September was national suicide awareness month, and even though we are half way through October, I thought it would still be a good time to share some suicide awareness and prevention information and resources.
Suicide is the 2nd leading cause of death (behind accidents) for youth ages 10-24 both in the US and in Alaska. The CDC recently reported that nationwide, 22% of 9-12th graders have seriously considered suicide in the past year. Sadly, Alaska has led the nation in youth suicide rates for more than a decade. The Alaska Native community is disproportionately affected with a youth suicide rate more than double that of other groups. Suicidality is greatest in LGBTQIA+ youth with up to 50% of that population considering suicide. Nationwide, more teenagers die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumoina, influlenza, and chronic lung disease COMBINED.
The strongest risk factor for a suicide attempt is a past suicide attempt, especially if there have been multiple attempts. About 30% of teens who attempt suicide will make another attempt. The majority of adolescents who attempt suicide have a behavioral health challenge, with depression being the most common. Other predisposing conditions include oppositional defiance disorder, conduct disorder, anxiety, eating disorder, and substance use. Childhood adversity is associated with increased risk of suicide, which is especially concerning considering the collective trauma of Covid as one big communal ACE (adverse childhood experience). And last but certainly not least is access to lethal means (firearms, medications, ropes, and sharps), which is a potent precipitating risk factor for suicide. Firearms are the most common means for suicide completion.
Importantly, asking about suicide and talking about suicide prevention are NOT risk factors for increasing suicidal thoughts and/or behaviors.
A key component suicide prevention is the formation of a safety plan. This is a plan that lists warning signs, coping strategies, resources, supportive and professional contacts and often includes an exploration of values. The safety plan can serve as a road map for coping with suicidal urges in the future. This is the one I like to use. As part of a safety plan, you will also need to suicide-proof your home by removing firearms, medications (even common ones like tylenol), long ropes, and sharps. I use this graphic to teach families how to suicide proof their homes.
Forming a safety plan is a great opportunity to explore strength-based healing. This means instead of focusing on the challenges and shortcomings that our teens are experiencing, helping them explore their strengths and values. A key part of safety planning and in healing from any level of suicidality is to ask teens what makes their lives worth living. What is important to them, really? What are their values and goals? Write this down. This exploration becomes the beacon that can drive all treatments and healing.
Taking a strength based approach has been shown to mitigate ACEs and negative social determinants of health. If we focus on all that is not going well in a teen’s life, chances are that that teen is going feel more defeated. If, however, we explore with them their values, goals, and strengths, we have the opportunity to help them build confidence and resilience.
Mindfulness practice can play an important role is decreasing depression and suicidality. Studies consistently show that mindfulness alters brain chemistry in ways that support increased positive emotions, self-awareness and impulse control. When we practice mindfulness and connect with our moment to moment lived experience, we can step out of our heads and into our bodies. Our awareness helps us decrease our reactivity and stay focused on the present rather than time traveling to the past or future. We increase mental flexibility and can recognize sadness and hopelessness as passing feelings. We are empowered and see that we have choices of how to act and that there are opportunities before us that may have been obscured.
Urge surfing is a mindfulness practice used to cope with cravings and maladaptive behaviors. It can be effective with suicidal and self-harm urges. To practice urge surfing, the teen first needs to recognize the urge to self-harm. The next step is to locate the sensations of this urge in the body, Is there a tightening, a numbness or tingling. Maybe a feeling of heat or pain or pressure. The teen should then choose one of the strongest sensations to work with and simply keep their attention on this sensation, noticing over time what happens. Does it change? Does it move or grow? Shrink or pass? This exercise shows us how urges pass all by themselves, no matter how strong they are initially. Urges are like ocean waves; they crest and fall and are often strongest just before they break. This practice replaces fear of urges with interest in the present moment experience of them. Urges that are not fed become weaker over time.
If you or somebody you know has suicidal thoughts, please call one of the resources below, your primary care or behavioral health provider, or go to the emergency room.
Want to learn more? Click here to see the slides from a presentation I recently gave on adolescent depression and suicidality at the Alaska PA conference.
Suicide Prevention and Crisis Resources
National Crisis Hotline 988
24/7 free confidential support open to all
Alaska Careline Crisis Intervention 877-266-4357
24/7 free confidential for those in crisis, those in recovery, those worried about someone else
24 hour National suicide hotline 800-273-TALK (8255) or 800-SUICIDE (563-2433)
24 hour crisis line 907-563-3200
Alaska Behavioral Health crisis line
Text Home to 741741
YouthLine: Text “teen2teen” to 839863 or call 1-877-968-8491
safe space for children and adults ages 11 to 21, to talk through any issues they may be facing
Trevor Lifeline (LGBTQIA+ support) 888-488-7386
24/7 free confidential support for LGBTQIA+ kids and teens during a crisis
LGBTQIA+ Hotline 888-843-4564
Trans Lifeline 877-565-8860
CDC. Youth Risk Behavior Sruveillance System (YRBSS). April 27, 2023a. https://www.cdc.gov/healthyyouth/data/yrbs/index.htm
CDC and Lewandowski RE, Acri MC, Hoagwood KE, et al. Evidence for the management of adolescent depression. Pediatircs, 2013. Oct;132(4):e996-e1009
Neha John-Hendeson, “Is Mindfulness as Good as Antidepressants?: Summaries of new research on the effects of mindfulness against depression, the health benefits of a good story, and how kids can deal with mixed messages they get from home and school.” Greater Good: The Science of a Meaningful Life, March 18, 2011, http://greatergood.berkeley.edu/article/research_digest/is_mindfulness_as_good_as_antidepressants
Williams M, Teasdale J, Segal Z, and Kabat-Zinn J. The Mindful Way Through Depression. Guildford Press, 2007. New York.