Important questions help us to decide how to handle any health issue including mental health. How do I find the right kind of help? Can’t my regular doctor take care of this? What medications are good for my condition? How will I pay for health care?

Answers are needed, and to move past our fears and doubts we need to gather information. When facing warning signs of suicide, speed is of essence. Hesitation may lead to great loss.

Some known experiences seem to statistically serve as risk factors for suicide. While warning signs are behaviors, words, and other forms of expression that indicate thoughts of suicide may be on a person’s mind, risk factors are discovered in the similar backgrounds of those who have completed suicide. Causality is not an element here; these are recorded commonalities found in the histories of young people who killed themselves. As one might expect, multiple or simultaneous factors may increase a teenager’s risk of suicide.

History of mental health concerns

• History of suicide attempt is considered by many to be the number one risk factor for death by suicide. One third of all suicide deaths were not the individual’s first attempt. During the year immediately following a person’s suicide attempt, risk of suicide is substantially increased.
• Major depression, schizophrenia, and recurrent affective (mood) disorder are also at the top of the list of risks for suicide. Affective disorders include depression (symptoms, causes)  bi-polar disorder, and anxiety. Each of these mental disorders interrupt one’s ability to function and can be debilitating.
• Untreated, under treated, and undiagnosed mental illnesses are also high risk issues.
• Abuse of alcohol or drugs
• Anti-social behavior
• Overwhelming shame or guilt
• Victimization by abuse of any kind including sexual, emotional, physical, and verbal among others, significantly increase one’s risk of future suicide.
• Risk is increased during the first month after discharge from a hospital stay due to psychiatric issues.

Recent loss 

• Death of anyone significant in a teen’s life. This could be a family member, friend, teacher, or even an adored celebrity. Grief sometimes can overcome a young person’s ability to cope. Two girls in Pennsylvania killed themselves because of the death of one girl’s boyfriend.
• Parents’ divorce or separation. I’ve heard that some experience this as worse than death.
• Broken relationship. Whether perceived or real, romantic or platonic, new or long-term, break-ups hurt.
• Loss of self-confidence due to humiliation or perceived failure
• Move to a new area
• Illness or injury leading to physical limitations
• A suicide in the family, among friends, in the community, or of a celebrity can lead to all-too-common “copycat” suicides
• Loss of identity. UFC’s bantamweight title holder Ronda Rousey, admitted on the Ellen show that she wondered what she had to live for after experiencing her first losing fight. “If I don’t have this, who am I?” she said.
• Other types of losses such as not making the team, getting poor grades, being turned down by the college of choice, etc. can be high pressure situations seeming to a young person as if this problem is the end of their world.

Family history- nature versus nurture

• After a parent completes suicide, a door has opened to the concept of suicide as an acceptable option. There are other correlations from the parent’s suicide to that of the child.
• Sexual, emotional, and/or physical abuse from a family member, especially if it is repeated, raises the risk of suicide. Researchers have suggested these experiences change a child’s brain leaving them more susceptible to depression and suicide. When I was admitted to a treatment center in 2013, I met dozens of women who had experienced such abuse. Almost everyone I spoke to had attempted suicide.
• Observing violence in the home. If the young person has to watch violence in the home, his or her risk for suicide is raised.
• If a child’s mother dies early, emigrates, or lives abroad, suicide risk for the child increases. This supports the idea that a child is deeply affected by an impaired relationship, and poor attachment and bonding between mother and child
• Genetic factors. Suicide can run in families. However, having a parent with depression or suicidal history does not indicate a teen will automatically have such issues.

Other stressors

• Bullying of any type. Cyber-bullying, with its anonymity, has become a tool of abusers worldwide. A 15 year-old boy took his own life because of such vicious attacks online as, “You really are a freak”’, “‘no one likes you” and “you deserve sick things to happen to you”.
• Extreme loneliness, perceived or real abandonment, rejection
• In real or serious trouble, especially for the first time
• Living alone, and/or social isolation. Even if one’s isolation is self-imposed, the increased risk of suicide is very real.

Everything I have read and heard from professionals in the mental health and suicidology fields indicates the strongest risk factors for youth suicide are mental disorders and a history of such. Reiterating the bottom-line theme of this series, lack of knowledge kills our teens. By improving our recognition of mental disorders, learning how and why to attain treatment, and discovering what management of a mental disorder means, we will reduce youth suicide. Becoming knowledgable on the topic prepares us to intervene in a timely manner.

The last two articles in this series will focus on obsession with death and common myths.

It’s important.

Stay tuned.