The link between COVID-19 and suicide: What parents should know

By Dr. Meredith Dennis, post-doctoral fellow at CHOC; and Alva Alvarez and Christopher Reeves, mental health social workers

It is an understatement to say that living through the COVID-19 has been tough. For kids and teens already struggling with mental health issues like depression, their symptoms may have worsened with the added stress of COVID-19. No parent wants to imagine that their child would think about ending their life or hurting themselves in any way, but the reality is that kids and teens are not immune to severe symptoms of depression like suicidal thoughts. Unfortunately, we have seen a negative impact of everything that comes with the COVID-19 pandemic on child and teen mental health, including increased suicidal thoughts. This can raise many questions and concerns for parents. Why is this happening? What can I do about it? How can I make sure my child is safe?

A good place to start as a parent is to be aware of the risk factors for suicide. Among others, here are things that could increase risk for thoughts of suicide:

• Feeling like a burden. If your child believes they are a burden to people in their life, this increases risk for suicide. Keep in mind that it doesn’t matter whether or not this is actually true. It’s about what your child may mistakenly believe.
• Being disconnected or isolated from others. No matter how much support you try and give, your child may feel lonely or think no one cares about them. This may be especially true if your child feels they do not have any friends.
• Repeated engagement in self-harm behaviors or suicide The more your child harms themselves or makes attempts at dying, the “better” they get at it. They are also better able to tolerate pain — studies show they experience less pain with more self-harm —, and become less scared of dying.
• If your child believes that things will stay this way and not get better, there is greater risk. Again, this is not about what is actually happening, but what your child believes to be true.

The COVID contribution

Our lives are nearly unrecognizable these days amid the COVID-19 pandemic. So many elements have changed as we work together to follow various safety guidelines. From the way we go to school and work to the way we interact with our social groups, this new way of life has vastly transformed our routines. Furthermore, these changes occurred suddenly and without warning. It is no wonder that we are seeing increases in symptoms of depression and anxiety, as well as in suicidal and self-harming behaviors. Here are some specific ways COVID-19 may be affecting mental health:

• Sudden disconnect from peers and support groups outside of the home may increase feelings of isolation while also deterring one’s motivation to seek support, knowing they are unable to interact face to face.
• Most opportunities we used to enjoy for fun and relaxation have been closed, canceled or restricted. There are limited replacement options. Daily life is now filled with more stress and less fun, making it harder to ignore feelings of loneliness, sadness, worry and hopelessness.
• Separation from stressful situations within the home may not be possible due to safety precautions. While confined to your home, your child may begin to focus more on their current stressors with little or no distraction from them.
• A major challenge many families face in these times is financial insecurity or loss of income. Though young, kids and teens are often acutely aware of their parents’ stress. Knowing that parents are worried about finances can increase a youth’s perception of being a burden, and thus increase risk for suicide.
• Increased exposure to social media and news coverage could lead to increased thoughts and risk of suicide for your teen. Since youth’s activities are severely restricted now, many are spending more time on their screens. This means increased exposure to “doom and gloom” news coverage as well as increased exposure to negative online peer interactions. These things increase hopelessness that the pandemic will ever be resolved and decrease the sense of social connectedness. Increasing suicidal thoughts and behaviors means kids and teens are more frequently exposed to this content online. We know this is a dangerous risk factor for youth suicide.
• Decreased physical activity along with an increase in screen time may diminish one’s ability to focus throughout the day and negatively affect sleep. Poor sleep and diminished concentration may lead to impaired judgment. This is a recipe for misinterpreting the environment — for example, believing no one cares about them, or feeling like they are a burden.

Accidental adult errors

More often than not, caregivers are doing a great job of reaching out for support and guidance when it comes to a child’s mental health. There are times, however, when adults inadvertently engage in verbal and non-verbal behaviors that can increase or exacerbate risk factors for suicide in children. While these behaviors can be perceived as harmless by adults, to a young person who is already struggling with suicidal thoughts, they can make the difference between ideation and intent. Examples of these behaviors can include:

• Avoiding conversations about the current state of events, including COVID-19, may accidentally increase distress in youth. This may include avoiding discussing your own thoughts and feelings regarding the impact of COVID-19. Attempting to protect children from the current state of life creates the impression that COVID-19 is too scary to talk about, potentially increasing anxiety or hopelessness about the situation.
• However, oversharing information — such as financial burdens, parental stress, workload and constant news updates — can also increase suicidal ideation in adolescents by creating what feels like a flood of negative messages that they feel they can’t escape from.
• Adults sometimes try to help youth feel better by telling them they are overreacting, that things aren’t that bad, or by saying things could be worse. This accidentally increases the intensity of those emotions, leading to escalations of experiences like depression, anxiety and self-harming behaviors.
• Expecting children and teens to continue functioning at the same pre-COVID-19 levels can place unrealistic pressure on them. Many adults continue to struggle with symptoms of grief related to COVID-19 losses that may be financial, emotional or social.As a result, adults have had to make adjustments to their own expectations for “normal” functioning. Youth also need to know that they are allowed to make adjustments and that not everything needs to be perfect.

Action steps to support children and teens suffering during COVID-19

There are things you can do as a parent, guardian or caregiver to help children and teens who are suffering during this time. Kids are resilient, meaning they have the ability to “bounce back” when difficult things happen. There are also several protective factors to be aware of that are helpful in lowering the chance your child will experience more serious risk. Here are a few ways you can help:

• Stay connected. With social distancing guidelines in place, it may be difficult to find safe and appropriate ways to keep your child socially engaged that meet your needs. Set up virtual hang-outs with friends, or meet at an outdoor space like a park where social distancing can be maintained if everyone agrees to wear a face covering.
• Stick to a routine. Maintaining predictability in the day can help your child build structure and have a sense of security. Daily routines also help increase engagement in activities, which can increase feelings of accomplishment and self-confidence, directly reducing things like hopelessness and feeling like a burden.
• Have a conversation. Setting aside time to talk to your child about how they are feeling is important. Give them a safe space to share their thoughts and feelings. Show them you are there to help by validating them and being supportive. Let them know it’s OK to feel the way they feel and that you will get through it together.
• Find time for self-care. Keep your child engaged in things they like that are fun and/or relaxing. It works best if you do this with them! Do fun things or a favorite activity, do things you are good at, learn a new skill, and keep them involved in extracurricular activities like sports or clubs if possible.
• Take care of basic physical needs. A healthy body helps us be as prepared for the daily stresses as possible. Get enough sleep, move your body and eat balanced foods.
• Limit screen time. Even though our lives revolve almost exclusively around screens, make time to disconnect and seek social connection, fun, relaxation and joy using “old school” ways.
• Self soothe. We could all use some extra comforting these days. Teach your children to use their physical senses to comfort themselves by listening to relaxing music, finding a soft comfort object such as a blanket or T-shirt, or using a favorite scented candle or lotion.
• Seek mental health support when needed. If your child seems to be having a pretty hard time and does not already have mental health services like therapy or counseling in place, this would be a great time to start. Medication may also be an option. Talk to your doctor, insurance, or school about where to get connected.
• Get immediate help if needed. If your child continues to express thoughts about harming themselves or dying, go to the nearest emergency room or call 911.
• Help your child identify reasons to live. What is important to your child? What are their values and goals? Helping them get connected to these things can be a very powerful way to recognize that they have things in their lives that are important and matter – and that this situation is not going to last forever.

Get more expert health advice delivered to your inbox monthly by subscribing to the KidsHealth newsletter here.