In the past few weeks, a high school student from the Lower Cape took his own life, leaving a gaping hole in his family, his circle of friends and his community. Far from a new phenomenon, teen suicide happens with striking regularity – and there are warning signs that, if heeded, can sometimes prevent tragedy.

Child psychiatrist Dr. Bart Main of Cape Cod Human Services, a Hyannis-based group practice affiliated with Cape Cod Health Care, said there are various risk factors for suicidal behavior. Biological depression or bipolar disorder can cause the feeling of hopelessness that prompts teens to take their own lives, but it often happens in the context of a stressful event. “Often that involves loss,” Main said. It might be a failed romance or an athlete whose career is ended by an injury, “but sometimes it's more subtle,” he said. Cyberbullying can also erode a teen's self-esteem over time, causing hopelessness.

Differentiating ordinary teen drama and warning signs for suicide means asking a series of questions, Main said. He asks teens if they have ever felt hopeless, or thought they shouldn't have been born. Do they ever thinking about ending their life, and have they figured out how they would do so? Have they ever attempted suicide, or do they know someone who has done so?

“I always try to do an assessment of impulse control,” he said. “If a kid has a history of reckless and dangerous behavior, that's a very scary sign.” But there's another big risk factor: substance abuse. A full 80 percent of successful suicides involve drugs or alcohol, which impair judgment and allow impulsive behavior.

A longstanding myth is that, by asking a young person whether he is contemplating suicide, parents might put the thought in their mind.

“That's wrong,” Main said. Suicidal behavior is so prevalent in popular culture that if a person is despondent, “it's already on their mind,” he said. For that reason, dialogue is important. But as any parent knows, dialogue isn't always easy with teens. Main said that's because children see their parents as their primary socializing influence only until about the age of six or seven, when peer groups become more important. After that time, parents become consultants, rather than dictators. But by keeping lines of communication open, parents can empower youngsters to feel comfortable seeking advice about problems. But if parents try to continue being in the role of “boss,” they're liable to find themselves cut off from communication, Main said.

Another contributing factor is the influence of electronic media, both social media and games, which can lead to social rigidity, he said.

“In many ways, our kids are training their brains not to be socially flexible,” Main said. For instance, in a multiplayer game, teens know that if they conduct a series of steps at a certain time, they win the game. “In social situations, we have to be much more flexible in our adaptations,” he said.

There's a school of thought that teen suicide might be linked to the fact that the teenage brain has not yet fully developed its frontal lobe, which is involved in impulse control.

“I think that's kind of bogus,” Main said. Having practiced child psychiatry for 35 years, he said most kids understand the consequences of their behaviors. “The average 12 year old knows that if you take a handful of pills, that's going to kill you,” he said.

When it comes to preventing and reacting to teen suicides, the community at large has a role.

“There's a lot of educational effort going into this right now,” he said. Main is on the board of Calmer Choice, a program that teaches mindful awareness to schoolchildren, helping them deal with stress and understand their own emotions. It's also critical that society loses the stigma surrounding mental illness, “so if you do feel depressed, you know that there is help for that, and that you're not the only person,” Main said.

When teen suicides happen, how the community reacts is important, since there is a “contagion effect,” he said. When celebrities take their own lives – think Kurt Cobain or Robin Williams – there is a predictable rash of teen suicides across the nation. “Those major media events tend to create copycat behavior,” Main said.

When a teen takes his or her own life, it's critical not to frame the event as an unavoidable tragedy. “To frame it as wimpy and inadequate is way better to control the peer group atmosphere,” Main said. That's often counter-intuitive to a society that tries not to blame suicide victims, he noted.

Resources are available for parents or caregivers who have concerns about their teen's behavior. Rather than trying to assess the risk of suicide on their own, adults should consult with a mental health provider right away. A primary care physician is a good starting point, but school officials can also connect parents with professionals. In emergencies, Cape Cod Hospital has mental health experts available as part of their emergency room staff, Main added.

Learn more by visiting www.APA.org and searching for “teen suicide.”