Questions to ask a suicidal teenager

For many adults, discussing suicide with a teenager can be discouraging. You might be afraid to plant the idea in the teen’s head, although research shows that simply asking about suicidal thoughts or feelings does not increase a person’s risk of suicide. Then there is the language. Should the conversation be casual or serious? Should it include the latest TikTok lingo? Perhaps most worrying is what to do when the teen reports having suicidal thoughts. Suddenly, the adult is thrust into a high-stakes situation, possibly unsure of how to help the teen he loves.

While these fears are understandable, parents, caregivers, and other caring adults should know that certain tools can take the guesswork out of a teen’s question about suicide. Doctors use a questionnaire known as the universal screener to accurately assess suicide risk, which adults can adapt for conversations with teenagers. In addition to turning to a trusted healthcare provider, adults can turn to local and national mental health organizations that offer referrals or search tools to find professional and informal support (more on these resources below). Hotlines also connect callers or texters to services, and that includes helping adults who are worried about a teenager.

Alex Karydi, a therapist with expertise in suicide prevention at the Education Development Center, a nonprofit research organization, says adults learn the symptoms of suicide risk in adolescents, can rely on a mental health screener to have a conversation with a teen, and planning the next steps ahead if the teen indicates he is suicidal.

Symptoms of a suicidal teenager

Karydi recommends that adults consider adolescent suicide risk as part of children’s overall health and well-being. For example, parents are taught to call a pediatrician if their child has a high fever or other worrisome symptoms. Likewise, adults should seek help when they see signs of emotional or psychological distress in a child they love.

“The first step is not to create a separation between body and mind,” says Karydi, who leads technical support for the Suicide Prevention Resource Center’s States and Communities initiative and urges adults to take a holistic approach to teen health that sees mental health as important as their physical well-being.

However, even with a holistic approach, some adults may find it difficult to differentiate between normal teenage behaviors, such as irritability or moodiness, and behaviors that indicate an increased risk of suicide. Searching for sad music or movies can be cathartic or fulfilling for teens and doesn’t necessarily indicate suicidal thoughts, Karydi says. However, when a teenager becomes over-identified with a fictional character who attempted suicide or died by suicide, it can increase suicidal thoughts through a process known as contagion. Karydi quotes Netflix young adult series 13 reasons why, in which the teenage female protagonist dies by suicide as a prominent example. Not everyone exposed to media and entertainment with graphic messages about suicide is vulnerable to contagion, but teens are particularly vulnerable.

“When a child is watching [13 Reasons Why] and look at this girl’s experience and say, “That’s me. I’m here. I don’t get out like they didn’t get out…they start over-identifying with certain personalities or identities out there, which really ends in death or increasing suffering,” says Karydi.

Other signs of suicide risk include increased drug use, problems at school, social isolation, withdrawal from friends and pleasurable activities, conflicts with parents and caregivers, and outbursts of anger. Teenagers may spend time researching depression-themed websites or forums where users talk about suicide. Some may even say things like, “I don’t want to be here anymore.” (To learn more about risk and protective factors for suicide, visit the Centers for Disease Control and Prevention.)

Teens who self-harm aren’t necessarily suicidal, says Karydi. Instead, they use a maladaptive coping skill to deal with overwhelming emotions, as self-inflicted physical pain can counterintuitively provide relief from intense feelings. However, self-harm can be a ritualistic behavior that makes a teenager more familiar with blood or pain, thus increasing their risk of suicide. Karydi says it’s not a “big leap” for a self-injured teen to think about taking their own life.

Questions to ask a suicidal teenager

Adults who notice these symptoms should definitely ask a teen about suicide. The American Academy of Pediatrics also recommends that physicians conduct suicide risk screening for all adolescents ages 12 and older, regardless of whether adults have noticed warning signs. While AAP urges physicians to screen their patients, some physicians may not be following this guidance. In addition, more than 4 million children do not have health insurance and may not have access to regular check-ups. Teens may also feel more comfortable sharing suicidal feelings with a trusted adult.

Caring adults who want to assess a teen’s suicide risk can use simple question screeners. Adults can take an empathetic approach and explain to the teen that they want to have open conversations about mental health or that they are concerned about the teen’s well-being based on recent observations. They should also be sensitive to factors that may increase the risk of suicide, such as bullying, discrimination, and historical trauma. What may seem insignificant to someone with a different background, identity, or life experience may lead to suicidal thoughts and behaviors in others.

To guide a conversation about suicide, Karydi recommends a handout for caregivers created by the Columbia Lighthouse Project, a suicide prevention initiative led by Columbia University researchers.

This screening contains six questions with specific instructions on whether to ask them all. These are the first two:

1) Have you wished you were dead or that you could go to sleep and not wake up?
2) Have you ever had thoughts of killing yourself?

Adults can ask the following questions in the handout based on the answers to the first and second.

Karydi also recommends the Ask Suicide-Screening Questions (ASQ) toolkit. Funded by the National Institute of Mental Health and proven accurate by researchers, the ASQ screening tool consists of four short questions to ask:

1. Over the past few weeks, have you felt that you or your family would be better off if you were dead?
2. Over the past few weeks, have you wished you were dead?
3. Have you had thoughts of killing yourself in the past week?
4. Have you ever tried to kill yourself?

A “yes” answer to one or more of these questions indicates an increased risk of suicide.

What to do when a teenager says he’s suicidal

Karydi says it’s important for adults to remain calm and not panic when the teen answers yes to these questions. If a suicide attempt is ongoing or imminent, Karydi says adults with the teen should go to the emergency room — or call 911 right away — to seek help. If the teenager shares that he’s had thoughts of suicide, Karydi recommends asking him if he’s come up with a plan. If the teen mentions a method or location, it is important that the adult disables or restricts access to the resources. This may include restricting drugs, firearms, and other deadly means. The adult should consult a mental health professional such as a therapist, psychologist, or psychiatrist for urgent support and treatment for the teen.

According to Karydi, adults and youth should take advantage of services like 988 Suicide & Crisis Lifeline, The Trevor Project and Trans Lifeline, which connect callers and copywriters with trained listeners who can de-escalate the situation and provide information on local mental health support.

Adults may underestimate the resources available to them, says Karydi. If the adult or teen does not have access to a trusted healthcare professional who can make recommendations, Karydi recommends speaking to a school counselor, youth counselor, or supportive faith leader, who will have their own suggestions. (Ideally, these professionals are empathetic and avoid judging or stigmatizing what the teen and their adult are experiencing.) County and state mental health organizations can also provide information about accessing medical care. Mental Health America, a national nonprofit, has a comprehensive list of resources for finding therapy. Adults interested in best practices for treating suicidal ideation and behavior in adolescents can read this guide produced by the Substance Abuse and Mental Health Services Administration.

While therapy can be vital for adolescents, it can be unattainable due to cost or a lack of mental health professionals. Karydi says adults should think creatively about ways to strengthen a teen’s bond, which will help reduce the risk of suicide. This may include ways to fulfill a teen’s desire to belong with a peer group at school, be accepted by friends and family, be part of a sports team, or participate in religious activities.

Adults can help teens make healthy choices that will help them stay safe and alive — and then make sure the teen carries them through. While this doesn’t necessarily address underlying mental illnesses that affect suicidal ideation or fundamental changes in life circumstances that make someone more suicidal, it can improve their sense of belonging. This, in turn, can lead to greater happiness and well-being, as well as reduced anxiety, depression, loneliness, and suicidal thoughts.

“We always want to help [a suicidal] person to re-engage, connect, feel a sense of belonging,” says Karydi.

If you are having thoughts of suicide or are going through a mental crisis, please speak to someone. You can reach the 988 Suicide and Crisis Lifeline at 988; the Trans Lifeline at 877-565-8860; or the Trevor Project at 866-488-7386. Text “START” to the crisis text line at 741-741. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday, 10:00 a.m. to 10:00 p.m. ET, or by email [email protected]. If you don’t like the phone, you should use the 988 Suicide and Crisis Lifeline Chat at crisichat.org. Here is a list of international resources.