Depression is unfortunately associated with increased lethality. Suicide is the second leading cause of death for 10-24 year olds, and depression increases one’s risk of suicide. Due to the immaturity of the brain’s frontal lobes at this developmental stage, teens are more impulsive and engage in poorer decision-making than adults. And their insight and judgment are especially poor when encountering strong emotions or a depressive state. Therefore, parents need to understand how they can assess and mitigate depression-associated risk.

ASSESSING RISK

Keep in dialogue with your child with goals of providing support, monitoring symptom severity, and identifying risk factors and early warning signs (see below). Ask about suicidal thinking, desires, planning, and rehearsals. Research has shown that asking kids about thoughts of suicide is not harmful and does not put thoughts or ideas into their heads. In fact, there is some evidence to suggest that asking at-risk minors about suicide actually reduces suicide risk (Gould et al., 2005). Also ask your child about self-injury, dangerous substance use, and reckless behavior. Be sure to check in regularly, and especially during periods of heightened stress.

Risk factors include:

  • Previous suicide attempt(s)
  • Easy access to lethal means
  • Impulsivity
  • Recent stressors
  • Recent losses
  • Low self-esteem or self-dislike
  • Feelings of humiliation or excessive guilt
  • Lack of social support and sense of isolation
  • Physical illness
  • Family history of suicide attempts or psychiatric hospitalization
  • Exposure to others who have died by suicide
  • History of trauma or abuse

Early warning signs may include:

  • Feeling hopeless about the future
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Recent deterioration in functioning
  • Loss of interest in things
  • Sleeping too little or too much
  • Acting anxious, panicked, or agitated
  • Engaging in reckless behavior
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings
  • Increasing the use of alcohol or drugs
  • Having strange thoughts or experiencing hallucinations
  • Talking about wanting to die or wanting to kill oneself

Share assessment results with your child’s doctors and work with them to collaboratively make decisions regarding the appropriate level of care for your teen.

REDUCING RISK FACTORS

Here are some things you can do as a parent to reduce your adolescent’s risk of suicide:

  • Remove access to weapons: If you have a teen with depression, guns should never be in the house. In my opinion, locks and home safes are insufficient as teens often know how to find/guess their parents’ keys and passwords. Store locked firearms at a local gun range instead.
  • Restrict access to medicines: Medication that can be used to overdose should not be accessible to a depressed teen. This includes both prescription and over-the-counter (OTC) medications. Disposal of old medications can be done at your local pharmacy.
  • Restrict access to drugs and alcohol. It is not uncommon for teens to self-medicate with substances. Unfortunately, many substances exacerbate depressive symptoms and increase impulsivity.
  • Decrease stress. When someone is depressed, the last thing they need is more stress. Try to identify ways to reduce the amount of stress that your child takes on. If your teen is overworked or overbooked, this may mean easing up on expectations and cutting back on commitments until they feel better.

ENHANCING PROTECTIVE FACTORS

Here are some ways that you can help improve your teen’s mental health:

  • Increase monitoring. Closer observation of depressed teens, especially during periods of heightened stress, is recommended. Temporarily increase supervision and prevent aloneness.
  • Increase social support. Social isolation and the perception of not belonging is associated with increased depression, hopelessness, and suicide. Do what you can to help your child feel valued and supported by family and friends. Connection and support may be especially important during times of stress, disappointment, and loss. Schedule positive activities and make face-time a priority. A strong predictor of positive outcomes in children is having a caring adult who they expect can listen without judgment.
  • Encourage healthy coping. How does your teen respond to difficult and distressing situations? Help your child to identify and implement healthy coping in response to stressors, and to practice Distress Tolerance skills. And what do they do for regular self-care? Encourage proactive self-care activities and participate with them to increase the likelihood of compliance!
  • Encourage physical wellness. Is your teen eating nutritiously? Do they engage in regular exercise? Are they getting sufficient sleep (9-10 hours per night)? Physical health and mental health go hand-in-hand.
  • Instill hope. Depression, when treated, gets better! Try to help your child find their patience, perseverance, and hope.
  • Encourage therapy compliance. Ask your child’s therapist how often they should attend therapy and follow doctor’s orders. Sometimes a temporary increase in session frequency may be needed to help stabilize the teen’s condition. Also, in my experience, only seeking therapy when in crisis is insufficient. Crisis intervention is, of course, very important. But the real work of therapy is often only possible between episodes of crisis — when we can think more clearly and reflect in thoughtful ways on our experiences. Furthermore, maintaining ongoing treatment, even after symptoms let up, is usually important and helps to prevent relapse of symptoms in the future.
  • Encourage medication compliance. If your teen is prescribed a psychiatric medication, be sure they take the medication exactly as directed. Teens frequently have difficulty remembering to take their medications every day. It is also not uncommon for teens to unilaterally decide to go off of their medications abruptly when they start to feel better. Unfortunately, sudden discontinuation of psychiatric medications often results in a quick resurgence of symptoms. Therefore, parents should monitor their child’s medication use, encourage compliance, and ensure that refills are ordered on time. If your child ever wishes to go off of their medication, help them make an appointment with their prescriber to create a gradual discontinuation plan.

DEALING WITH CRISES AND EMERGENCIES

For guidance on how to handle urgent and emergent situations, please consult the following article: How to respond to a mental health emergency or crisis