As teen suicide rates go up, a psychiatrist offers parents warning signs and prevention tips

Famously impulsive teens are known for bad decisions and poor risk assessment skills - jumping down too many stairs on a skateboard, blowing off homework. But during this sometimes-tumultuous stage in life, Dr. Bruce Lovelace of St. Thomas Community Health Center says there's something else parents should be aware of. Though it's often hard to think about, troubled young people are at risk for suicidal thoughts and behaviors, and hospitalizations for kids thinking about suicide are on the rise.

At a May Pediatric Academic Societies Meeting, a new study revealed that the percentage of children and teens hospitalized for suicidal thoughts between 2008 and 2015 had doubled since the last period studied. Centers for Disease Control (CDC) and Prevention data cites suicide as the second-leading cause of death nationally for people between the ages of 10 and 24; rates in particular are on the rise among girls ages 10-14.

What's going on? Lovelace can't explain why there's been an uptick in suicidal ideation, but he says parents need to be conscious that today's children and teens deal with challenges far beyond familiar school and relationship issues. A number of modern factors contribute to a fraught mental health environment for young people.

"[There's] social media, which we've heard a lot about. ... The amount of time that I see kids spending on electronics is shocking, even to me, and I grew up in the first Nintendo generation," he says. "I see kids making terrible mistakes with sexting a lot. ... You make these stupid mistakes, and now they're public record."

Also a problem: contemporary drugs. Unregulated drugs like synthetic marijuana are often very accessible to teens, can be dangerous, and are somewhat invisible to parents, Lovelace says. Locally, many kids also have been exposed to unusual levels of trauma related to violent crime, leaving them vulnerable to mental health issues.

"I love this city, but it is a violent, violent place. The number of kids coming through my office with first-degree relatives who've been murdered is stunning," he says. "I can see the effect [violence and incarceration] has on the fabric of society and the family networks."

As they navigate these and other stressors, when teens do withdraw or start seeming depressed, it's easy to write it off as a phase or typical adolescent moodiness. But parents should be attuned to a battery of signs that might indicate suicidal impulses. First, parents should be aware of pre-existing risk factors: any mental health diagnosis, such as anxiety or depression, puts young people at a higher risk or suicide, as does substance use. It's useful to be aware of a family history of other mental health issues, and for perhaps obvious reasons, unlocked firearms in the household can increase suicide risk.

Other behavioral signs are more subtle, and include giving away possessions or a sudden uptick in high-risk behaviors.

"A teen will make what seems like a passing comment [about death or dying], but I would definitely advise parents to take any comments about death, dying, suicide, very seriously," Lovelace says. "Also, watch for major changes in behavior. ... If their functioning level drops, a kid who's been making A's and B's is suddenly failing out, skipping class, those sorts of things, [that's a concern].

He urges parents not to be afraid to ask their child if she's having thoughts about hurting herself. Teens in particular tend not to volunteer information, but can be surprisingly open if asked flat-out.

"Communicating with teens is difficult. ... You have to do an awful lot of listening," he acknowledges. "That's hard to do. ... If you can somehow convince them that you're really listening, you'd be shocked what they'd tell you."

If you're worried about your child, Lovelace says you don't have to wait for a psychiatrist appointment for an initial evaluation. (Especially in New Orleans, private psychiatry practices can have long wait times.) Along with the clinic at St. Thomas Community Health Center, he says the Jefferson Parish Health Services Agency has child psychiatrists on staff, but a primary care doctor or any licensed therapist also can assess for suicidal thoughts and, if necessary, connect parents to more intensive treatment.

Above all, he says, stay checked in with your kids, even if it's hard for you to imagine a young person ever committing suicide - it's kind of a "better safe than sorry" thing.

"They're all going to have bad days," he says. "[But] if there's any doubt, it's always a good idea to talk to them about it. ... Unfortunately it's often obvious in retrospect."