In June, the Centers for Diseases Control and Prevention (CDC) reported that suicide in the United States had increased in all age groups since the beginning of the century.

Seeing that report, I asked a handful of my pediatric colleagues if they had current patients with suicidal thoughts. Three responded yes, including one with a 12-year-old patient in intensive care from hanging himself. He later died.

He was the second pre-teen to die from hanging admitted to Harbor-UCLA Medical Center in South Los Angeles in the past year.

“I had another 11-year-old boy who hung himself after a fight with his older brother,” said Tom Kallay, chief of pediatric intensive care at Harbor-UCLA. The big brother found the boy hanging from a belt in his closet. Kallay and his team were not able to resuscitate the boy.

Worldwide, suicide claims the lives of nearly 1 million people every year. In the U.S., suicide is the third leading cause of death for youth ages 10 to 24, with nearly 4,600 lives lost each year. Although infrequent, suicide for U.S. children ages 5 to 12 is a growing problem, as 1,309 children in this age group took their own lives from 1999 through 2015.

In California in 2015, 495 youth, ages 5 to 24, died from suicide. Twenty three of them were younger than 14. Nearly 4,300 Californians of all ages died from suicide in 2016, a 50 percent increase from 2001. Suicide rates are higher in California’s rural counties, where there are fewer mental health resources. The rates are highest among whites and Native Americans and lowest among Hispanics.

“We don’t know all of the reasons for the rise in suicide, but one possibility is social media,” said Kathleen McKenna, clinical professor of psychiatry at Harbor-UCLA. McKenna said on social media, others’ lives look glamorous, which can lead young people to think their lives are worthless. Another problem is cyberbullying, which can cause suicidal thoughts.

Research has identified mental illness (depression is common), gender dysphoria, bullying, a parent who committed suicide and feeling socially isolated as risk factors for youth suicide. Impulsivity and easy access to lethal means, such as guns, are also risks.

These risk factors, however, are not predictors. The CDC report also noted that 54 percent of suicide victims had no known mental illness.

In one study that tried to pin down risk factors for suicide among young children, researchers reviewed 693 child suicide deaths. They compared information for children ages 5 though 11 with data for early adolescents, 12 to 14 years. In both age groups, black children were more likely than others to die by hanging or suffocation. Among the younger children, most were male, died at home and had relationship problems with family or friends. About one-third of the children were diagnosed with mental disorders, with depression being more common among the early adolescents and ADHD being more common for the younger kids. Of note, depression and anxiety may be misdiagnosed as or co-exist with ADHD.

Nearly one-third of young children in the study had discussed suicide with another person. Parents often don’t take talk of suicide by young children seriously because they think kids don’t understand the concept.

But they do.

By ages 5 to 7, children begin to understand death, though many do not grasp its irreversibility until about age 11.

Historically, white children and teens have higher suicide rates than black youth. This is still true for teens. However, since 2008, suicide rates for elementary school-age black children (2.5 per million) are more than three times higher than their white peers (0.77 per million).

The causes of the racial disparities are not well understood. Possible factors include that African American youth are more likely to have experienced violence or traumatic stress, which have been associated with suicide. Also, black youth are less likely to receive mental health services, for reasons including the stigma around mental illness and a lack of access to treatment. Daily exposure to racism also contributes to depression and anxiety for young people. “One consideration is the loss of social cohesion [within the black community] that may happen with gentrification,” said McKenna.

The parents, siblings and loved ones of suicide victims are left wondering “Why?” The truism “Suicide doesn’t end the pain; it just transfers it to someone else” is especially apt for child suicides.

Parents are often overwhelmed with grief, depression, anger and even consider suicide themselves. Siblings may feel those same emotions. Kallay recalls that seeing the pain and guilt on the big brother’s face was as hard as caring for the boy who died.

“There is a lot of pain that comes with adolescence,” said McKenna, “They need people to care about them, and not just relatives.” Her first suggestion – be kind. She also encourages teaching children, starting at young ages, skills to cope with distress and build resilience.

Learning the common warning signs is one way anyone can help prevent suicides. If you are considering suicide, know that there are people waiting to listen and help. Reach out to them.

Suicide prevention hotline: 1-800-273-8255

Kids Help Phone: 1-800-668-6868 and https://kidshelpphone.ca