Suicide and the School

Suicide in Youth 


Watkins, MD 

According to the Surgeon General, a youth commits

suicide every two hours in our country. In 1997, more

adolescents died from suicide than AIDS, cancer, heart

disease, birth defects and lung disease. Suicide claims

more adolescents than any disease or natural cause.

Adolescents now commit suicide at a higher rate than the

national average of all ages. The rate of adolescent

suicide in adolescent males has tripled between 1960 and

1980. Suicide rates for adolescent females have

increased between two to three fold. There have been

striking increases in suicidal behaviors among African

American males, Native American males and children under

14. Much of the increase can be accounted for by deaths

due to guns. 

Suicidal behavior is the end result of a complex

interaction of psychiatric, social and familial factors.

There are far more suicidal attempts and gestures than

actual completed suicides. One epidemiological study

estimated that there were 23 suicidal gestures and

attempts for every completed suicide. However, it is

important to pay close attention to those who make

attempts. 10% of those who attempted suicide went on to

a later completed suicide. A suicide has a powerful

effect on the individual’s family, school and community.

We must deal with it as a public health crisis in our

schools, clinics and doctors’ offices. 


changes that might be related to the rise in adolescent

suicide include an increased incidence of childhood

depression, decreased family stability, and increased

access to firearms. 

Suicidal behaviors are often associated with depression.

However, depression by itself is seldom sufficient.

Other co-existing disorders, such as attention deficit

hyperactivity disorder, substance abuse or anxiety can

increase the risk of suicide. Recent stressful events,

can trigger suicidal behavior, particularly in an

impulsive youth. Girls may be more likely to make

suicidal attempts, but boys are more likely to make a

truly lethal suicide attempt. 

Risk factors for suicide


  • Previous suicide attempts

  • Close family member who has committed suicide.

  • Past psychiatric hospitalization

  • Recent losses: This may include the death of a

    relative, a family divorce, or a breakup with a


  • Social isolation: The individual does not have

    social alternatives or skills to find alternatives

    to suicide

  • Drug or alcohol abuse: Drugs decrease impulse

    control making impulsive suicide more likely.

    Additionally, some individuals try to self-medicate

    their depression with drugs or alcohol.

  • Exposure to violence in the home or the social

    environment: The individual sees violent behavior as

    a viable solution to life problems.

  • Handguns in the home, especially if loaded.


research suggests that there are two general types of

suicidal youth. The first group is chronically or

severely depressed or has Anorexia Nervosa.  Their

suicidal behavior is often planned and thought out. The

second type is the individual who shows impulsive

suicidal behavior. He or she often has behavior

consistent with conduct disorder and may or may not be

severely depressed. This second type of individual often

also engages in impulsive aggression directed toward


Adolescents often will try to support a suicidal friend

by themselves. They may feel bound to secrecy, or feel

that adults are not to be trusted. This may delay needed

treatment. If the student does commit suicide, the

friends will feel a tremendous burden of guilt and

failure. It is important to make students understand

that one must report suicidal statements to a

responsible adult. Ideally, a teenage friend should

listen to the suicidal youth in an empathic way, but

then insist on getting the youth immediate adult help. 



  • Suicidal talk

  • Preoccupation with death and dying.

  • Signs of depression

  • Behavioral changes

  • Giving away special possessions and making

    arrangements to take care of unfinished business.

  • Difficulty with appetite and sleep

  • Taking excessive risks

  • Increased drug use

  • Loss of interest in usual activities


Checklist from “American Foundation for Suicide




  1. Previous suicide attempts/current suicidal thoughts

  2. Drug or alcohol abuse

  3. Access to firearms

  4. Situational stress



Signs of depression in teens

  1. Sad, anxious or “empty” mood

  2. Declining school performance

  3. Loss of pleasure/interest in social and sports


  4. Sleeping too much or too little

  5. Changes in weight or appetite

Signs of Bipolar Disorder in


  1. Difficulty sleeping

  2. Excessive talkativeness, rapid speech, racing


  3. Frequent mood changes (both up and down) and/or


  4. Risky behavior

  5. Exaggerated ideas of ability and importance


Three steps parents can take

  1. Get your child help (medical or mental health


  2. Support your child (listen, avoid undue criticism,

    remain connected)

  3. Become informed (library, local support group,


Three steps teens can take

  1. Take your friend’s actions seriously

  2. Encourage your friend to seek professional help,

    accompany if necessary

  3. Talk to an adult you trust. Don’t be alone in

    helping your friend.



Intervention can take many forms and should throughout

the different stages in the process. Prevention includes

education efforts to alert students and the community to

the problem of teen suicidal behavior. Intervention with

a suicidal student is aimed at protecting and helping

the student who is currently in distress. Postvention

occurs after there has been a suicide in the school

community. It attempts to help those affected by the

recent suicide. In all cases it is a good idea to have a

clear plan in place in advance. It should involve staff

members and administration. There should be clear

protocols and clear lines of communication. Careful

planning can make interventions more organized, and


Prevention often involves education. This may be done in

a health class, by the school nurse, school

psychologist, guidance counselor or outside speakers.

Education should address the factors that make

individuals more vulnerable to suicidal thoughts. These

would include depression, family stress, loss, and drug

abuse. Other interventions may also be helpful. Anything

that decreases drug and alcohol abuse would be useful. A

study by Rich et al found that 67% of completed youth

suicides involved mixed substance abuse.  PTA meetings

family spaghetti dinners can draw in parents so that

they can be educated about depression and suicidal

behavior. “Turn off the TV Week” campaigns can increase

family communication if the family continues with the

reduced TV viewing. Parents should be educated about the

risk of unsecured firearms in the home. Peer mediation

and peer counseling programs can make help more

accessible. However, it is critical that students go to

an adult if serious behaviors or suicidal issues emerge.

Outside mental health professionals can discuss their

programs so that students can see that these individuals

are approachable. 

Intervention with a suicidal

student: Many schools have a written protocol for

dealing with a student who shows signs of suicidal or

other dangerous behavior. Some schools have automatic

expulsion policies for students who engage in illegal or

violent behavior. It is important to remember that teens

who are violent or abuse drugs may be at increased risk

for suicide. If someone is expelled, the school should

attempt to help the parents arrange immediate, and

possibly intensive psychiatric and behavioral


  1. Calm the immediate crisis situation. Do not leave

    the suicidal student alone even for a minute. Ask

    whether he or she is in possession of any

    potentially dangerous objects or medications. If the

    student has dangerous items on his person, be calm

    and try to verbally persuade the student to give

    them to you. Do not engage in a physical struggle to

    get the items. Call administration or the designated

    crisis team. Escort the student away from other

    students to a safe place where the crisis team

    members can talk to him. Be sure that there is

    access to a telephone.

  2. The crisis individuals then interview the student

    and determine the potential risk for suicide.

    1. If the student is

      holding on to dangerous items, it is the highest

      risk situation. Staff should call an ambulance

      and police and the student’s parents. Staff

      should try to calm the student and ask for the

      dangerous items.

    2. If the student has

      no dangerous objects, but appears to be an

      immediate suicide risk, it would be considered a

      high-risk situation. If the student is upset

      because of physical or sexual abuse, staff

      should notify the appropriate school personnel

      and contact Child Protective Services. If there

      is o evidence of abuse or neglect, staff should

      contact parents and ask them to come in to pick

      up their child. Staff should inform them fully

      about the situation and strongly encourage them

      to take their child to a mental health

      professional for an evaluation. The team should

      give the parents a list of telephone numbers of

      crisis clinics. If the school is unable to

      contact parents, and if Protective Services or

      the police cannot intervene, designated staff

      should take the student to a nearby emergency


    3. If the student has

      had suicidal thoughts but does not seem likely

      to hurt himself in the near future, the risk is

      more moderate. If abuse or neglect is involved,

      staff should proceed as in the high-risk

      process. If there is no evidence of abuse, the

      parents should still be called to come in. They

      should be encouraged to take their child for an

      immediate evaluation.

    4. Follow-Up: It is

      important to document all actions taken. The

      crisis team may meet after the incident to go

      over the situation.  Friends of the student

      should be given some limited information about

      what has transpired. Designated staff should

      follow up with the student and parents to

      determine whether the student is receiving

      appropriate mental health services. Show the

      student that there is ongoing care and concern

      in the school.

Postvention: An attempted

or completed suicide can have a powerful effect on the

staff and on the other students. There are conflicting

reports on the incidence of a contagion effect creating

more suicides. However, there is no doubt that

individuals close to the dead student may have years of

distress. One study found an increased incidence of

major depression and posttraumatic stress disorder 1.5

to 3 years after the suicide. There have been clusters

of suicides in adolescents. Some feel that media

sensationalization or idealized obituaries of the

deceased may contribute to this phenomenon. 


school should have plans in place to deal with a suicide

or other major crisis in the school community. The

administration or the designated individual should try

to get as much information as soon as possible. He or

she should meet with teachers and staff to inform them

of the suicide. The teachers or other staff should

inform each class of students. It is important that all

of the students hear the same thing. After they have

been informed, they should have the opportunity to talk

about it. Those who wish should be excused to talk to

crisis counselors. The school should have extra

counselors available for students and staff who need to

talk. Students who appear to be the most severely

affected may need parental notification and outside

mental health referrals. Rumor control is important.

There should be a designated person to deal with the

media. Refusing to talk to the media takes away the

chance to influence what information will be in the

news. One should remind the media reporters that

sensational reporting has the potential for increasing a

contagion effect. They should ask the media to be

careful in how they report the incident. Media should

avoid repeated or sensationalistic coverage. They should

not provide enough details of the suicide method to

create a “how to” description. They should try not to

glorify the individual or present the suicidal behavior

as a legitimate strategy for coping with difficult



can you say to support a

student with suicidal thoughts and a low self-esteem?

  • Listen actively. Teach problem-solving skills

  • Encourage positive thinking. Instead of saying that

    he cannot do something, he should say that he will


  • Help the student write a list of his or her good


  • Give the student opportunities for success. Give as

    much praise as possible

  • Help the student set up a step-by-step plan to

    achieve his goals.

  • Talk to the family so that they can understand how

    the student is feeling.

  • He

    or she might benefit from assertiveness training

  • Helping others may raise one’s self-esteem.

  • Get the student involved in positive activities in

    school or in the community.

  • If

    appropriate, involve the student’s religious


  • Make up a contract with rewards for positive and new




Rich et al, San

Diego Suicide Study: Young versus Old Subjects. Arch

Gen Psychiatry 43: 577-582 1986. 

Apter et al

Correlation of Suicidal and Violent Behavior in

Different Diagnostic Categories in Hospitalized

Adolescent Patients, Journal of the American Academy

of Child and Adolescent Psychiatry, 34:7-11 1995. 

Garnefski, N. et

al, Suicidal Behavior and the Co-occurrence of

behavioral, emotional and cognitive problems among

adolescents, (in press) Archives of Suicide Research

Brent, D.A. et

al, Long-Term Impact of Exposure to Suicide: A

Three-Year Controlled Follow-up, Journal of the

American Academy of Child and Adolescent Psychiatry,

35:5-13, 1996. 

Hughs, D.H., Can

the Clinician Predict Suicide? Psychiatric Services:

46:5-13, 1995. 


Psychiatric Press Textbook of Psychiatry, Second Edition.

Chapter on Suicide. 


Foundation for Suicide Prevention 


Association of Suicidology   

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