It's common for teens to think about death to some degree. Teens' thinking capabilities have matured in a way that allows them to think more deeply - about their existence in the world, the meaning of life, and other profound questions and ideas.

There are many reasons why a young person may think about or actually carry out a suicide. The most common underlying problem is depression. Depression in teens does not always look like sadness; sometimes it appears as a loss of interest in activities, falling grades, or irritability blowing up for no reason at all. "In others, depression may hide behind a mask of humor" or an "I don't care" attitude.

A suicide survivor said in his interview: "I did many things to try to die. It was truly hell on earth".

Teen girls and boys are both at risk for suicide. Teenage boys are four to five times more likely to die by suicide than girls, although girls actually attempt suicide four times more frequently. Boys may be more inclined to take impulsive action. Girls may use suicide attempts such as swallowing pills (where there is often time for others to intervene) as a way to call out for help. Boys may feel that asking for help even in such a dramatic way is unmanly or babyish. So they choose suicide actions that are more surefire. Over half of teen suicide deaths are inflicted by guns.

Many suicide attempts occur when a teen is under the influence of alcohol or drugs. Alcohol and drugs have depressive effects on the brain. Misuse of these substances can bring on serious depression, especially in teens prone to depression because of their biology, family history, or other life stressors.

The primary care physician should refer most patients with persistent suicidal thoughts to a psychiatrist skilled in psychotherapy. Patients who do not begin to improve in 4 to 6 weeks should be referred to a psychiatrist, who may recommend a higher dosage, a different medication, and a shift in psychotherapy approach, hospitalization, electroconvulsive therapy, or other treatment.

Dealing with teenagers can be very difficult at the best of times. If you are aware of a young person who seems constantly unhappy or bad tempered, don't be afraid to ask them about how they are feeling. Often just knowing that someone cares is enough to let them unburden their problems, and may prevent tragedy.