Monday, July 6, 2015

How do I talk to my kids about suicide?

Although kids cannot relate to the circumstances around Robin Williams' suicide, they'll definitely have questions about suicide when they hear about it. Here's how you can talk about it with your kids.

How do I talk to my kids about suicide?

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Robin Williams' suicide last week, like all suicides, was shocking. He was funny, successful, rich, beloved.

At 63, he was also middle-aged, white, male, depressed, battling a debilitating disease, and had a history of substance abuse. Those are some of the major risk factors for suicide. Combine them with where we are at this point in American history, and he may have had a target on his back. For, we are in the midst of a suicide epidemic, one that is hitting the baby- boomer generation hardest.

Although kids cannot relate to Williams’ situation, they’ll definitely have questions about suicide when they hear about it. And what should you do if your child, passing by the TV or riding in the car while the news is on, asks “What does ‘suicide’ mean?”  If your child is old enough to understand the permanence of death (around age 7), tell the truth.

  • Sometimes people can get so sad that they believe they will be sad forever
  • They aren’t thinking clearly
  • They kill themselves because they mistakenly believe this is the only way to make that sadness go away.
  • People who die by suicide aren’t bad people at all. They were ill and needed help.

For the tween or teen who already knows what suicide is, talking about it openly and calmly, as well as correcting any false assumptions, will help. 

“Children tend to think single life events lead to suicide. I’ve heard things like ‘if you are bullied, then you’ll kill yourself,’” says Catherine Siciliano, Associate Area Director for Philadelphia chapter of the American Foundation for Suicide Prevention and a middle-school teacher.

Say instead that suicide is more complicated than that, and no single or one-time bad experience leads a person to end their life. Repeat that it’s always better to talk about – rather than conceal– suicidal feelings. Remind them that, yes, anyone can have feelings like that, even people, like Williams, who are popular and fun. “Let children know that it is not always easy to see how sad someone is – sometimes they hide their sadness,” said Siciliano.

Why do we need to start talking about suicide? The epidemic among the middle-aged has been going on for 15 years and the numbers are horrifying for all ages.

The rate of suicide among Americans 45 to 64 rose 30 percent from 1999 to 2010. The rate for white, middle-aged men increased 50 percent. Suicide is the third leading cause of death among adolescents, and the fourth among adults 18 to 65, according to Centers for Disease Control and Prevention data released last year,  Beginning in 1999, more Americans killed themselves each year, from 29,199 to 39,518 in 2011. For the first time since the rise of the car, Americans are now more likely to die by their own hand than in a car crash.

There are various theories about the cause. Boomers are aging at a time when better care prevents or delays death by infections or chronic disease, leaving more people more time to commit suicide. Add stressors from the economic downturn.

And then there are those black-box warnings the U.S. Food and Drug Administration imposed about a decade ago stating that some antidepressants were linked to more suicidal behavior. The warnings led fewer doctors to prescribe those drugs and fewer people to take them. Earlier this summer, I wrote about a study in the British Medical Journal that found these warnings may have resulted in an increase in suicide attempts over the last 10 years by adolescents.

Post-mortem studies have suggested that more than 90 percent of people who commit suicide are mentally ill, mostly depressed. There is effective care for depression, but not enough people can get it quickly enough to overcome those temporary feelings of hopelessness.

More chilling, research suggests that suicide rates will keep rising, even among younger people.

In other words, there's no end in sight.

That's scary. So let's learn more about it: The National Suicide Prevention Lifeline is 1-800-273-TALK; visit the American Foundation for Suicide Prevention at

How might you prevent a suicide? First, know there is no evidence that talking about the subject with a suicidal person makes him or her more likely to try. And don't accept the notion that you can't stop a person who is thinking about serious self-harm.

 "Because so many suicidal people are ambivalent about it, you can help just by being there, talking about it openly, destigmatizing it," says Cory Newman, director of the Center for Cognitive Therapy at the University of Pennsylvania. "You can absolutely make a difference, especially if your care, concern, and support encourages the person to take the all-important step of seeking professional help."

Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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