Rates of mental health emergencies are increasing among teenagers around the world, according to a new study from the University of Calgary. It found an increase in pediatric emergency room visits for suicide attempts, suicidal ideation, and self-harm during the first year of the pandemic.
It’s a particular concern because for teenagers, suicide can be contagious.
Teenagers with a friend or family member who died of suicide were at significantly higher risk of suicide than those without, according to a 2016 review published by the American Association of Suicidology.
"[Teenagers'] emotional development means that they experience trauma and tragedy in slightly different ways," said Seth Abrutyn, Ph.D., and associate professor of sociology at University of British Columbia who has studied youth suicide contagion, in an email to ABC News. "Youth rarely are ready to make sense of a death – let alone something as confusing as a suicide."
A growing crisis: 'Perfect recipe for declining mental health'
Suicide rates were growing even before the COVID-19 pandemic. According to data from the Centers from the Disease Control (CDC), suicide rates in U.S. preteens increased by over 40% from 2009 to 2019.
"[This] crisis has been growing for many, many years," Dr. Neha Chaudhary, a child and adolescent psychiatrist at Massachusetts General Hospital and Chief Medical Officer at BeMe Health, told ABC News in an email. "Add to the social isolation, grief, and lack of structure an overwhelming sense of uncertainty and you have a perfect recipe for declining mental health."
Per the CDC’s 2021 Youth Behavior Risk Survey, there are high levels of hopelessness across all ages and demographics. The data shows that one in three teenage girls and one in seven teenage boys "seriously" considered suicide.
Teens are particularly vulnerable to contagion because of constant exposure to their peers through school and social media, Abrutyn said. They see their peers as role models and are highly susceptible to their influence. In the case of a suicide, this can be extremely jarring to their developing sense of identity.
Having a friend or person in their peer group die by suicide or attempt suicide can also normalize something that drastic, according to a study from the Journal of Health and Social Behavior. Girls are more vulnerable to this contagion than boys, according to a review by the American Sociological Association. That review also found that friends’ suicide attempts can have more of an impact than family members’ if they were perceived as a role model.
"If adults do not step in to help make sense of the trauma in health and appropriate ways…the wrong sorts of stories about suicide may spread; stories that kids can identify with easily to make sense of their own problems," Abrutyn said.
How parents can help
Hearing or talking about suicide isn’t inherently dangerous, experts say.
"The idea that talking about suicide causes suicide is unfortunately rampant among adults and not based in any evidence-based research" Abrutyn said. "It fosters a culture of stigma and repressed help seeking."
But the discussion should be framed in a thoughtful way — like that it’s a disease that can be treated, Chaudhary said.
"Parents can explain that someone was struggling with a disease and died because of it, and that it is a very sad thing that happened," she said. "It's also important to let kids know that if they or someone they know has thoughts of suicide, that there are several ways to get help right away."
An important way for parents to protect their kids from suicidality is to ask about it, Chaudhary said.
"If you've never talked about it before, it's OK to say to an older kid, 'Hey, I know this might seem out of nowhere, but I wanted to ask you— have you ever had thoughts of suicide before?,'" Chaudhary said.
With younger kids, you can phrase the conversation differently. "You might say something like: ‘Sometimes when kids are feeling sad or really upset they feel like they don't want to be alive anymore. Have you ever had that feeling before? It's OK if you have, I just want to know so we can figure out how to help you not feel like that again, or to know what to do if the feeling comes back.’"
The Huntsman Mental Health Institute at the University of Utah has guides available for talking to children about suicide at various ages.
Parents can also encourage kids to stay physically active and exercise. Exercise can help protect against suicide, research shows. One study found that at least 5 hours of physical exercise per week was associated with less risk of suicidal ideation in college students.
Suicide prevention programs in middle and high schools can also be effective. The Substance Abuse and Mental Health Services Administration (SAMHSA) has a free toolkit available with information sheets, training tools, and screening protocols for high schools. The American Foundation for Suicide Prevention (AFSP) has a list of recommended community programs for both students and teachers.
One program, Sources of Strength, has been implemented in thousands of schools across the U.S. and Canada. Research published in the American Journal of Public Health showed its approach improved help-seeking, connectedness with adults, and school engagement. These factors are protective against suicide, as well as school dropout, depression, and substance use problems.
"If we're going to move the needle in a high school, we have to have high school students involved," Sources of Strength CEO Scott LoMurray told ABC News. "We showed that you could use peer leaders to change population level health norms"
Resilience can also be contagious, he said.
"Positive things can spread through networks in really remarkably similar ways to [negative things]," LoMurray said. "We're training students to… become patient zero in an epidemic of health."
If you or someone you know is struggling with thoughts of suicide — free, confidential help is available 24 hours a day, 7 days a week. Call or text the national lifeline at 988. Even if you feel like it, you are not alone.
Nisarg Bakshi, DO is a pediatrics resident at University of Chicago Comer Children's Hospital and a contributor to the ABC News Medical Unit.