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Adolescent Suicidal Thoughts: A Mismatch Between Parent Unawareness and Teen Denial :

January 14, 2019

If we are going to prevent an adolescent from death by suicide, we need to be aware that a teen is at risk and intervene. But just how much do parents suspect their teen has suicidal ideation or otherwise at risk?  

If we are going to prevent an adolescent from death by suicide, we need to be aware that a teen is at risk and intervene. But just how much do parents suspect their teen has suicidal ideation or otherwise at risk?  How much do teens admit to their parents that they are at risk?  To answer that question, Jones et al. (10.1542/peds.2018-1771) share with us a sad but must-read study in which over 5000 adolescents and parents from a large pediatric health network were interviewed about these teens’ lifetime suicidal thoughts.

While the authors do show some moderate congruence between parent and teen in terms of both recognizing and admitting to the teen’s suicidal ideation, the agreement became much lower for thoughts of their teenager actually thinking of death or dying.  More notably, 50% of parents of suicidal teens were unaware that their children had thought of killing themselves, and more than 75% of parents did not realize their adolescent was having recurrent thoughts of death. If parents thought their teenager might kill themselves, the teen denied that thought 48% of the time and in terms of thinking about death, teens predicted to do by parents denied that 67.5%.  These findings suggest that a number of teens at risk for suicide will go undetected—maybe until it is too late.

So what can we do to repair these discrepancies?  We asked Drs. Khyati Brahmbhatt and Jacqueline Grupp-Phelan from UCSF, experts on the topic of teen suicide prevention to provide us with an accompanying commentary (10.1542/peds.2018-3071).  They point out the strength of the findings in this study, given the large sample size, and highlight the fact that teens will often deny their suicidal ideation in a self-report, and that parental awareness even with their teen’s denial is worth pursuing in preventing an at-risk teen from going forward with an actual suicide attempt.  The authors provide more information on risk factors associated with suicide attempts that can help parents, other caregivers, family, and friends to increase their suspicion of whether suicide might be attempted and better direct appropriate preventive treatment strategies such as group and family therapies. Their suggestion of pediatricians having better training in assessing suicidal ideation and using multi-informant assessments to do so, may be the first step in our doing more to prevent attempts from happening.  This study and commentary are must reads if we are going to raise our awareness and that of the communities we serve about better preventing teen suicides and addressing the underlying problems.

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