Youth Suicide and Other High-Risk Groups: Prevention and Intervention

Suicide Prevention

Suicide prevention starts with listening. Most people with suicidal thoughts or suicidal ideation are dealing with life problems that lead them to feel trapped, hopeless or helpless. Although there are a number of resources dedicated to suicide prevention, someone may feel more comfortable expressing their suicidal ideations with close friends or family.

When this happens, friends and family should try to listen without judgment or argument. It's natural for friends and family to feel afraid, concerned or tense, but responding emotionally or harshly may cause a fight or exacerbate crisis situations.

A lot of people will at some point experience suicidal thoughts or suicidal ideations. Although most people are determined to live, the expression of suicidal ideations, urges, statements or behaviors should be taken seriously, and the person's problems should never be minimized.

Preventing Youth Suicide

According to youth.gov, youth are particularly vulnerable to suicidal ideation, as suicide is the second leading cause of death among youth age 15 to 24. And approximately one out of 15 high school students report engaging in suicidal behavior each year, with one out of 53 high school students reporting a suicide attempt that required medical treatment. For every suicide death among youth, there are likely 100 to 200 more suicide attempts. And some youth are at even greater risk for suicidal ideation or suicidal behavior including:

• Youth who are exposed to the child welfare system
• Youth who are involved in the juvenile justice system
• Youth with parents in the military
• LGBTQ+ youth
• American Indian youth
• Alaska Native youth

Young people, among others, may feel ostracized for their identity, and often feel isolated by the issues that arise from poor grades, family conflicts, sexual identity or loss of relationship. These mental health and social challenges may manifest as suicidal ideations or crisis situations. Although the problems may seem minor to adults, they should never be minimized: these are very real problems with real consequences to adolescent mental health.

So, again, youth suicide prevention is grounded in empathetic listening and the involvement of professional resources whenever possible.

Parents or other adult guardians—including family members, family friends, teachers, school administrators, coaches and mentors—should be on the lookout for any warning signs or risk factors.

Warning Signs of Suicidal Ideation

Suicide prevention can and should be both proactive and reactive. Family and friends don't have to wait for a loved one to verbalize suicidal thoughts or suicidal ideations. They can look for the warning signs and intervene ahead of time, before a person engages in any suicidal behaviors.

The warning signs that may indicate the occurrence of suicidal ideations include:

• Increased substance use
• Impulsivity or recklessness
• Agitation
• Aggression
• Social withdrawal
• Loss of interest in activities
• Mood swings
• Preoccupation with death
• Talking about death more often
• Purchase of pills or weapons
• Giving away valued possessions
• Expressing hopelessness
• Sleeping very little or too much

If any of these warning signs seem connected to a painful or traumatic event, or result in a mental health crisis, loved ones should be particularly concerned. And if a loved one appears suicidal, immediately consult professional resources, prevention helplines and expert opinion.

Risk Factors That Increase the Likelihood of Suicide

Analyzing and predicting the risk of suicide is complicated. There are no flawless metrics by which to accurately predict someone's risk of suicide, but certain life events, traumatic histories, and mental health and substance use disorders put someone at greater risk. Risk factors that increase the likelihood of suicide or suicidal ideation include:

• History of trauma
• Serious medical disorder or chronic pain
• Access to a firearm
• Head injury
• Substance use disorder
• Significant loss
• Intense emotional distress
• Feeling helpless or hopeless
• Clinical depression
• Psychosis
• Isolation or limited social support
• Limited coping skills
• Prolonged and significant stress
• Family history of suicide
• Personal history of attempted suicide

Assessing a person's risk for suicide becomes more complicated by its nature: suicidal behavior is often precipitated by many factors rather than just one. Also, fewer than half of people who die by suicide have known mental health conditions, and a significant number of people who engage in suicidal behaviors are intoxicated. It's hard to say whether those elements are suggestive of poor access to clinical assessment and diagnosis, or the rate of undiagnosed substance use disorders, but they complicate risk assessment.

At-Risk Groups for Suicidal Ideation and Suicidal Behavior

Suicide crosses all genders, cultures, ages, financial situations, sexual orientations, social groups and races. But professionals heavily consider the intersections—where a person belongs to two or more at-risk groups—among these factors to weigh and assess for suicide risk.

In general, members of the LGBTQ+ community are at a higher risk of suicide, and women are more likely to attempt suicide while men are more likely to die by suicide. The rates generally depend on a multitude of factors, though, and those at highest risk of suicidal ideation and suicidal behaviors are people who belong to several risk categories.

Protective Factors That Limit the Risk of Suicide

Even if a person has a long list of risk factors, they will also have a variety of protective factors, potentially including:

• Social support
• Coping and problem-solving skills
• Access to mental health treatment and other services
• A sense of purpose
• Religious or spiritual beliefs
• Limited access to means of harm

Family and friends can become preemptive support mechanisms. They can support their at-risk loved one, and they can enable and encourage the use of other protective factors and resources, thereby limiting the effects of a crisis, improving mental health and reducing the likelihood of suicidal behavior.

Professional Screening for Suicidal Ideation

To further prevent suicide, medical and behavioral health professionals screen for suicidal ideation, asking patients about historical and recent suicidal thoughts, urges and behaviors. When combined with the analysis of risk and protective factors, medical and mental health professionals can properly evaluate someone for suicide risk, and serve an important role in suicide prevention.

Concerned friends and family members should rely on this resource to better navigate a crisis or high-risk period, encouraging someone who might be at risk of suicide to consult with medical or mental health professionals.

Interventions for Suicidal Ideations or Behavior

Interventions are an important part of suicide prevention, and loved ones can intervene by providing nonjudgmental emotional and social support. They should openly discuss a person's suicidal thoughts, how a person plans to harm themselves and what's keeping that person safe—so long as the family member or friend can respond with patience and without fighting.

When trying to problem solve, family and friends should approach only the short term, and help their loved one get through the present moment. Family and friends should remember that, if the solution were simple, the person would have solved the problems already. And during crisis situations, concerned loved ones should remove any means of harm, like firearms or drugs.

In addition to supportive family members and friends, a person at risk for suicide should be connected with professional resources and consultation, including mental health providers, school counselors, psychiatrists or family physicians.

Professionals may use therapeutic interventions and medication management, and will monitor and adjust techniques over time to reduce the effects of risk factors, increase the effects of protective factors and improve a person's coping skills.

By collaborating with patients, professionals will be able to create safety plans, identify warning signs, build coping skills and find support networks. This way, a person with suicidal ideation will be able to self-regulate—where a person monitors and manages their emotions, thoughts and behaviors—and will learn how to navigate any crisis situations by utilizing their resources.

If you or someone you know is experiencing suicidal ideation, please seek professional help and resources. If you're in need of an urgent intervention, the local emergency room can conduct an assessment and provide hospitalization, or a crisis hotline like the National Suicide Prevention Lifeline can answer your calls at 1-866-831-5700.