"Adolescents with underlying mental issues such as depression, anxiety or drug abuse are at the highest risk," Shaffer warned.
Red flags: Parents should look for signs of depression, anxiety, irritability and withdrawal that seem to go beyond the usual teenage angst. "Depression in particular is very untreated in adolescents. This is a problem because many don't understand it or know how to articulate it, and because of this parents miss it or don't take it seriously," Shaffer said.
Symptoms of depression can include extreme self-criticism, statements of hopelessness, loss of energy and interest, and neglected hygiene. Changes in sleep and eating patterns are common.The child may also complain frequently of physical ailments, such as a stomachache or make other excuses to get out of going to school and to avoid social interactions. Impulsive, risk-taking behavior, such as drinking and drug taking, are major warning signs, especially for boys. More than two-thirds of suicidal boys are classified as alcohol abusers."
Suicidal boys will often make their attempt spontaneously -- for example, immediately after getting into trouble at school, after someone they know has attempted suicide or even after hearing about a suicide in the media. Perfectionists who can't seem to shut off worry may attempt suicide just before a big, stressful event. Surprisingly, kids in treatment sometimes attempt suicide just as they seem to be making improvements. Shaffer speculated that is when they finally have the energy and the will to carry out their plans.
Take action: If you suspect your child may be having suicidal thoughts, don't delay asking your child about how he or she is feeling. Because teens often won't disclose much face-to-face, consider downloading a depression questionnaire from the Internet and having them fill it out. "That's my top recommendation." Shaffer said. "Studies show kids are more likely to tell a form or a computer how they're feeling than anyone else."
If your teen scores high on a depression screen, or you otherwise suspect he or she may be having suicidal thoughts, Shaffer urges parents to take immediate action. "Take them to the family doctor or a psychiatrist who specializes in youth. The sooner they start treatment the better."
At Risk: "We are learning there is a powerful biology connected to the presentation of an eating disorder," said Dr. Walter Kaye, director of the eating disorders treatment and research program at the University of California at San Diego. "Perfectionists, achievement oriented, anxious, compliant teens tend to be at a higher risk though not everyone who suffers from an eating disorder has all of these traits." Girls are more susceptible than boys, and minorities are diagnosed at a similar rate to whites.
Red Flags: Dieting often precedes an eating disorder such as anorexia, warned Kaye. Changes in eating habits such as eating very small meals, going vegetarian and avoiding fat are typical as well, and "becoming very concerned about the way they look and seeing themselves as fat even when they are emaciated."
Bulimics, those who binge and purge but may not lose weight, tend to be secretive about food. "Watch for teens who hide food or who avoiding eating meals in front of others," Kaye advised. Bulimics are more apt to struggle with impulse control and may engage in risk-taking behaviors, such as drinking, promiscuity and even kleptomania.