This publication was written for an audience of teenagers (ages 13 through 18) and their parents/guardians. Its purpose is to inform the reader about adolescent mental health and suicidality, ways that adolescents can provide empathetic support to a friend they met online, ways that adults can help, and the importance of self-care.

Introduction

Meeting new people on the Internet can be exciting! Starting a friendship with someone who likes the same music as you, plays the same video games, or takes part in similar sports or activities can be a lot of fun. This new online friend might live somewhere else in the United States or even in another country. Sharing what is happening in our lives with a friend can make us feel good and cared about. Sometimes, a friend may share some difficult thoughts or feelings—for example, they are hurting themselves, or they are thinking about suicide. Helping a friend stay safe and get the support that they need can seem overwhelming. It can be even more difficult when the friend is online, and their location is unknown. There are several things that can be done to support an online friend who is thinking about self-harm or suicide to help them be safe.

Adolescent Mental Health

Adolescence is a time of many physical and psychological changes. Experiencing life changes can bring up feelings of stress, and how we handle stress can influence how we feel. Many different situations can elevate stress, from grades and issues with friends to relationship problems and trouble at home or with family members (Stikkelbroek, Bodden, Kleinjan, Reijnders, & van Baar, 2016). In 2019, a Centers for Disease Control and Prevention (CDC) survey of high school students nationwide found that 31.5% felt sad or hopeless almost every day over a two-week period in the last year (Centers for Disease Control and Prevention, 2020). A CDC report in 2021 found that suicide attempts that ended up in visits to emergency rooms had increased over 50% for teenage females and almost 4% for males since 2019 and during the pandemic (Yard et al., 2021). Developing coping mechanisms can help with stress management and emotional processing.

Coping Strategies and Risk Behaviors

Coping strategies can be healthy (such as writing down our feelings, getting some exercise, or talking about our feelings with a friend), or they can be unhealthy (such as substance use, violence towards others, and illegal activities). Psychologists have an idea why adolescents may engage in unhealthy coping strategies. Despite knowing the consequences of unhealthy coping strategies, an individual may decide to engage in harmful behaviors anyway because of what the behavior may mean to them (Institute of Medicine and National Research Council, 2011). For example, a person might engage in self-harm because they feel as though they can be in control of one aspect of their life.

One type of unhealthy coping strategy is self-harm or self-injury. As many as 7% to 18% of adolescents have reported that they engaged in self-injurious activities without the intent to end their life (Monto, McRee, & Deryck, 2018). Reasons for engaging in self-harm vary. However, the main reason teens report is that they have been wanting: to get relief from intense, distressing events; to inflict punishment on themselves; and to turn emotional pain into physical pain (Wilkinson & Goodyer, 2011).

Sometimes, when pain and emotions are so overwhelming, a person may think about dying by suicide. The Centers for Disease Control and Prevention (CDC) reported in 2020 that 15.7% of adolescents in the United States had planned for suicide and that 8.9% have had a suicide attempt. Female adolescents are twice as likely as male adolescents to act on feelings of suicide. Adolescents who identify as lesbian, gay, bisexual, or transgender were almost five times more likely to have thoughts of suicide or have attempted suicide as their heterosexual peers (Centers for Disease Control and Prevention, 2020). A person in suicidal crisis may share or post warning signs such as:

• Talking about being trapped, hopeless, or in pain
• Feeling isolated, acting anxious or agitated
• Talking about being a burden to others
• Expressing the desire or wish to injure themselves or die (National Suicide Prevention Lifeline, n.d.)

How can I help?

When an online friend tells you that they are thinking about suicide or self-harm, it can be really frightening. It can be difficult to know how to begin to offer support, especially if you are unaware of where they live, or do not know much about them. The good news is that there is a lot that you can do to be supportive (Kelly et al., 2011).

• Empathetic listening: Listen to your friend nonjudgmentally. Give them space to talk about their struggles and emotions. Ask them in plain language if they have been thinking about self-harm or suicide and assess their current safety. Bringing up the topic of suicide does not make things worse; rather, talking about it in the open can help (National Suicide Prevention Lifeline, n.d.). Brainstorm ideas to help your friend cope with their feelings or to help them take good care of themselves.
• Encourage your friend to talk with an adult: Parents, teachers, therapists, school counselors, and other trusted adults can provide or seek out long-term support so your friend can get the help they need and deserve.
• Inform the app or service: Many social media apps and gaming sites have ways to get help if you are concerned about your friend’s safety. This is especially important if you do not know their full name or where they live. Instagram®, Snapchat®, TikTok®, and many other apps have a “Report” function that can be used if you see something worrying on a post or in a message. App or site administrators may be able to locate your friend to get them some in-person support. If you believe your friend is in immediate danger, don’t wait—call emergency services right away (for example, dial 9-1-1 and refer to the list of resources at the end of this publication).
• Take care of yourself: Supporting someone in crisis can bring up a lot of emotions within ourselves. It is important that you receive good support. Talk with a parent or other supportive adult, trusted friend, therapist or counselor, or hotline. Eat healthy food and drink water. Practice self-care by engaging in some relaxing or energizing activities. Get a good amount of sleep—the recommended amount of sleep for teens is 8 or 9 hours. Sleep helps you de-stress and is important for physical and cognitive growth.

Should I tell an adult?

Reaching out to an adult for help can bring up a lot of different feelings. It may feel as though you are breaking your friend’s trust if you talk with an adult about what is going on. It might be awkward to discuss what is happening with an adult because you are unsure how that adult might react. Trusted adults—such as parents, teachers, relatives, family friends, or counselors—can reach out to others to help your friend get support. Being there for a friend who is struggling can bring up a lot of feelings for you as well. Talking with a trusted adult can provide emotional support and can help you identify and practice good coping strategies (Nemours TeensHealth, 2020).

Resources and Support

The resources listed below have staff or volunteers trained in crisis intervention and mental health issues. They are great places to turn to for support. If you or others are in an unsafe situation, call 9-1-1 right away.

YouthLine

1-877-968-8491 or text “Teen2Teen” to 839863

http://theyouthline.org

A free, confidential teen-to-teen crisis and support line. Teens are available every day from 7:00 PM to 1:00 AM (Eastern Time) to answer phone calls, texts, and online chat messages from teens who need support. Adults are available to provide support by phone at all other hours.

Crisis Text Line

Text “HOME” to 741741

http://crisistextline.org

A 24/7 free texting service for people in crisis. Volunteers provide support through text messages or through WhatsApp.

National Suicide Prevention Lifeline

1-800-273-8255

http://suicidepreventionlifeline.org

A 24/7 phone line for people having thoughts of suicide. Talking with a crisis center through the NSPL is free and confidential.

Acknowledgements

The authors would like to thank the members of the UF Emerging Adult Research Lab for their review and feedback on this publication.

References

Centers for Disease Control and Prevention. (2020). Youth Risk Behavior Survey Data. http://www.cdc.gov/yrbs

Institute of Medicine and National Research Council. (2011). The Science of Adolescent Risk-Taking: Workshop Report. Washington, D.C.: The National Academies Press. https://doi.org/10.17226/12961

Kelly, C. M., Mithen, J. M., Fischer, J. A., Kitchener, B. A., Jorm, A. F., Lowe, A., & Scanlan, C. (2011). Youth Mental Health First Aid: A Description of the Program and an Initial Evaluation. International Journal of Mental Health Systems, 5(1), 4–12. https://doi.org/10.1186/1752-4458-5-4

Monto, M. A., McRee, N., & Deryck, F. S. (2018). Nonsuicidal Self-Injury among a Representative Sample of US Adolescents, 2015. American Journal of Public Health, 108(8), 1042–1048. https://doi.org/10.2105/AJPH.2018.304470

National Suicide Prevention Lifeline. (n.d.). Support for Suicidal Individuals on Social and Digital Media. https://suicidepreventionlifeline.org/wp-content/uploads/2020/04/Lifeline-Social-Media-Toolkit-2020.pdf

Nemours TeensHealth. (2020). Suicide. KidsHealth—For Teens. https://kidshealth.org/en/teens/suicide.html

Stikkelbroek, Y., Bodden, D. H. M., Kleinjan, M., Reijnders, M., & van Baar, A. L. (2016). Adolescent Depression and Negative Life Events, the Mediating Role of Cognitive Emotion Regulation. PLOS ONE, 11(8), e0161062. https://doi.org/10.1371/journal.pone.0161062

Wilkinson, P., & Goodyer, I. (2011). Non-Suicidal Self-Injury. European Child & Adolescent Psychiatry, 20, 103–108. https://doi.org/10.1007/s00787-010-0156-y

Yard, E., Radhakrishnan, L., Ballesteros, M. F., Sheppard, M., Gates, A., Stein, Z., Hartnett, K., Kite-Powell, A., Rodgers, L., Adjemian, J., Ehlman, D. C., Holland, K., Idaikkadar, N., Ivey-Stephenson, A., Martinez, P., Law, R., & Stone, D. M. (2021). Emergency Department Visits for Suspected Suicide Attempts among Persons Aged 12–25 Years before and during the COVID-19 Pandemic — United States, January 2019–May 2021. Morbidity and Mortality Weekly Report, 70, 888–894. http://dx.doi.org/10.15585/mmwr.mm7024e1