I’m a doctor. This is the surprising truth about teen suicides

Written by Jessica Pierce, M.D., M.Sc. and originally published as a Newsweek MyTurn essay

If you or someone you know is considering suicide, contact the 988 Suicide and Crisis Lifeline by dialing 988, text "988" to the Crisis Text Line at 741741 or go to 988lifeline.org.

It happens quietly, often late at night over the glow of a smartphone.

Sometimes the message is clear, a statement about overdosing or a photo of an empty prescription bottle resting next to a goodbye note.

Sometimes the signal is more subtle, a vague apology or an expression of gratitude written in the past tense.

One child takes a step toward suicide and another grapples with how to respond from the other end of the phone.

As a pediatric psychiatrist evaluating patients in crisis at a busy children’s hospital, I’m alarmed by this increasingly common narrative.

A while back, a distraught mother in the intensive care unit tearfully asked me on repeat: “What if she hadn’t come over?”

Her son overdosed late at night, texted a friend afterward, and then stopped replying.

The friend tried to call his parents, but their ringers were off.

She then woke up her own father and insisted that they drive to the boy’s home.

He required intubation and dialysis, but recovered fully.

In another astounding case, a middle schooler messaged a friend through a video game platform as she ingested a bottle of pills.

Her cyber-only friend — living several states away — mined the chat history for identifying information and called the local police.

When the girl’s parents awoke to an officer knocking at the door, their daughter was already unconscious on the floor.

She, too, made a full recovery.

These stories are remarkable, but unfortunately not uncommon. An adolescent attempts suicide non-fatally in the United States every 36.8 seconds.

For medically serious suicide attempts requiring treatment in a pediatric intensive care unit, national rates doubled from 2009-2017.

Sadly, suicide is the second leading cause of death among American youth ages 10-24.

Invisible in these numbers is a vital element that deserves our attention: the children on the other end of the phone. What’s an adolescent to do if they encounter a message of distress?

For a kid scrolling social media two hours after they’re supposed to be asleep, the calculus is complex.

Maybe I misinterpreted the post. Maybe someone else will do something. Should I call their parents? Maybe I should wake up my own parents. Will they be upset? Maybe I should call 911…

What’s more, they’re maneuvering all this in the context of the unwritten social contract governing adolescents’ engagement with one another.

Breaking confidence is no small thing.

These kids are placed in a double bind, left on their own to weigh the consequences of how their friend might feel if they “tell on them” and how their friend might fare if they don’t.

Add in the potential negative effects of losing a peer to suicide — development of depression, anxiety, post-traumatic stress disorder, suicidal thoughts and self-questioning about one’s own actions — and it’s clear that these what-should-I-do? decisions may have long-lasting consequences for everyone involved.

The point here is not to champion the practice of youth leaning on youth in matters of such gravity, but to highlight the fact that this is the practice already.

Studies show that young people reach out to peers rather than professionals for help during mental health crises.

While some friends show exceptional poise and judgment in responding, research suggests that the majority do not share their concerns with an adult or seek professional help.

The heartbreaking truth is that I have cared for these kids in the hospital, too, the friends who responded — or didn’t respond — in a critical moment.

The despair in these situations is crushing.

No matter how strongly (and rightly) we assert that children should not bear responsibility for keeping their friends alive, the situation remains that our national youth suicide crisis weighs heavily on society’s smallest shoulders.

We need continued research and public health investment in youth suicide prevention, including innovative strategies for the social media age.

At the individual level, we must simply talk more with our kids about suicide.

In my professional opinion as a child psychiatrist and from my personal perspective as a concerned parent, this is a measure akin to promoting seat belts and bicycle helmets.

The American Foundation for Suicide Prevention and the Kids Mental Health Foundation offer helpful guidance for approaching these discussions.

Talking about suicide does not plant ideas or increase risk; it reduces stigma, encourages openness and saves lives.

For the sake of the kids on the other end of the phone, I’d like to propose another dimension to these conversations.

Ask your child what they would do if they received a concerning message or weren’t sure how to interpret a text or post.

Role-play scenarios that are appropriate to field on their own and situations that ought to prompt adult input.

Assure them that you want to be bothered if they’re distressed, no matter the timing or circumstances.

Share your phone number with your kids’ friends and encourage other parents to do the same.

Program the 988 Suicide and Crisis Lifeline into every phone.

As a doctor, I operate by a mental wellness rule: Never worry alone. We cannot protect our children full-stop from the heartache associated with youth suicide.

Let’s at least prepare them to recognize the moments when they shouldn’t worry alone.

At stake is the well being of both children in this regrettable dyad.

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