Suicide prevention can begin with asking a direct question

In my office, a conversation about suicide may start with a patient saying they cannot sleep, a parent mentioning that their teenager has withdrawn from friends or an older adult struggling with pain, illness or the loss of a spouse. None of these concerns necessarily means someone is considering suicide, but each is a reason to ask more questions.

Suicide Prevention Week, Sept. 13-19, gives us a reason to talk about those questions. In 2022, 1,599 Arizonans died by suicide, including 786 people in Maricopa County. According to the Arizona Department of Health Services’ Arizona Suicide Prevention Action Plan 2024-2026, of the statewide deaths, 403 involved adults 65 and older and 46 were children 17 and under. Nationally, suicide claimed 48,824 lives in 2024. Suicide affects patients and families at every stage of life.

Risk does not look the same from one patient to the next. Factors can include depression or another mental illness, a previous suicide attempt, substance use, chronic pain, financial or legal problems, the loss of a relationship, social isolation, bullying and access to lethal means. Rates are also higher among some groups, including veterans, people in rural communities and workers in industries such as mining and construction. Lesbian, gay and bisexual young people report more suicidal thoughts and behavior than their heterosexual peers.

For children and teenagers, changes in behavior matter. Most young people who attempt suicide have a significant mental health disorder, usually depression. Attempts are often impulsive. Warning signs may include changes in eating or sleeping, frequent sadness, withdrawal from family and friends, declining schoolwork, preoccupation with death or giving away important possessions. A young person may make suicidal statements out loud like “I wish I were dead” or say they won’t be a problem for much longer.

My advice to parents who do not know how to begin is to keep the conversation from feeling like an interrogation. Start with a question that cannot be answered with yes, no or fine: "Which emoji describes your mood today?" "What are you most worried about right now?" "Who would you text first in an emergency?" or "What can I do to support you better?" Give the young person time to answer because the first response may not be the whole answer.

If you are worried, be direct: "Are you thinking about suicide?" Asking does not put the idea in someone's mind or make the person more likely to act. It can give someone permission to say what they have been afraid to say and help them accept treatment. I would rather have a parent ask and learn the answer is no than stay silent because the question feels uncomfortable.

A yes answer should always be taken seriously. If there is immediate danger, call 911 or go to the nearest emergency room. Anyone experiencing suicidal thoughts, emotional distress or a mental health or substance use crisis can call or text 988 or chat at 988lifeline.org. The 988 Suicide & Crisis Lifeline is available around the clock, and conversations are free and confidential.

Families do not have to sort this out alone. This is exactly the kind of concern to bring to a family physician or pediatrician, who can evaluate changes in mood and behavior and connect a patient with appropriate care. School counselors and mental health professionals can also help. Support from family and friends, a sense of belonging, access to good physical and behavioral health care and reduced access to lethal means can help protect people at risk.

No one needs a perfect opening line. Notice when something has changed, ask what is going on and be willing to hear the answer. That conversation may be the first step toward getting someone the help they need.