Author : Joachim Lee, Senior Psychotherapist
The Samaritans of Singapore (SOS) reports that the number of suicides in Singapore rose 10 per cent in 2018, with suicides among boys aged 10 to 19 at a record high. Suicide mortality among youths and males is a “significant societal concern”, SOS said, highlighting that for every 10 suicides in 2018, at least 7 involved males. Among boys aged between 10 and 19 years old, there were 19 suicides last year – the highest since records began in 1991 and almost triple the seven cases recorded in 2017.
Suicide does affect children and adolescents, and avoiding the topic does nobody any favours – burying your head in the sand won’t help them learn how to get help if they find themselves needing it. One common misconception about the discussion of suicide is that talking about it plants the idea in people’s heads, causing children and adolescents to think about it. The simple truth is that parents won’t ever know if their child harbours suicidal thinking if they are too afraid to broach the topic. Suicidal behavior in children is complicated. It can be impulsive and associated with feelings of confusion, sadness, or anger. The so-called “red flags” people are cautioned to look for can be subtle in young children. While a young adult might say something along the lines of, “You’ll be better off when I’m gone,” in contrast, a child might say some something similar to, “No one cares if I’m here.”
While the warning signs in children can be subtle, learning to identify potential red flags plays a crucial role in intervention.
Changes in baseline behaviour:
Take note of behavioural changes that aren’t short-lived. While suicidal behaviour is often associated with symptoms of depression, you might also notice the following changes in your child:
- Changes in sleeping habits (too much, too little, insomnia)
- Changes in eating habits (overeating or eating too little)
- Withdrawing from family and friends (social isolation)
- Psychosomatic symptoms: headaches, stomach-aches, other aches and pains that can’t be explained
Changes at school:
It’s perfectly normal for children to experience ups and downs during the learning process, but a pattern of negative change can be a red flag that a child needs help. Make a note of the following:
- Drop in academic performance
- Decreased interaction with teachers and kids at school
- Lack of interest in school
- Refusal to attend school
- Loss of interest in normal daily activities (playing, sports, co-curricular activities)
Preoccupation with death:
It’s natural for children to think about death at times, particularly when they are coping with loss or hear about tragic events in the news. Preoccupation with death, researching ways to die, and/or talking about their own death can be red flags. Watch for the following warning signs that involve thoughts about death:
- Frequent questions about or looking up ways to die
- Statements about dying or what will happen if the child dies (Examples: “You won’t miss me when I die, I wish I was dead, I won’t bother you anymore when I’m gone.”)
Feelings of hopelessness:
Children who have suicidal thoughts might communicate feelings of hopelessness for the future. They might also make statements about helplessness. These kinds of statements indicate that the child feels as if there is nothing to be done to improve their outcome, and no one can help.
Some children give away their favourite possessions or tell parents, siblings, or friends who should get their favourite possessions. While talk of dividing up possessions might seem like fantasy play to parents, it can signal thoughts of suicide when combined with other changes in behaviour.
Writing or drawing about death or suicide:
Young children often struggle to verbalize intense emotions, but they are likely to take to the diary or drawing block to explore these emotions. Poems, stories, or artwork depicting suicide or, frequent writings and drawings about death should be evaluated.
Significant changes in mood:
Kids experience changes in mood as they grow and work through stressors, but significant changes in mood signal a problem. If your child suddenly shifts from calm and relatively happy to aggressive, completely withdrawn, or very anxious, it’s important to get help.
In addition to the warning signs that a child might experience suicidal ideation, there are also certain factors that can elevate the risk.
- Previous suicide attempt (regardless of how serious)
- Experiencing a loss (this can include grief and the loss of a relationship due to divorce or family discord or break-up)
- Chronic bullying
- Family history of suicide or suicide attempts
- Violence or witnessing violence
- Acute rejection
- Feelings of hopelessness
- Feeling like a burden
Communication Tips with your Child
Any signs of suicidal ideation or behaviour should be taken seriously.
Parents should ask specific, direct questions about suicidal thoughts – “Are you thinking about hurting or killing yourself?”
Parents should also talk openly about depression by asking questions like, “Are you feeling depressed or very sad lately?” These questions show your child that you understand and that you care. Conveying empathy in a time of emotional crisis is crucial. You may be concerned about saying the “right” thing. But the truth is that just having an open and honest discussion with your child can provide them with much-needed support.
Keep the Talk Age-Appropriate
- Make sure that your child understands what you are saying and is not confused or bored by the discussion.
- Use words that your child can understand. Words such as “depression” or “emotional reaction” are probably too complex for a younger child but may be appropriate for an older child or adolescent.
- Try comparing your child’s depression to something that your child is already familiar with like a physical illness such as the flu or an ear infection.
Keep the Conversation Positive
- Depression is a serious illness that causes emotional and physical pain, but try to keep the conversation focused on the positive.
- By maintaining a positive and hopeful outlook in your discussions, you will avoid unnecessarily alarming your child.
Prioritize the Positive
Another important way to prevent suicidal behaviour is to prioritize interacting with your child in positive ways. Sometimes we get into a sort of vicious cycle with a child. The child does something concerning; the parent gets critical; the kid does something more concerning; the parents get more upset. All interactions turn contentious. Interacting in positive ways means doing fun things together, hanging out and chatting about things that aren’t controversial, that aren’t difficult.
- Don’t make promises you cannot keep.
- Don’t go into detail about topics that you are not certain of.
- Do tell your child what you do know.
- Make a list of questions to discuss with your child’s mental health professional.
- Your child needs to know that you recognize and respect their feelings.
- Even if you do not quite understand their thoughts, don’t dismiss their feelings.
- Avoid comments like “What do you have to be depressed about?” or “Don’t be ridiculous.”
- Dismissive comments can cause a child to hide their feelings or become defensive.
It may seem obvious to you that you love your children, and that they know you love them. But when they’re having a hard time, children need to hear over and over again from you how much you love them, and how much you care about them. It’s not good enough to just say, “You know I love you.” You need to convey that in small and big ways. These days, we all have so many things we’re juggling that our children can end up unsure of where they fit in, and whether you really have time for them. Let them know how important they are to you.
Be a Good Listener
- Allow your child to talk openly and express their opinions and thoughts.
- Avoid interrupting, judging or punishing them for their feelings.
- Listening demonstrates that they have someone they can confide in help to sort out their feelings.
If there are any safety concerns, do not provide judgment or discipline; simply remove your child from immediate danger, do not leave them alone, and get them immediate help.
Never dismiss suicidal thoughts in a child and any suicidal thought or behaviour should be brought to the attention of your mental health provider immediately. If needed, bring the child to an emergency room or call an ambulance.
If for some reason the above options are not available, make a referral to the Samaritans of Singapore (SOS) by writing to email@example.com, or calling its 24-hour hotline at 1800-221 4444.
The author hopes that the suicide prevention/awareness workshops he conducts at schools and corporations are doing some good.