Teen suicide is the second-leading cause of death in teens between ages 15 and 19, according to the American Academy of Pediatrics (AAP). The physicians’ group is urging pediatricians to screen for suicide risks among teens.

Pediatricians should ask teens about mood disorders, alcohol and drug use, suicidal thoughts, bullying, sexual orientation, previous suicide attempts and other risk factors as part of a routine conversation with patients, according to the clinical report, published in June in the journal Pediatrics .

The new guidance is about heightening awareness about depression and suicide in teens, said Dr. Anne Walker , a pediatrician with Novant Health Walker Pediatrics in Charlotte, North Carolina. She sees patients with these tendencies every day in her practice. 

“Teens need to hear us say, ‘Suicide becomes a permanent solution to a temporary problem,’” Walker said.

About 17 percent of high school-age kids have seriously considered suicide during the previous 12 months and 2.7 percent had actually made an attempt that required medical attention, according to a 2013 survey of adolescents released last year by the Centers for Disease Control and Prevention.

Roughly 1,750 young people took their lives in 2013, but the pediatrics academy said the true suicide rate among teens is actually higher because many of these deaths are recorded as accidental.

Teen girls are twice as likely as boys to attempt suicide, but male teens are three times as likely to succeed at killing themselves.

To identify at-risk teens, Walker routinely asks her patients about their “secret worry.” “Many kids are afraid of asking for help,” she said.

“Loneliness and unspeakable fear of some things are two things that really scare kids,” Walker said. “I encourage kids to find a ‘listening adult’ that can puncture the façade of loneliness. I tell them to find an adult mentor.”

Uncovering fears and discussing feelings of loneliness in confidence are two common themes that help an adolescent feel safe when talking to an advisor, Walker said.

Walker offers this advice to parents: Listen and also invade. “Listen to find out what is going on, know their friends, allow them to make mistakes in a safe place,” she said. “Invade, because cellphones belong to parents and privacy is a privilege not a right.”

The American Academy of Pediatrics report identified three factors in particular that put teens at higher risk of suicide, including bullying; “pathological internet use” and related online behavior; and lack of treatment with antidepressants.

Pathological use of the internet means video gaming and using the internet for more than five hours a day. That behavior is associated with higher levels of depression and suicide attempts in teens, the academy said.

Bullying and cyberbullying raised the risk of suicide and suicidal thoughts for both the victim and the bully. The report found girls at risk regardless of the frequency of bullying, while boys were only at higher risk when exposed to frequent bullying.

Walker said she believes that the problems of electronic overuse and bullying have only grown worse over the past 15 years.

Pediatricians should consider and discuss the use of antidepressants in appropriate cases with parents. In 2004, the Food and Drug Administration issued a “black-box warning,” the strictest warning labeled on certain prescriptions, about an increased risk in suicide in children and teens treated with antidepressants. Subsequent studies have demonstrated that the FDA overestimated this risk in children, the pediatrics academy said, and not treating a depressed or suicidal teen with antidepressants may actually put him or her at greater risk.

Walker said that there has been a great overestimation in the risk of using antidepressants in teens by the medical community. Consequently, many parents are unwilling to try the therapies with their children. 

“Pediatricians need to become more comfortable prescribing antidepressants to teens with anxiety and depression,” she said. “The risk of becoming suicidal on antidepressants is really low, especially as compared to being untreated for depression.”

“As doctors, we need to raise the comfort of parents and teens in considering the use of antidepressants for anxiety and stress,” she added. “Many families are prejudiced against using the very medications that can help a kid get to where counseling will do them some good.”

The new recommendations offer techniques and questions for pediatricians when speaking with teen patients. They also recommend interviewing the teens alone without their parents present.

Walker said this new approach will help pediatricians better identify and treat these vulnerable patients.