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Teen Suicide: Practical Interventions for Adolescents in Crisis
10 CEUs Teen Suicide: Practical Interventions for Adolescents in Crisis

Section 2
Suicidal Behavior

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Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track, we discussed five theories why adolescents choose suicide.  These five theories are, motivations for suicide, depression and mental illness, rebellion and escape, low-self esteem and lack of communication, and suffering a loss.

On this track, we will discuss three warning signs for teen suicide.  These three warning signs are verbal clues, behavioral changes, and situational clues. 

After Lonnie, 17, attempted suicide with a firearm, I met with his parents, Roy and Karen while Lonnie was in intensive care.  Roy stated, "Lonnie didn’t act like those kids you read about in the papers.  He was a happy boy, and doing well in school.  I had no way of knowing this was coming!  I mean, he was a little moody lately, but all teenagers have those phases.  If only I had known!"  As Roy described the weeks leading up to Lonnie’s suicide attempt, it became clear that Lonnie had actually attempted multiple times to let those around him know he was thinking about suicide.

3 Warning Signs for Teen Suicide

Warning Sign #1 - Verbal Clues
A first warning sign of teen suicide involves verbal clues.  In looking into Lonnie’s attempt, I discovered that on the day of his suicide attempt, Lonnie had stated clearly and directly to a friend that he wanted to die.  His friend had not told anyone, since she had promised Lonnie she would keep it a secret.  She also believed that Lonnie was being dramatic, and would not go through with it. 

Statements such as "I am going to commit suicide" or "I don’t want to live anymore" are fairly clear cut messages, but I have found that individuals who hear these comments may not understand the full degree of severity of the statement.  Individuals are likely to react to the word suicide with fear and confusion.  They do not want to believe what they are hearing, and the message from the teen goes unheeded.

"Subtle Clues Checklist" Technique
Clearly, not all verbal cues are as direct as the statement, "I am going to kill myself."   I stated to Ron and Karen, "there are other, subtle ways teens tell those around them they are thinking about suicide.  When a teen makes a subtle statement, he or she is hoping you will understand and be willing to ask and talk abotut he meaning behind the statement."  I provided Ron and Karen with the "Subtle Clues Checklist" technique. 

The items on the checklist are:
-- "soon I won’t be hurting so much"
-- I wish I could go to sleep and never wake up.
-- They will be sorry when I’m gone.
-- I wish I had never been born!
-- You won’t have to put up with me much longer.
-- I wonder what it’s like to be buried.
-- I don’t think I can manage much longer.
-- Do you think dying hurts?
-- They would be better off without me.

I feel that providing this checklist technique to the parents of teen clients is a good way to encourage parents to pay more attention to subtle clues that the teen may be giving out.  Would providing this technique to the parents of a potentially suicidal teen be helpful to your clients?

Warning Sign #2 - Behavioral Changes
A second warning sign of teen suicide involves behavioral changes. In retrospect, Lonnie’s moodiness could have been perceived as a sign of depression.  I have found that the two most significant behavioral changes that occur before most teen suicidal behavior are poorer schoolwork and withdrawal.  Other behavioral changes I look for in teen clients are sadness or crying, disinterest in previous activities, confusion, mood shifts, impatience, impulsivity. 

The inability to concentrate, boredom, and listlessness are also predictors of a depression and possible suicidal ideation.  I also advise parents to be aware of changes of sleep or eating patterns, giving away prized possessions, obsession with death, increased use of drugs or alcohol, lack of energy, guilt, self reproach, and expression of worthlessness.  A copy of these behavioral changes which you might provide to the parents of at risk teen clients is provided at the end of the Manual that accompanies this course.

Warning Sign #3 - Situational Clues
In addition to verbal clues and behavioral changes, a third warning sign of teen suicide involves situational clues.  As we discussed on Track 1, one of the most dangerous situational changes involves the loss of a relationship.  This may be a loss through death, or through a romance or friendship breaking up.  The grief response of overwhelming yearning is similar in all three instances.  If the teen is floundering and has not learned to care for her or himself after losing someone or something precious, he or she may think that the grief will last forever, and that despair becomes intolerable. 

Other situations teens might experience that provide situational clues for suicide risk include alcohol or other drug abuse, pregnancy, delinquency, or trouble at school.  Acting out in ways that are unacceptable to society is related to the incidence of suicide.  Teens who are placed in juvenile detention centers, or young mothers who seek abortion, are the most likely to threaten or attempt suicide. 

Additionally, the presence of a mental or serious physical illness should always be taken into consideration, especially when the teen has a perceived or actual lack of social support.  During sessions with teen clients, I am especially mindful of the expression of a sense of isolation through comments such as "I could never tell my parents, they just don’t listen," or "all they do is tell me this is my fault.  I’m tired of being stupid and lazy!" 

Clearly, these statements indicate a rift in the communication link between the teen client and her or his social support, and send up a red warning flag.  What other red flag statements regarding situational clues do you look for when assessing suicide risk in a teen client?

On this track, we have discussed three warning signs for teen suicide.  These three warning signs are verbal clues, behavioral changes, and situational clues. 

On the next track, we will discuss three aspects of addressing thoughts and feelings with a suicidal teen client.  These three aspects are communicating feelings, separating thoughts and feelings, and active listening. 

Peer-Reviewed Journal Article References:
Braun, M., Till, B., Pirkis, J., & Niederkrotenthaler, T. (2020). Suicide prevention videos developed by and for adolescents: A qualitative study. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication.

Cheng, Q., Shum, A. K. Y., Ip, F. W. L., Wong, H. K., Yip, W. K. K., Kam, A. H. L., & Yip, P. S. F. (2020). Co-creation and impacts of a suicide prevention video: A case study of a YouTube short film on youth suicide prevention. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(1), 7–14.

Javdani, S., Sadeh, N., & Verona, E. (2011). Suicidality as a function of impulsivity, callous–unemotional traits, and depressive symptoms in youth. Journal of Abnormal Psychology, 120(2), 400–413. 

Madjar, N., Sarel-Mahlev, E., & Brunstein Klomek, A. (2020). Depression symptoms as mediator between adolescents' sense of loneliness at school and nonsuicidal self-injury behaviors. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication.

Sheftall, A. H., Schoppe-Sullivan, S. J., & Bridge, J. A. (2014). Insecure attachment and suicidal behavior in adolescents. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 35(6), 426–430. 

Online Continuing Education QUESTION 2
What are three warning signs for teen suicide? To select and enter your answer go to CEU Test.

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