How to Talk to Children About Spade and Bourdain Suicides

Two tragic celebrity deaths by suicide have saturated the media over the past week. American fashion designer, Kate Spade, killed herself on June 5, 2018. Three days later, celebrity chef and food writer, Anthony Bourdain, also died by suicide. These deaths by the hands of beloved, well-known icons shocked the world. News stories about the well-publicized suicide deaths have abounded; in particular, people's social media news feeds have filled up with innumerable articles about the recent celebrity suicides.

The problem with prolonged media exposure for these high-profile deaths is suicide contagion, a term used to describe a recognized phenomenon in which direct and indirect exposure to the suicidal behavior of others increase the risk for some individuals. More than 50 research studies have found that certain types of news coverage can increase the likelihood of suicide in vulnerable individuals, especially in adolescents and young adults.

Suicide is the second leading cause of death among 15-24 year olds, and the Centers for Disease Control and Prevention recently announced that rates have increased dramatically. Suicide has increased by 30 percent since 1999, in nearly every state, across demographics.

Children and teenagers who are struggling with thoughts about suicide often are already seeking information about suicidal behaviors, with online searching being the most common method by far. Reading about high-profile, successful celebrities who killed themselves may serve to elicit increased feelings of hopelessness in the youth.

In recent years, as access to technology has become ubiquitous for children and teenagers, with many of them using smartphones, tablets, and laptops, it has become more challenging to ensure that the youths have developmentally appropriate exposure to potentially harmful material in the mass media.

In 2017, a controversial Netflix series called 13 Reasons Why was released and quickly became a hit among preteens and adolescents. The show centered on a teen protagonist who died by suicide, and the story line was controversial, with many mental health professionals concerned that it appeared to glorify suicide as a justified end to life’s challenges. With Season 2 just released, an international coalition of leading experts in mental health, suicide prevention, and education have co-released a 13 Reasons Why Toolkit to aid clinicians, media, and parents in addressing the topic of suicide.

While 13 Reasons Why was fictional, the unexpected real-life suicide of a popular, affable sophomore, named Patrick Turner, in January 2018 from an affluent neighborhood in Newport Beach, California, struck a raw chord in the nation's psyche. The male student left behind a comprehensive suicide note addressed to, “Dear Family, Friends, and whoever reads this.” In the letter, he detailed, “...so much pressure is put on kids to do good . . . if failure happens, it’s something like not going to college or not getting an A in a class or a test.”

This suicide, with Patrick’s letter detailing academic pressures as the primary reason for his suicide, led to a significant shift in the academic culture at the school, with the principal urging the parents, "We must reach the point where, if our sons and daughters don't live a perfect young adult experience, it is not the end of the world," and sparking a national debate on the competitive and academic pressures on adolescents.

The dramatic increase in suicides in America over the past three decades, combined with the pervasive media exposure to suicide news stories now intensified due to social media platforms, is a powder keg waiting to explode in a mental health crisis that is killing our children. It should serve as a wake-up call to parents. However, for parents, it can be challenging to know when and how to talk with their children about suicide.

First, how can parents determine whether their teenagers’ behaviors are that of typical “moody” teens going through puberty and hormonal changes, or whether their teenagers are exhibiting real warning signs above and beyond a typical teenager moodiness? What are the risk factors for suicide; that is, what increases the likelihood that a child will engage in suicidal behaviors?

Parents should be on the lookout for risk factors, such as a recent or serious loss (e.g., death, divorce), a mental disorder (e.g., depression, anxiety, substance abuse), impulsivity, disciplinary problems (e.g., detention/suspensions), sexual orientation confusion, witnessing family violence, family history of suicide, lack of social support, being a victim of bullying or being a bully, access to lethal means (e.g., firearms), and having poor access to mental health services (e.g., stigma, low financial means).

When should parents be worried about their children's risk for suicide?

Parents should take heed when they observe the following specific warning signs:

• Changes in behavior: Difficulty concentrating, difficulty focusing on school or following routine activities, researching ways to kill oneself on the internet, increasing use of alcohol or other drugs, acting recklessly

• Changes in personality: Appearing withdrawn, isolating to their room, irritability, extreme mood changes that is more than typical moodiness, exhibiting rage or talking about seeking revenge

• Changes in sleep patterns: Insomnia, oversleeping, nightmares

• Talking about dying: Any mention of dying, disappearing, going away, or other types of self-harm

What can parents do to help protect their children and teens?

Protective factors against suicide include:

• Teaching problem-solving and conflict resolutions skills
• Building a strong connection to family, friends, and community support
• Restrict access to highly lethal means of suicide, such as firearms
• Provide access to effective mental health care, including substance use treatment

If you notice warning signs in your child or teenager, what should you do?

First, talk to your child. Many people are fearful that talking to their child about suicide will increase their risk of suicide. This is a myth.

Research studies show that talking about suicide in an open and caring manner can increase hope, reduce the child’s feelings of loneliness, and protect them from following through with suicide.

It is important to ask direct questions in a straightforward manner. Tip-toeing around the issue can inadvertently signal to the child or teen that they should be feeling shameful or stigmatized for having suicidal thoughts. This will lead them to keep their thoughts secret from you.

An example of the direct ask: “I noticed that you’ve been staying in your room every night since you and Jackie broke up, and today I noticed that you did an online search for stories about suicide. Are you having thoughts about hurting yourself?”

During your talk, let your child or teen know you love them and emphasize how important they are to you. Be empathic and listen; do not minimize their verbalized stresses; and encourage them to identify their future goals.

Do let them know they’re not alone, and that you are there for them. Inform them there are effective treatments to help reduce their hopelessness. Give specific examples of people you both know who have needed and received mental health help.

If you don't have examples of family or community members, then you may give examples of celebrities your child knows — be sure to select people who have raised awareness about their own mental health condition in a helpful manner, and have openly talked about how they effectively participated in mental health treatment. You will want to do your research beforehand to ensure that you have selected a positive celebrity role model.

Second, increase behavioral activation. Research studies show that behavioral activation, e.g., engaging in behaviors that feel rewarding/reinforcing, is very effective. Meta-analyses have shown that behavioral activation is as effective as medication (in the short term), and somewhat better than cognitive therapy, in the treatment of suicidal behaviors and depression.

Encourage and support your child or teen to engage in reinforcing or rewarding activities, such as going to the movies with friends, walking the dog, playing a sports game, working on a Lego project, and bowling or hiking. While you may start by encouraging your child to increase his or her rewarding activities, be sure to obtain professional help with a therapist who is experienced in behavioral activation treatment.

Third, minimize your child or teens' exposure to media (including social media) about completed suicides. Reading and hearing repeated stories about suicides can increase a vulnerable individual’s risk for attempting suicide. Suicide contagion is a real phenomenon, but can be managed by limiting your child’s exposure, such as during the media storm following Kate Spade and Anthony Bourdain's suicides.

Finally, when it comes to potential suicidal thoughts, it is better to err on the side of caution. If you have a feeling or intuition that something doesn’t feel right with your child, if you notice warning signs, and/or if you recognize your child has many of the risk factors for suicide and few protective factors, seek professional help.

Contacting any general mental health provider is usually not enough. Be sure to find a mental health provider who has experience with suicidal youth, who has training in evidence-based therapies for suicide or depression for children and adolescents, and who you and your child feel comfortable talking with during your first session.

Resources in the U.S.:

Immediate help, 24/7: National Suicide Prevention Lifeline, 1-800-273-TALK, or Crisis Text Line by texting TALK to 741741.

The Trevor Project, aimed for bisexual, transgender, and questioning youth, 1-866-488-7386

American Foundation for Suicide Prevention

To locate a therapist trained in anxiety, depression, PTSD, and suicidal behaviors, go to Anxiety and Depression Association of America (ADAA) Therapist Directory

Psychology Today Therapist Database

Resources in Canada:

Canada Suicide Prevention Service: Immediate help, 24/7, Toll-free phone number: 1-833-456-4566, or text message number: 45645

http://www.crisisservicescanada.ca/

International Resources:

International Association for Suicide Prevention: http://www.iasp.info/resources/Crisis_Centres/