Talking points: How to talk to teens about depression and suicide

Many of us are familiar with depression in some way. Maybe we have experienced it ourselves or perhaps we have seen a loved one struggle with the disease. I have written about tough topics such as suicide and depression before, for the Transcript and in other contexts as well. I choose to write about these topics for two reasons. First, both are part of my life experience. As much as I've tried to deny it, suicide and depression are a part of who I am. Second, these tough topics need to be talked about often, especially when it comes to our youth. The Center for Disease Control identifies suicide as the third leading cause of death for youth ages 10- 24, as 4,600 young people die by suicide in the U.S. each year.

In this week's continuing coverage of the New Rockford-Sheyenne (NR-S) 2017 Youth Risk Behavior Survey (YRBS), the focus is on parents, mentors and friends, and communication as the vital tool. The YRBS data from NR-S reveals that nearly 29 percent of junior high and high school students have felt sad or hopeless every day for at least two weeks in a row. While teen moods can often be intense and unpredictable, it is important to recognize prolonged feelings of sadness and hopelessness are serious signs of depression.

The National Institute for Mental Health (NIMH) identifies the following as symptoms of teen depression, which have been adapted and listed in the graphic to the right. For me, depression feels like a heavy load of bricks holding me down. I remember how it felt in 2010, when I had sat down with my husband to tell him my depression had returned, despite my beautiful family, comfortable house and successful career. It was like a giant rock sat in my throat as I struggled to say the word "depression." You see, my depression didn't want me to call it out, but I knew I needed to. I couldn't afford to keep it a secret. As the American Foundation for Suicide Prevention (AFSP) says, "Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Conditions like depression, anxiety and substance problems, especially when unaddressed, increase risk for suicide."

Of the junior high students who responded to the YRBS, 26.2 percent reported having thought about suicide. Nearly 24 percent of high school students answered 'yes' to the same question. Perhaps the most startling piece of data I saw in the YRBS report was that 23.8 percent of junior high students and 17.1 percent of high school students said that in the 12 months prior to the survey, they had made a plan for ending their life.

This is the kind of information that leaves parents, mentors and friends stunned and asking, "How do I know if someone I care about is among those who reported feeling depressed or having thought about suicide?" and "What can I do to help someone who is struggling with depression or thoughts of suicide?"

The answer is both fairly simple and incredibly complicated, as it depends on one vital component: communication. The National Association of School Psychologists (NASP) says youth who are feeling suicidal are not likely to seek help for a variety of reasons. Teens may not acknowledge the problem or may not be aware that treatment is available. They can also be concerned about stigma or shame, becoming resistant to ask for help.

The NASP elaborates, "youth who are contemplating suicide frequently give warning signs of their distress. Parents [and others] are in a key position to pick up on these signs and get help. Most important is to never take these warning signs lightly or promise to keep them secrets."

A list of warning signs has been adapted from the APA website http://www.apa.org/research/action/suicide.aspx and is included on the graphic on the right.

While parents, mentors and peers don't have to wait for a loved one to display warning signs in order to have a life-saving conversation, these warning signs are red flags that require attention. Starting the conversation doesn't have to be terribly awkward.

It may help to set aside time in which you'll not be interrupted. This could be during a walk or a long drive, while cooking dinner, gardening or tinkering in the workshop. The important thing is that both parties involved feel comfortable and safe to talk openly.

For many, the thought of having a conversation about depression or suicide is extremely uncomfortable, and they are right. Eddy County Community Cares (ECCC) has hosted both ASIST and SafeTalk in recent years, to prepare professionals so they can best help those struggling with suicidal behaviors get the care they need. ECCC President Mindy Meier says, "The conversation is never an easy one to have, but it helps to acknowledge that truth. Being direct can open new pathways to communication and offer a deeper level of compassion and understanding." Additional information on future trainings through ECCC will be shared as information becomes available.

While it may be helpful to engage in some chit-chat before diving into the heavier aspects of the conversation, it is most effective to be direct. Asking about depression or suicide does not cause or encourage suicidal behavior. In fact, the APA states, "Addressing the topic of suicide in a caring, empathetic and nonjudgmental way shows that you are taking your child seriously and responding to their emotional pain."

Here are a few initial talking points to get the conversation started:"I've been noticing that you seem very sad and not yourself lately. I'm really concerned. Can we talk about what's going on?"

"I'm really worried about you. Can we talk?"

"You know, I never thought this was something I'd be talking about with you, but I think it's really important."

"I had no idea things were so bad for you. I'd like to hear more about what's going on."

One of the most powerful things we can do is directly ask if the person is feeling suicidal. As we do so, it is important to show empathy and compassion. We can do this by letting the person know that we recognize how difficult it is to share. Also, it is important that we stay calm.

While it is normal be emotional during such an intense conversation, we don't want the anger or heartbreak we are feeling to interfere or minimize the way the teen is feeling. As uncomfortable as it is, it is most effective to ask the difficult questions directly. Here are some questions to ask:

"Sometimes when people find themselves in a really tough spot, they begin thinking about hurting themselves. Is this something you've been experiencing?"

"It sounds like you are dealing with a lot right now. Does it ever just feel like too much?"

"Do you feel safe?"

"Have you been thinking of hurting yourself?"

Or simply, "Are you feeling suicidal?"

If a teen shares that they are experiencing severe depression or are having suicidal thoughts, it is best to respond with genuine concern for their well-being and offer reassurance that help is available. Here are some ways to continue the conversation:

"I do not want you to hurt yourself. I will do everything possible to keep you safe."

"I know things are feeling exceptionally bad now, but I promise we will get you the help you need."

When seeking professional help for depression, it may be helpful to first visit a primary care physician. Not only can a provider make a referral to a psychologist, he or she can also prescribe antidepressants, which can provide great relief during difficult times. You may also want to ask trusted friends if they can make any recommendations for a therapist or counselor. In addition, informational pamphlets prepared by ECCC are available at the library, social services, clinics and other public spaces throughout the community. Below is a list of some of mental health professionals available in the area:

 • Advanced Counseling for Change Horizon: Lisa Hawley, LICSW- (701) 662-1893

 • Blooming Prairie Assessments Mental and Therapy Centers: Jennifer Hoffarth, Psy D & Jocelyn Soderstrom, Psy D- (701) 622- TALK

 • Lake Region Human Service Center- (701) 665-2200

 • Sanford Health (with availability in Carrington): Dr. John Collins, Psychologist- (701) 251-6000, and Jessie Fuher, MS, NCC- (701) 252-9838

There are times that immediate help is required. If a teen is struggling with suicidal thoughts, the most important follow-up question to ask is whether they have a plan for suicide. There are not many easy ways to ask this question, but it very well could be the most important question that can be asked. Also it is important to be direct. Some examples include, "Has suicide been on your mind for sometime now? Do you have a plan you intend to carry out?" or simply "Do you have a plan?"

If the teen has made specific suicide plans, it is a crisis that requires immediate attention. In such a crisis, your task is to seek out the appropriate help. If possible, take the teen to a clinic, psychiatric hospital or emergency room.

There are several facilities in N.D.'s larger cities that offer psychiatric inpatient services to aid people in recovering from severe depression and suicidal ideation:

 • Altru Hospital, Grand Forks - (701) 780-5000

 • Prairie St. John's, Fargo (877) 333-9565

 • CHI St. Alexius Health, Bismarck- (877) 530-5550

 • Sanford Health, Fargo & Bismarck- (800) 437-4010

If it is not possible to seek out professional help immediately, do not leave the teen alone. It is advised to restrict access to hazardous objects such as firearms, sharp objects, alcohol and illegal substances, poisonous materials and prescription drugs. You can always call the National Suicide Hotline 24 hours a day at 800-273-TALK to speak with a trained professional who can help.

On a final note, a safety plan can help teens who are struggling with depression or suicidal thoughts during any stage of their recovery. The American Academy of Child and Adolescent Psychiatry outlines the elements of a safety plan:

 • Identify triggers: For some this could be a song, a time of the year or a specific situation.

 • Develop coping strategies, including healthy and unique hobbies. (I find nature or art-based hobbies to be most beneficial. Drawing, painting, photography, taxidermy and foraging are just a few of my go-to activities, but anything that stimulates the imagination is great.)

 • Find reasons for living by celebrating even the smallest of victories. It can be very healing to have future possibilities to look forward to as well as loved ones to share time.

 • Create a list of people to call upon in times of distress. This can include trusted family members, close peers, healthcare professionals, pastors or other mentors, and hotlines.

This is by no means a complete or definitive collection of information on the topics of depression and suicide. It is merely a starting point to a conversation that can continue to develop through time. You may want to do additional research on your own, or speak to folks in the area who have experience and training in these situations. In an ongoing effort to help the youth of community, we can help teens integrate resiliency factors into their coping strategies. These resiliency factors include problem-solving stills, family support, open communication, strong social capital and access to effective medical and mental health resources, and can help moderate the impact of stress on depression and suicidal behavior. The youth of our community are our future-- let us help them shine.