Suicide is a leading cause of death in the U.S. and one that can have devastating effects on families, friends and entire communities. High-profile examples, such as the deaths of five elite college athletes this year, are a stark reminder that we don’t always know who among us is struggling. But the rate of depression and anxiety is rising worldwide, according to the World Health Organization, and the number of people — particularly teens and young adults — seeking treatment for suicidal thoughts has increased since the COVID-19 pandemic began nearly three years ago. Memorial Hermann’s Mental Health Crisis Clinics, for example, have seen a 14 percent increase in visits by people 18 and younger since the pandemic started.

So what can you do if you suspect a loved one may be considering suicide? Dr. Mariam Wahby, a licensed therapist and the manager of behavioral health education with Memorial Hermann’s Behavioral Health Services, shares some insights for National Suicide Awareness Month.

Q: Are suicide rates increasing among young people, or are suicides simply getting more attention? 

Dr. Wahby: Both. One, certainly, it’s getting more attention — needed attention. And mental health on the whole is getting more attention. We still have a long way to go to get to the point where everyone recognizes that it’s equal to physical health, and that we need to be proactive with it. A lot of the attention it gets is fear-based coverage. But it is getting talked about more, and hopefully soon we’ll get to the point where we can also stress that our mental health, like our physical health, requires preventive care.

The second part is, unfortunately, yes, teens and young adults are attempting suicide more. There’s a lot more depression and anxiety in young people, and the pandemic has played a big part in that. School went virtual and teens were more isolated. If you had social anxiety to begin with, quarantine fed that anxiety. Expecting them to come out of that period and seamlessly reintegrate into social settings is asking a lot. It’s very stressful.

Q: Are there certain risk factors that make some people more likely to consider suicide?

Dr. Wahby: Teens are at greater risk than adults, and young adults are at greater risk than older adults. Suicide is the second leading cause of death for people aged 10 to 14 and 25 to 34. Teens don’t have the same cognitive development that an adult does, and they haven’t learned some of the coping skills that adults might use to deal with difficult feelings.

Q: What are the biggest factors that contribute to suicide?

Dr. Wahby: A feeling of hopelessness or helplessness is at the top. Depression is part of it, but not everyone who feels depressed is suicidal. If someone has depression but thinks, “This will pass. I can go somewhere to get help,” then they’re less likely to attempt suicide. It’s more of an issue when you don’t think there’s anywhere to turn, or that you have a problem that no one can solve. For someone with suicidal feelings, it’s often a last resort; an escape from a hopeless situation. They might lack support or resources, or they don’t know how to access them — so they don’t believe they exist.

Q: What warning signs should we watch out for?

Dr. Wahby: If they’re saying things that sound escapist — “I can’t do this anymore” or “I want to go to sleep and never wake up” — those are definitely red flags. So are expressions of hopelessness: “I don’t know how to get out of this,” or “No one understands what I’m dealing with; it’s too much.” But less direct statements might also be red flags. Someone who’s tying up loose ends, resolving things, saying things like, “You’ve always been a great friend, and I want you to know how much I appreciate it,” or even, “Hey, could you keep my dog for a while?” Major changes in behavior or personality can also be a warning sign. Maybe someone who’s withdrawing from their social groups, who usually likes to go out and do things, but they’ve stopped, or they’re usually social and chatty and they’re not anymore. Any one of these things might not be a red flag in itself, but it’s something to keep an eye out for. And if you’re worried about someone, you can tell them you’re worried. People think, “Oh, I don’t want to offend them,” but that’s a mistake. It’s never too much to check in on someone. The worst that can happen is you check on them and they’re fine. Most people really don’t mind. They appreciate that you care.

Q: Are there any myths or misunderstandings about suicide that can be dangerous?

Dr. Wahby: We often think if people are talking about suicidal thoughts that means they’re not really serious about it, or else they would keep it to themselves. That’s a huge misconception. People want help. They don’t want to feel this way. And this feeling is all-consuming, so it slips out. If someone’s talking about it, you take it as seriously as possible. That’s a huge indication that they are thinking seriously about it.

A related myth is that suicide attempts that fail are not serious — that they’re just attention-seeking behavior. That couldn’t be more wrong. Attempted suicide is the biggest predictor of completed suicide. I think that labeling of “attention-seeking” has gotten less common over the years, but it’s still a problem. Even if you insist on calling it attention seeking, you should never dismiss it. If someone is feeling that desperate for attention, connection and support that they’re willing to risk their lives for it, we need to take that very seriously.

Q: What resources are out there for people with suicidal feelings? 

Dr. Wahby: There are a lot of good resources now that are helpful for young people that allow them to text or chat instantly instead of calling someone or booking an appointment. You can connect with crisis counselors 24/7 at the 988 Suicide and Crisis Lifeline by dialing or texting 988, or using chat services at 988lifeline.org. For teens, who live in a screen-based world, texting takes some of the pressure off. Making a phone call or sitting down face-to-face with someone can be hard. If they can text a number to start, that helps. Now you can also see mental health providers virtually, which can get you into treatment faster and make it more private.

Other resources: Memorial Hermann’s Mental Health Crisis Clinics fill an important niche for people with urgent mental health needs. While the average wait time to see a mental health provider is around 90 days in the Houston area, these clinics provide immediate care to the people who need it most, including those who are considering suicide. The clinics are located in Humble, Spring Branch and Meyerland. All are near bus routes to ease access and inside retail centers to reduce stigma. Each year, these crisis clinics serve over 3,200 patients, from young children to older adults, regardless of insurance status or ability to pay.

To learn more about Memorial Hermann’s Mental Health Crisis Clinics, visit: www.memorialhermann.org/services/specialties/mental-health