Worried that your preteen may be suicidal? Learn how to spot the warning signs of suicide to get your child needed help.

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Credit: moodboard Photography/ Veer

Suicide is a hard topic for parents to think and talk about. Yet when "13 Reasons Why" premiered on Netflix last year, it sparked a conversation in classrooms and around dinner tables. The first season of the show followed Hannah Baker, a high schooler who committed suicide and left cassette tapes behind for her classmates. It caused Google searches for suicide how-tos and prevention to increase. Now that season 2 of the show is available to watch, it's likely that a conversation will again be sparked about suicide (and hopefully suicide prevention). If parents allow their children to watch the second season, experts recommend families watch it together and discuss topics raised. It is also important to recognize the warning signs and know what to do if you are concerned about your child.

Although suicide is rare for children between ages 10 and 14, it is still the second leading cause of death for this age group as of 2016, according to the Centers for Disease Control and Prevention. A 2011 study from the University of Washington found that 40 percent of children who have attempted suicide have done so at least once before high school, making suicide an important issue to address at these younger ages. "Suicide and suicidal behaviors are not caused by single agents, such as what causes malaria or some other physical disease. Typically, many risk factors are involved," explains Lanny Berman, Ph.D., executive director of American Association of Suicidology. Some of the most common elements that can influence a child's risk for suicidal tendencies are:

Suicide Risk Factors

Genetic factors:

  • family history of suicide
  • family history of mental illness

Psychological factors:

  • mental health disorders such as bipolar or psychotic disorders
  • self-injurious behavior
  • depression

Contextual factors:

  • substance abuse
  • family conflict
  • divorce
  • emotional or physical abuse
  • bullying

History factors:

  • traumatic past experiences
  • abuse

"The underlying factors that place a child at risk for suicide are often more challenging to detect from the outside," says Christine Moutier, M.D., chief medical officer for the American Foundation For Suicide Prevention. One reason might be that some mental health conditions may not have fully emerged or been diagnosed, and preteens often haven't begun to engage in some of the more obvious typical warning signs of suicide, such as verbalizing feelings of hopelessness, self-injury, and alcohol or substance abuse. "But if a parent or teacher notices changes in behavior that could indicate the presence of or a deterioration in mental health, this recognition of significant underlying contributing risk factors and getting the child help could be a critical step in preventing suicide," Dr. Moutier says.

Warning Signs to Look Out For

If you're concerned that your child may be suicidal, "be on the lookout for changes in behavior, anger outbursts, significant mood changes, withdrawal from family and friends, and changes in daily patterns like sleep, appetite, or energy changes," Dr. Moutier says. Keep an eye on children who perceive and remember most events as negative, and disregard positive events. "If your child lets you know he is thinking about suicide, or if he is talking about suicide, or if you sense that he may have a plan to attempt suicide, don't hesitate to access help right away," says Jephtha Tausig-Edwards, Ph.D., a clinical psychologist in private practice and a clinical instructor at Mt. Sinai Medical Center in New York City. Dr. Berman suggests using the acronym IS PATH WARM? (for more information, visit suicidology.org) to help parents, teachers, and others who work with children to determine if a child is at risk for suicide.

Ideation (or thoughts of suicide)Substance AbusePurposelessnessAnxiety (agitation, restlessness, insomnia)TrappedHopelessnessWithdrawalAngerRecklessnessMood Changes?You must ask

"Take any indication of suicide risk in a child seriously. The idea that a child is being manipulative or making a 'cry for help' is dangerous," Dr. Moutier says. "Not only could the child's risk actually be critical, but even if [she is] not at short-term risk for suicide at that time, that plea for attention does indicate that a deeper issue is going on that warrants evaluation and could be addressed. There is help available; proactive steps can make a difference in the overall course of mental health."

What Parents Can Do

If you suspect your child could be suicidal, start open-ended conversations by saying, "Tell me more about how you feel" or asking "Can you explain what you are thinking?" If you notice any troubling psychological changes, or changes in mood, sleep or appetite, contact your pediatrician, local mental health service providers, or 1-800-273-TALK (the National Suicide Prevention Lifeline) for referrals and recommendations for professionals trained in suicide risk. If you sense that your child is in a volatile state and an immediate threat to himself, seek help immediately by going to the nearest emergency room or calling 911, Dr. Tausig-Edwards says. "It is always better to err on the side of caution in this situation and seek professional help right away. Remember that, while suicide in preteens is rare, the risk sharply increases once they hit their high school years. Now is the time to keep a watchful eye for any changes, ask questions, listen, and seek help when needed. Suicide is never something to keep secret."