Keynote speaker Susan Tolle speaks during a town hall meeting Tuesday night at South Iredell High School.

Editor’s Note: This is the first of a three part series: (1) Risks and warning factors of teen suicide; (2) Stories of youth and families affected by suicide; and (3) How to talk to youth about suicide ideation and getting treatment.


At the Suicide Prevention Town Hall on Tuesday night at South Iredell High School, community members learned about teen depression and suicide risks and how to identify warning signs and risk factors for suicide in teens. They also gained understanding of their role in reducing those risks and learned how to approach youths when they suspect suicidal ideations.

Keynote speaker Susan Tolle, a former field advocate for the American Foundation for Suicide Prevention, was thankful for the event’s attention on children in crisis. Though suicides overall have decreased, Tolle said additional progress in reducing stigma is essential to preventing more suicides.


Though suicide numbers have dropped since 2018, the numbers are still staggering. In 2019, the U.S. reported 47,511 suicide deaths, or 13.93 suicides per 100,000 population (age adjusted).

Among youth ages 10 to 24, 6,488 deaths were attributed to suicide, or about 13.66 percent of American suicides. Suicide is the leading cause of death for this age group at 10.22 suicides per 100,000 youths.

Young males are much more likely to complete suicide because of their greater access to more lethal means and the cultural expectations for males to suppress emotions to avoid looking weak.

The Centers for Disease Control (CDC) recently reported that during 2020, the proportion of mental health–related emergency department (ED) visits for suspected suicide attempts among adolescents ages 12 to 17 increased 31 percent compared to 2019.

In May 2020, during the COVID-19 pandemic, ED visits for suspected suicide attempts began to increase among adolescents ages 12 to 17, and especially among girls.

Also, from February 21 through March 20 of this year, suspected suicide attempt ED visits were 50.6 percent higher among girls ages 12 to 17 than during the same period in 2019; among boys ages 12 to 17 years, suspected suicide attempt ED visits increased 3.7 percent.

Evening more frightening, for every completed youth suicide, experts estimate that there are 100 to 200 attempts. In 2019, about 2.5 percent of high school aged youth reported making a suicide attempt that required medical treatment.


Suicide ideation is life-threatening and must be taken seriously each time it is expressed, warned Tolle, who further explained health (mental and physical), historical, and environmental suicide risk factors. She defined suicide risk factors as influences that endure over a period of time, while suicide warning signs indicate a crisis situation with an imminent suicide risk that must be addressed quickly.

Teen suicide risk is often clearly linked to mental health conditions, with both often occurring together. These conditions include major depressive disorder, conduct disorders, substance use, eating disorders, anxiety disorders, schizophrenia, and bipolar disorder.

Physical illnesses such as tinnitus (ringing sound), traumatic brain injury, rheumatoid arthritis, and chronic pain disorders also increase suicide risk.

Historical factors include a family history of completed suicide or suicide attempts, alcoholism or substance use disorder, family trauma, witnessing or being a victim of abuse, or family mental health history, such as multiple relatives with depression or anxiety.

Environmental risk factors include bullying, relationship problems such as a break-up or divorce, witnessing or being a victim of violence, experiencing the loss of a loved one, or being a victim of sexual violence.

Warning signs require immediate intervention. These indications include conversations about killing themselves (joking or not), having no reason to live, being a burden to others, feeling trapped, or being in unbearable emotional or physical pain.

Certain behaviors also suggest enhanced suicide ideation signals, especially when relating to a painful event, loss, or change. These behaviors include increasing use of drugs or alcohol, researching methods or means to end their lives, acting recklessly, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, or displaying increasingly aggressive behavior

Unusual moods may also portend a threat of suicidal ideation. Depression, loss of interest in previously enjoyed activities, unusual rage, increased irritability, displaying feelings of humiliation, and exhibiting increasing anxiety can indicate suicidal thoughts.

Oddly, sudden, unexplained happiness after the preceding type of moods or behaviors can also be a sign that a suicide attempt is imminent. Once the decision is made to end their painful mental state, they see the end to the “tunnel” and relief from the swirl of crisis thinking in which they are trapped, according to Tolle.


The Suicide Prevention Town Hall was presented by Iredell-Statesville Schools, Partners Health Management, United Way of Iredell, and the Children’s Hope Alliance.

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