Suicidal Risk and Prevention in Children and Adolescents: What to do about it? (Part 2 of 3)

This week our guest post comes from nationally certified school psychologist Jason Basinger. Jason is currently part of the Trauma Team for the Utah Education Association, is a board member for the Utah Association of School Psychologists, and serves on the Utah Youth Suicide Prevention Coalition. This blog post is the second of a special 3 part series that will review the risk and protective factors associated with suicidality.

Suicidal Risk and Prevention in Children and Adolescents: What to do about it? (Part 2 of 3)  by Jason Basinger

 Risk Factors: Why is there an increase in suicidality during adolescence?
There is a social problem when it comes to discussing suicide. When it comes to suicide, we usually don’t want to talk about it. One reason it is difficult to discuss is that we lack some understanding about why it happens. If we are to have important conversations with kids and teenagers about suicide, we need to understand why someone becomes suicidal. 
Interpersonal Theory of Suicide provides an explanation for why suicidality increases during adolescence, which suggests that suicidality—thoughts, planning, and attempts—occurs because of emotional pain, perceived burdensomeness, and failed belongingness (Joiner, 2009). Emotional pain includes mental health issues but according to the theory necessitates that their mental stress is severe enough to result in self-harm (Joiner, 2009). Perceived burdensomeness is the perception that one is more often a problem than help to others. Failed belongingness refers to feeling like you are not part of a social group and you do not have a place where you belong. The idea is that each factor creates more for suicidality, and research has shown that risk for suicide is highest when all three factors are present. 
Testa (2017) found that transgender and gender-nonconforming youth are more at-risk for having failed belongingness and perceived burdensomeness and at high risk for suicidality. When anger is paired with failed belongingness and perceived burdensomeness the risk of suicide is even higher (Hawkins, 2014). 
The severity of depression is also a risk factor for suicide, with many studies having found that increased symptoms of depression were associated with increased likelihood of suicide (Flores, 2020; Iorfino, 2017; Janiri, 2020; Schlagbaum, 2020). Other psychological disorders also increase risk of suicide, with mood dysregulation and anxiety being relevant factors (Iorfino, 2017). In one study, participants reported unbearable mental pain and hopelessness as their motivation for suicide (May, 2020).
Another important risk factor is prior suicidality (Iorfino, 2017; Schlagbaum, 2020). One study found that youth who reported suicidal thoughts or attempts at ages 13-14 were more likely to report suicidality at ages 15-16, suggesting that prior behavior is a predictor of risk for ideation and attempts (van Vuuren, 2020).
Other factors also increased risk of suicidality in youth. Current alcohol or substance use, multiple sex partners, lower academic performance, problems with sleep, and poor social support are all factors that increase suicide risk (Flores, 2020; Iorfino, 2017; Schlagbaum, 2020). Flores (2020) found that females in early high school who identify as bisexual, experienced bullying in the past year, or experienced sexual victimization are at increased risk for suicidal behaviors. Holden (2020) found that individuals who reported experiencing bullying during a one-month period were nearly twice as likely to experience suicidality. It has also been found that child-reported family conflict and increased weekend screen time were suicide risk factors (Janiri, 2020).
Stressful life events—which include recent friend/family deaths—are associated with a 45% increased risk for suicidal ideation and a 37% higher risk for suicidal behaviors (Howarth, 2020). Even temporary events that are perceived as a life crisis lead to increased risk of suicide among adolescents (Schlagbaum, 2020). Adolescents and youth may consider COVID-19 related events to be stressful. Compounded by shelter-in-place orders and social isolation, adolescents and children have increased likelihood of experiencing negative emotions (uncertainty, fear, and despair) that impact their mental well-being. Yip and Chau (2020) commented that the Hong Kong community’s “mental wellness was at heightened risk in the SARS epidemic, and the same is true in the current climate of COVID-19″ (pp. 1-2). Health professionals have started suggesting that COVID-19 will lead to increases of “acute stress disorders, post-traumatic stress disorder, emotional disturbance, sleep disorders, depressive syndromes and eventually suicides” (Mucci, 2020, p. 64). 
It is imperative that we address risk factors of suicide with children and teenagers. Not only is adolescence a high-risk period for suicidality, but the current stress of COVID-19 may lead to increased risk. By identifying risk factors, we can provide appropriate support. The next blog post will address protective factors and what decrease risk for suicide.

Jason BasingerAbout the Author

Jason Basinger is a Nationally Certified School Psychologist in Salt Lake City School District. He is currently part of the Trauma Team for the Utah Education Association, is a board member for the Utah Association of School Psychologists and serves on the Utah Youth Suicide Prevention Coalition. He enjoys playing and watching sports with his family, plays guitar, and loves running. He may be contacted at or on Twitter @jason_basinger.
**National Suicide Prevention Week is September 6-12, 2020 and World Suicide Prevention Day is September 10, 2020**
The following are good resources and organizations that promote youth suicide prevention:
If you or someone you know is suicidal, get help immediately via 911, the National Suicide Prevention Lifeline at 1-800-273-TALK or the Crisis Text Line (text “HOME” to 741741).
  • Flores, J. P., Swartz, K. L., Stuart, E. A., & Wilcox, H. C. (2020). Co-occurring risk factors among US high school students at risk for suicidal thoughts and behaviors. Journal of Affective Disorders, 266, 743–752. 
  • Hawkins, K. A., Hames, J. L., Ribeiro, J. D., Silva, C., Joiner, T. E., & Cougle, J. R. (2014). An examination of the relationship between anger and suicide risk through the lens of the interpersonal theory of suicide. Journal of Psychiatric Research, 50, 59–65. 
  • Holden, R., Mueller, J., McGowan, J., Sanyal, J., Kikoler, M., Simonoff, E., Velupillai, S., & Downs, J. (2020). Investigating bullying as a predictor of suicidality in a clinical sample of adolescents with autism spectrum disorder. Autism Research. 
  • Howarth, E. J., O’Connor, D. B., Panagioti, M., Hodkinson, A., Wilding, S., & Johnson, J. (2020). Are stressful life events prospectively associated with increased suicidal ideation and behaviour? A systematic review and meta-analysis. Journal of Affective Disorders, 266, 731–742. 
  • Iorfino, F., Davenport, T. A., Ospina-Pinillos, L., Hermens, D. F., Cross, S., Burns, J., & Hickie, I. B. (2017). Using new and emerging technologies to identify and respond to suicidality among help-seeking young people: A cross-sectional study. Journal of Medical Internet Research, 19(7), 62–75.
  • Janiri, D., Doucet, G. E., Pompili, M., Sani, G., Luna, B., Brent, D. A., & Frangou, S. (2020). Risk and protective factors for childhood suicidality: A US population-based study. The Lancet Psychiatry, 7(4), 317–326.
  • Joiner, T. E., Jr. (2009). Suicide prevention in schools as viewed through the interpersonal-psychological theory of suicidal behavior. School Psychology Review, 38(2), 244–248.
  • May, A. M., Pachkowski, M. C., & Klonsky, E. D. (2020). Motivations for suicide: Converging evidence from clinical and community samples. Journal of Psychiatric Research, 123, 171–177.
  • Mucci, F., Mucci, N., & Diolaiuti, F. (2020). Lockdown and isolation: Psychological aspects of COVID-19 pandemic in the general population. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 17(2), 63–64.
  • Schlagbaum, P., Ruch, D. A., Tissue, J. L., Sheftall, A. H., & Bridge, J. A. (2020). Depressed mood prior to death: Implications for precipitating factors of youth suicide. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 
  • Testa, R. J., Michaels, M. S., Bliss, W., Rogers, M. L., Balsam, K. F., & Joiner, T. (2017). Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors. Journal of Abnormal Psychology, 126(1), 125–136. 
  • van Vuuren, C. L., van der Wal, M. F., Cuijpers, P., & Chinapaw, M. J. M. (2020). Are suicidal thoughts and behaviors a temporary phenomenon in early adolescence? Crisis: The Journal of Crisis Intervention and Suicide Prevention. 
  • Yip, P. S. F., & Chau, P. H. (2020). Physical distancing and emotional closeness amidst COVID-19. Crisis: The Journal of Crisis Intervention and Suicide Prevention.

Watch Jason Basinger’s Webinar

Masked K-12 students working in class
“Mindfulness in Schools: Strategies for Promoting Mental Wellness in a COVID Environment”
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