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The Division of Psychiatry at Cincinnati Children’s provides answers to frequent questions about depression, suicide and other issues that teens and their families often face.
Teens can often feel better by expressing their feelings to a parent, friend, trusted adult or family member. Teens especially need to feel connected to their families. Family connectedness is a protective factor against depression and suicide.
Teens can connect with their parents by expressing their feelings, showing affection or writing notes / letters to them. When communicating thoughts and feelings to their parents or family members, it is important they use “I” statements. In that way, the teen takes responsibility for his or her feelings instead of placing blame. For example, instead of saying, “You make me mad,” say, “I get upset when …” Hugging their parent(s) or caregivers can also help when feeling sad. Just saying, “I need a hug” or “I love you” can be a good start.
Journaling is another technique that many teens find helpful. Many teens express how they are feeling about their daily life events in a journal. It can also be beneficial for teens to journal each day positive things about their lives or something for which they are thankful. When feeling down, teens can review the positive things they have written to help them feel better.
Exercise is something else teens can do to feel better. Exercise can help get their brain chemicals back to normal. Walking, running, jumping rope, doing aerobic exercises, using the treadmill, bicycling and skating are just some of the things teens can do to exercise. Twenty to 30 minutes of exercise a day can make a difference.
Teens also need at least nine hours of sleep a night. Sleep allows brain chemicals to be restored. Relaxation exercises, listening to music or reading may help if a teen has trouble falling asleep. Inspirational books are especially good to read when feeling down.
Being involved in recreational activities is another way to feel better. Many teens are easily overwhelmed with schoolwork, a part-time job and extra-curricular activities. It’s important to balance work with play. Eating a balanced diet is also important.
Laughter can also be good medicine. Some doctors have even made a CD using this concept for depressed people. Reading a joke book, watching comedy shows, listening to comedians and being around those with a good sense of humor can also be helpful.
However, if a teen has several symptoms of depression such as irritability, anger, sadness, hopelessness, constant fatigue, eating pattern changes, sleep disturbances, social withdrawal and / or poor and declining school performance lasting everyday (or most days) for at least two weeks or longer, he or she needs to be evaluated. Seeing a family physician or pediatrician may be the first step. These doctors can decide whether the teen needs a referral to a mental health professional. It’s important to treat depression early so the teen does not end up in crisis.
There does seem to be a genetic link to depression. Studies have shown that there is a 25 percent chance of a child getting depression if one parent has depression. If both parents have depression, the risk increases to 75 percent.
Environmental factors can also trigger depression. For instance, teens can become depressed as a result of unresolved grief over losses and stressful life events. Often, however, there is a combination of biological and environmental factors that cause depression. Studies with twins have shown that an identical twin has a 30-40 percent chance of getting depression if the other twin has depression. However, for fraternal twins, the risk is only 15-20 percent, which suggests that there is interplay of both factors.
Suicidal thoughts can be a sign of depression. Major depression is the major risk factor for suicide. Studies suggest that approximately 90 percent of suicides were committed by people with major depression or another diagnosable and treatable mental disorder, such as bipolar disorder or schizophrenia. Studies also suggest that genetics have more of an influence toward suicidal tendencies than environmental influences. Certainly, having a friend or family member commit suicide is a risk factor for teen suicide.
Family therapy is an important part of treatment for depressed children and teens. Research has shown that they have an increased risk of suicidal ideation and suicide attempts when family processes are disturbed. Teens who have suicidal thoughts often perceive their families as having poor communication and high levels of conflict. Family therapy can help to enhance family communication and problem-solving skills and reduce power struggles within the family.
If children are actively suicidal, they need to be taken to the emergency room. These are times when they make statements about killing themselves and are feeling unsafe in this respect.
It is important that parents actively listen to their children and accept how they are feeling without reacting and judging. Showing understanding will enable their children to open up and express their thoughts and feelings.
Sometimes teens think about death with no real plan or intention to die. These teens need to be evaluated by a physician as soon as possible, however. If parents are unsure how their children are feeling or of their intentions, then it would be best to call their child’s physician immediately for advice.
Parents who have worries of their children being suicidal should also practice means restriction. This means removing from the home or locking up poisons, prescription medications, some over-the-counter medications (e.g., aspirin, Tylenol), and especially guns. The risk of suicide is increased 20 times when there is access to a gun.
Yes, schools should be addressing the topic of suicide. In fact, there needs to be training at all levels within the schools on how to recognize, respond to and refer students showing signs of suicide risk and associated mental and substance use disorders. As the suicide prevention liaison for the Division of Psychiatry at Cincinnati Children’s, Cathy Strunk, RN, goes into junior and senior high schools to address this issue in health classes and during teacher and parent presentations. Of course, many high school health teachers already include topics of suicide in their curriculum, but aren’t equipped to cover the topic in depth.
Thanks to a grant provided by the J.E. & Z.B. Butler Foundation, there is now a comprehensive effort to address this issue in area schools. Since the initiation of the program, many school nurses, counselors and health teachers have observed more teens asking for help. Teens are also better at recognizing when their friends are having problems and are either reporting it to appropriate adults or encouraging these teens to get help.
Again, teens and children may feel better if they can freely talk about their feelings to friends, family members or trusted adults. Many children will revisit their grief during milestones in their lives. Assuring them that it is OK to cry during these times may be helpful.
During Surviving the Teens / Suicide Prevention Program sessions, many teens become tearful when discussing grief and loss. These teens continue to grieve the loss of their parents years after their deaths. Words aren’t always necessary when comforting a teen during these times. Some teens have expressed how thoughtless comments from others have made them feel worse. Hugging and just showing love and concern will often bring comfort to teens while they are grieving.
Encouraging and sharing cherished memories about the deceased parent can also be helpful. If there are unresolved issues with the deceased parent, it may be helpful to discuss these in counseling. There are also support groups and grieving centers that can help children and teens work through the grieving process. In Greater Cincinnati, Fernside and Companions On a Journey are two grieving centers that offer free counseling and support groups to children and teens who have lost a loved one.
Yes, some parents may do this. High pressure to succeed is a risk factor for suicide in teens. Many depressed, suicidal teens think they can’t meet up to their parents’ expectations or that they should be perfect. They then feel like failures when they don’t do well in certain areas. It’s important for parents to let their children know that it’s OK not to be perfect. Teens need to be able to make mistakes without being shamed by them. Parents need to help their children see mistakes as valuable learning experiences instead of failures.
It’s important for parents to discuss concerns with their children first and share their observations with them. Then parents should discuss concerns with their doctors who can either evaluate their children or make a referral if necessary.
Parents can obtain information about substance abuse from:
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