John Trautwein’s eldest son, Will, was 15 years old when he took his own life.

The night before, Will studied hard for a test he was supposed to take that day. He was going to get his driver’s permit that weekend and get his braces off the following week. Those were big events in his life that he was preparing for, and his parents had no inkling that their popular, athletic son was contemplating suicide.

“We were so stunned — and so unaware — that we thought someone had come in and killed him,” Trautwein said of his son’s death in 2010.

“If you had told me that my son was unhappy, let alone suicidal,” he told HuffPost, “I would have told you you’re absolutely nuts.”

The largest study to date measuring what, if anything, parents know about their teens’ suicidal thoughts shows that many parents, like Trautwein, said they are completely unaware that their adolescents have thought about taking their own life.

In interviews with more than 5,000 Philadelphia-area kids ages 11 to 17 and their parents, researchers found that among the teens who reported that they had thoughts about taking their own life, 50 percent of their moms and dads said they had no idea.

Three-quarters said they had no idea their children had recurrent thoughts about death.

“Previous research has also found poor agreement not just in suicidal thoughts but in things like depressive symptoms and perceptions of family functioning,” said study author Jason Jones, a research scientist at PolicyLab at Children’s Hospital of Philadelphia. “There’s a lot of evidence that parents are not aware.”

Jones and his team were surprised to find similar disagreement in the other direction, between children’s downplayed reports of their thoughts versus what their parents saw as troubling indicators. A significant number of teenagers denied they had thought about suicide or death, even though their parents told the researchers they had.

“But I think for something as straightforward as this,” he continued. “I mean, ‘Have you ever thought of killing yourself?’ is a pretty direct question. To see the level of disagreement we’re seeing, it’s alarming.”

The findings were published in the journal Pediatrics on Monday.

A Troubling Trend

Suicide is the second-leading cause of death among Americans ages 10 to 24, and it continues to rise for reasons that are not entirely clear.

Experts have identified suicide as a pressing public health crisis — and suicide among young people in particular as an issue that requires a multipronged approach, bringing together health care providers, parents, schools and researchers to better understand the challenges and approaches to prevention. A 2015 national survey reported that 18 percent of high schoolers have had thoughts of suicide (the rate in the current study, which included children as young as 11, was lower, about 8 percent), and it is estimated that two-thirds of adolescents who experience suicidal thoughts don’t get help.

Jones said the new research raises hard questions for health care providers, particularly pediatricians, regarding the best ways to screen for depression and suicidal thoughts among children.

For example, given that some parents said their teens considered suicide but their teens denied it, doctors might consider asking caregivers about what they see or believe might be happening, Jones said. That, however, raises practical concerns, such as how to fit that conversation into the limited window doctors typically have with patients, as well as ethical ones about how much doctors should be taking parents’ subjective opinions into account.

What Parents Need To Look For

Experts say that the message for parents is, perhaps, a bit more clear-cut.

“My takeaway for parents is that they need to know what to look for, and then they need to know what to do with what they find,” said Teri Brister, the director of information and support for the National Alliance on Mental Illness. (Brister was not involved in the study.)

“We tell people, start with your child’s pediatrician,” she added, emphasizing that she is by no means saying that parents must start out with an understanding of how to navigate the complex mental health care system.

And parents should be talking to their children about things like depression and suicide, she added.

“I see it all the time — parents will read about suicide or hear about a study like this and say, ‘Gee, that’s a terrible thing. How sad for those families.’ But they have what I call not-my-kid syndrome,” said Clark Flatt, the president of the Jason Foundation, a nonprofit that he and his family began to help prevent suicide after his younger son, Jason, killed himself in 1997.

Flatt, too, was completely surprised by his son’s death, describing him as a well-liked teenager who played sports, had plenty of friends and seemed to enjoy school.

“You have to look for the warning signs,” Flatt said. “And I don’t mean you have to get up every morning and run through a checklist to see if your child is at risk for suicide. But be aware of the warning signs and the risk factors.”

Those signs include notable mood swings, talking or writing about suicide and using drugs or alcohol. Having suicidal thoughts does not necessarily mean a person will take his or her own life, but it is a major risk factor for a suicide attempt. (The National Suicide Prevention Lifeline offers free, immediate support for people in distress and their loved ones.)

“And ask questions,” Flatt added. “Tough questions sometimes.” It can be a hard but meaningful way to encourage kids to open up.

“This is the trouble with mental illness. It’s very maskable. It’s not something that shows up on tests sometimes. So we want our kids to be able to say, ‘Hey, I’m not OK,’” echoed Trautwein, who started the Will to Live foundation in his son’s honor and wrote a book, My Living Will.

“My son Will was afraid to say ‘I’m not OK’ because I didn’t talk about these things with him,” he said. “He didn’t want me to see him as not OK because he worried that would be disappointing to me. And that breaks my heart.”

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside the U.S., please visit the International Association for Suicide Prevention for a database of resources.

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