).
- Having several accidents resulting in injury; "close calls" or "brushes with death."
- Obsession with guns and knives.
- Previous suicidal thoughts or attempts.
High risk children:
- Are preoccupied with death, and don't understand it is permanent.
- Believe a person goes to a better place after dying or can come alive after dying.
- Are impulsive (act without realizing the consequences of their actions).
- Have no or little sense of fear or danger.
- Tend to have perfectionist tendencies.
- Truly feel that it would be better for everyone else if they were dead.
- Believe that if they could join a loved one who died, they would then be rid of their pain and be at peace.
- Have parents or relatives who have attempted suicide (modeling behaviors/genetic factors can be involved here).
- Are hopeless; feeling that things will never get better, that they will never feel better.
Child's attempt or suicidal behavior:
- Doesn't know why they're doing it, but feels unable to stop it.
- May not remember the attempt when it's over
- Feels as if they were/are in a trance.
- May think they will be rescued.
- Acting out pain because of an inability to verbalize feelings.
- Increased impulsiveness and impaired judgment, perceptions and cognitive skills.
Healthy, non-impulsive children who talk about death or seem preoccupied after losing a friend or loved one, but have a clear understanding that death is final, and who are not depressed, are probably at a very low risk for suicidal behavior.
Typically, when asked about their own death, children most often state it will happen due to old age or getting sick when they’re old. Many suicidal children believe that when others die, death is final, but that if they die, their death is reversible. Vulnerable children and adolescents who may be under stress (internal or external) may have a change in perceptions of and feelings about death.
Know What To Do
Because children aren't always able to understand and explain their feelings, as adults we must be more vigilant in understanding the ways depression and suicide manifest in children, and work to get them the help they need.
If you think a child may be suicidal...
Ask questions about suicide like, "Do you ever...
- ...have thoughts of hurting yourself?"
- ...feel so badly that you have thoughts of dying?"
- ...wish you could runaway or disappear?"
- ...wish you could go to sleep and not wake up?"
- ...have scary dreams about dying?"
Treatment options might include:
- Depression Inventory Scales, Suicidal Risk Assessments, Suicidal Intent Scales, Degree of Hopelessness Scales, Diagnostic Interview Questionnaires.
- Out-patient psychotherapy:
- Cognitive Therapy - teaches more positive thinking, coping skills and problem-solving
- Interpersonal Therapy - might teach children how to make friends
- Group Therapy - with others of similar age that have a depressive illness
- Family Therapy - works with the entire family and discusses various family dynamics
- Various supports at school. Talk with a school nurse about the options available.
- Various forms of play therapy, relaxation therapy, biofeedback, visualization.
- Antidepressant medications, stimulants, also some types of alternative medicine.
- Hospitalization (in-patient, partial hospitalization, day-treatment).
How to Help
- Educate yourself on childhood & adolescent depressive illnesses and suicide.
- Assure your child they can feel better, that suicidal thoughts are only temporary, and that there are people who can help them.
- Always take suicidal tendencies seriously and respond immediately.
- Know that early intervention is the key to successful treatment for children who suffer from depressive illnesses.
- Understand that treatment should be a team-approach including a psychotherapist, a child/adolescent psychiatrist, parents, relatives, caregivers, school personnel, friends, babysitters, neighbors and other significant people in the child's life.