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October 7, 2025 15 mins

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Did you know that teen suicide attempts PEAK in October?  In this episode, we share why October is so stressful for US teens, what YOU can do in your office to identify and help teens with suicidal thoughts.  FInally, we share THREE THINGS we wish everyone knew to reduce suicide risk in teens! 

00:00 Introduction and World Mental Health Day

01:07 The October Suicide Peak

02:20 Factors Contributing to October's Suicide Risk

04:39 Identifying At-Risk Groups

05:44 Strategies for Clinicians to Help

09:46 The Importance of Sleep

11:02 Building Positive Coping Skills

13:51 Nutritional Considerations

14:38 Conclusion and Final Thoughts

Check out our website PsychEd4Peds.com for more resources.
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Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Elise Fallucco (00:21):
Welcome back to Child Mental Health for
Pediatric clinicians, thepodcast formerly known as
Psyched for peds.
I'm your host, Dr.
Elise Fallucco, childpsychiatrist, and mom.
I'm recording this podcast inanticipation of October 10th,
which is World Mental HealthDay, and this is a great
opportunity to increaseawareness and discussion around

(00:43):
mental health issues in childrenand teens.
And the hope is by having theseconversations and sharing this
information, we can not onlydecrease stigma, but hopefully
increase early recognition ofkids and teens who are
struggling and get them the helpthey need so that they can feel
better.
In today's episode, we're gonnabe talking about an incredibly
important public health issue inchildren and adolescents,

(01:07):
suicide risk.
Since we love to be practical onthe podcast, I'm gonna share
questions you can ask that canhelp identify which teens are at
risk for suicide.
And finally.
I'm gonna share three thingsthat I wish everybody knew that
can help reduce risk for suicidein teens.
Let's get started.

(01:28):
Now, many of you already knowthat suicide is the third
leading cause of death among usteens, but what you may not know
is that October, this month iswhen we see the peak number of
suicide attempts in the UnitedStates.
Last year on the podcast, wetalked about a beautiful study
published in JAMA that showedmajor peaks in emergency

(01:50):
department visits and inhospitalizations for suicide
attempts among kids 10 years andolder during the month of
October.
So you may be wondering, whyOctober?
Why would this be the peakmonths for suicide attempts?
Well, the interesting answercomes from the fact that
suicidality seems to show asignificant trend in kids in

(02:12):
adolescents that fluctuatesbased upon the school calendar.
So those of us in clinicalpractice.
Know that the summers tend to berelatively quiet for most of our
kids, especially when we'rethinking about suicide attempts
but there are a couple timesduring the school year when kids
are particularly at risk.
October being the worst.

(02:33):
And let's dig in just a littlebit.
Given the school calendar, whywould October be the month of
the perfect storm for suiciderisk?
Couple of thoughts.
One has to do with academicpressure.
So we all know that as schoolstarts in August or September
that the first couple weeks andeven the first month or so,
there's a lot of review period,and there's a lot of going over

(02:53):
old material, and we might evencall this a honeymoon but as we
steep closer and closer to themonth of October, kids are
getting exposure to a lot morenew academic material and are
even beginning.
To prepare for midterm exams bythis second or third month of
school, it's still possible forkids to be able to bring their
grades up or to catch up or makeup for any missed work or.

(03:18):
Less than stellar performance inthe first couple months as
opposed to later in the semesterwhen kids are preparing for
finals and it feels like theirgrade at that point may already
be a foregone conclusion.
Okay, so one potential reasonfor increase in suicide attempts
could be related to academicpressure.
For those kids who are playingsports, October is often the

(03:41):
time when our fall sports seasonis coming to a close and the
teams are getting involved inplayoffs or in district and
regional championships, which ofcourse are exciting, but also
carry a great deal of pressurearound that.
So in other words, we're seeinga little bit of the perfect
storm, where we've got a majorincrease in academic pressure at
the same time as someextracurricular or sports

(04:03):
related pressure.
October also tends to be aperiod of increased social
stress, where a lot of highschools have homecoming games
and homecoming dances.
Back when I worked in the St.
Louis Children's Hospital, wewould dread being on call in the
emergency room during theweekends after some of our local
high school homecomings becausewe very often saw a number of

(04:24):
suicide attempts related to thestress of these events.
There are plenty of otherpotential variables that could
explain why October is a month,particularly elevated risk for
suicide attempts You could it bea decrease in sunlight?
Could it have to do with thefact that it's flu season and
that all of the cytokines thatare going around in people's

(04:46):
bodies and the inflammationassociated with various
infections is contributing tolow mood?
Quite possibly, although thishas not been systematically
studied.
Shifting gears from thinkingabout why is October a
particularly high risk month?
Now, let's talk about who shouldwe be worried about, so who is
particularly at risk?
Honestly, anytime you thinkabout suicidal thoughts and

(05:08):
suicide attempts, there arevery, very clear gender findings
where girls are at much, muchhigher risk of having suicidal
thoughts and attempting suicidethan are boys.
That being said, when boysattempt to end their life, they
often use very lethal means, andso sadly, that's often more

(05:28):
likely to result in a death bysuicide.
Children who are racial orethnic minorities or who
experience significantdiscrimination are also at
increased risk for suicide.
And likewise, the L-G-B-T-Qyouth population is at increased
risk for suicide, which is feltto be largely related to the
stress from discrimination andoften lack of support related to

(05:52):
their sexual identity.
Okay, so we've talked about whyOctober is scary, which kids are
particularly at risk for suicideduring this time.
But what we really need to knowis what can we do about it?
The first thing as cliniciansthat we can do is to normalize
this.
Any patient who you see in youroffice this month, or frankly

(06:14):
this season, let them know thatthis tends to be a particularly
stressful time of year.
That it's normal to feel a lotof pressure and stress, and
after you normalize it, it's aperfect opportunity to open the
door and ask them, how are youdoing with this?
How are you?
How have you been feeling?
And most importantly, how areyou managing stress?

(06:34):
Because stress in in itself isnot an awful thing.
Stress is something we'reexperiencing all the time, and
it really comes down to do wehave the right support and
resources to help us manage it?
So after we normalize that, thisis a stressful time, this opens
the door to ask how have youbeen feeling and what helps you

(06:55):
manage stress?
Sometimes I like to use theanalogy of a battery, especially
because many of us are connectedto smartphones that are
constantly finding their batterytrained, and so I'll talk to
people and.
I discuss the analogy of, youknow, our energy is very similar
to our cell phone battery.
There are things that we do andthere are people we're around in
activities that can charge us upand give us lots of energy.

(07:18):
And likewise, there are alsothings that drain our
psychological battery.
So what about you?
Can you tell me about a coupleof things that really energize
you?
And likewise, what would you sayis the main thing or the couple
main things that are stressingyou out and bringing you down?
and even just acknowledging thatthere is stress in life and that

(07:40):
there's a lot going on can betherapeutic And by asking you're
helping them think about whatthey can do to connect to some
of the energizers in their life.
Just these simple questions andhaving a very brief conversation
during an office visit can beincredibly helpful because so
few of us have time to stop andreflect, Of course, you know,
I'm gonna talk about usingscreening tools for mental

(08:02):
health and getting out your PHQnine, or any sort of suicide
risk screening tool that youuse, and possibly the scared
which helps to screen foranxiety, but in addition.
To those patient reportquestionnaires.
Just having this conversationcan be incredibly helpful in the
context of a brief office visit.
Obviously the huge batterychargers for those teens who are

(08:23):
struggling and who areparticularly at risk, you know,
could involve getting connectedwith cognitive behavioral
therapy.
And as a side note, one of themost common complaints that I
hear from the.
My pediatric colleagues is thatit is really hard to get
families connected to therapyeither because of lack of access
OR because families don'tnecessarily buy in.

(08:46):
That they have this idea thatthis involves a major time
commitment and they're notconvinced that they have
flexibility in their schedule todo that.
And there seems to be a lot ofuncertainty about how beneficial
therapy can be, and so whenyou're having these
conversations, particularly thistime of year, this can be a
great way to refresh the waythat we talk about therapy to

(09:06):
our patients.
And one of my colleagues, Dr.
Peggy Reco, the very esteemedpediatric psychologist, has a
very brief description of thebenefits of therapy that I've
used that's really helpful forfamilies.
And what I typically say is.
Having a therapist is a lot likehaving a specialized coach,
someone who gets to know youpersonally and gives you

(09:29):
particularly skills andexercises that'll help you
address the stressors in yourlife.
And these are skills you canlearn now and they'll be helpful
for the rest of your life.
And I think when you phrasetherapy that way, that's a much
more compelling.
Reason to motivate families.

(09:53):
okay, so we've talked aboutbattery drainers, battery
chargers, and that as a finalbonus I wanna share three
protective factors foradolescent mental health.
Number one, in our national datafrom the.
Youth risk behavior surveillancestudy, which the CDC puts out
every two years.

(10:14):
Our most recent data shows thatone of the most protective
factors for adolescent mentalhealth.
And suicidality is drum roll,please sleep.
Oh my goodness.
Getting at least eight hours anight of sleep on a regular
basis is perhaps the strongestprotective factor and the thing

(10:38):
that's most likely to help yourchild's overall mood and to
reduce.
Suicide risk.
I know what you're thinking.
If only that were so easy, ifonly teens weren't incredibly
busy with school and academicpressure and all of these
extracurricular activities.
But knowing this, and especiallyhaving really recent national

(11:00):
level data from us high schoolstudents.
We can share this with parentsand encourage them to really try
to prioritize sleep, to havediscussions with their teens
about when they're going to bed,when screens and lights are
turning off, and of course,making sure that there are no
screens or technology in thebedroom that could interfere

(11:22):
with sleep.
One of the other highlyimportant factors that can
reduce a child's risk forsuicide having a set of positive
coping skills.
The common thing that we see inmany of the kids and teens who
end up in the emergency roomafter suicide attempts is not
even so much that they'reexperiencing.
Excessive amounts of stress, butrather that when they feel

(11:45):
completely overwhelmed by thestress, they don't have a large
toolbox of things that they cando, people they can talk to,
strategies that they can use todiffuse some of the stress and
to help them feel better.
And so in the absence of thesepositive coping skills, this is
where we turn to pills or toother means.

(12:05):
And just another brief pitch fortherapy.
Therapy is a fantastic place.
To do some great brief timelimited work with your teen to
help them develop coping skills,but for those families who maybe
don't have the time or theresources or whatever else that
is needed to get them theprivilege of engaging in

(12:27):
evidence-based therapy.
There are things you as aclinician can do in the office
to help, just like the batteryconversation.
I would recommend asking them,wouldn't you feel overwhelmed or
very stressed out?
What helps you feel better andget them to name or list a few
things.
And also expect that some ofthese things may not be really

(12:50):
healthy adaptive coping skills.
You have to be imagining thisconversation with a teenager in
your office.
Okay.
So when you're not feeling well,what do you do to help you feel
better?
Well.
I mean, I open Instagram or lockit or whichever social media
thing, and I scroll or I look atthis.
Okay, I'm gonna try not to bejudgmental.

(13:12):
Let me ask you, does it work?
How do you feel after you spendtime there?
Are you laughing at cat videosor do you find you're spiraling
down into feeling worse?
And just ask questions toencourage teenagers to
self-reflect about how well arethese coping strategies working?
And this may be a good time toalso bring a parent in or a

(13:35):
family member to be part of thisconversation so they can
collectively brainstorm like.
What helps you feel thehappiest?
Is it spending time with yourfriends?
Is it journaling?
Is it playing video games?
What, what are the things thatyou find helpful and how can we
come up with a much broadervocabulary or a larger toolkit,
if you wanna use it that way, ofstrategies that are positive and

(13:58):
adaptive to help you cope withstress.
Okay, so we've talked aboutthree things you can do to
reduce risk.
Number one is sleep.
Number two is build your toolboxof positive coping skills, and
then the third has to do withnutrition.
Let's try to make sure thatwe're.
Eating the rainbow, or at leastthat there's some color other

(14:18):
than brown and beige on most ofour plates.
The bar can be really low in myhouse at times and in
particular, consider checking avitamin D level as that can
affect mood and vitamin D.
Insufficiency or deficiency israther common in our teenagers.
So you may need to supplementwith vitamin D.
And a very easy thing that youcan tell families without even

(14:41):
having to do any blood work isto consider taking fish oil
capsules or fish oil gummiesthat have been shown in smaller
studies of teens to help withmood instability.
And the Omega-3 fatty acids are.
Wonderful for your brain as abonus.
Okay?
So thank you for your attentionand for this public service

(15:04):
announcement about World MentalHealth Day.
I hope that you took somethinghelpful that you can share with
your patients or with thechildren and teens in your life,
and look forward to talking toyou on the next episode of Child
Mental Health for pediatricclinicians see you next time.
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