If your teen is socially withdrawn, be on the lookout for more serious problems, study suggests

By Kristen Rogers, CNN

(CNN) — If your teen’s opting out of the school football game or shopping with friends, chalking it up to teen angst can be easy. But you should pay more attention since social withdrawal could signal something deeper is going on, a new study has found.

Being socially withdrawn and experiencing physical discomforts as a preteen is associated with a higher risk of having suicidal thoughts at age 16, according to the study published Thursday in the journal JAMA Network Open.

The authors considered their study urgent. Across the globe, 10% to 20% of adolescents experience suicidal thoughts, and suicide is one of the leading causes of death among them, highlighting the need for strengthened prevention efforts. Rates of suicide attempts and deaths by suicide among children and young adults in the United States have also been increasing in recent years, according to the US Centers for Disease Control and Prevention.

To the authors’ knowledge, “previous studies on suicidal thoughts mainly focused on (one category of) psychopathological symptoms such as depression, anxiety and psychotic symptoms,” said Dr. Shuntaro Ando, lead author of the study and associate professor in the department of neuropsychiatry at the University of Tokyo, via email.

But the current study examined the associations between the long-term trajectory of multiple categories of psychological and behavioral symptoms and suicidal thoughts.

The authors studied adolescents involved in the Tokyo Teen Cohort study, which has examined mental and physical development during adolescence since 2012. The 2,780 participants in this study were born between 2002 and 2004; their parents answered questionnaires about their child’s mental and behavioral symptoms at ages 10, 12 and 16.

Those symptoms were in the categories of social withdrawal, “somatic complaints,” anxiety or depression, social problems, thought problems, attention problems, delinquent behavior and aggressive behavior. Somatic complaints refer to physical symptoms without a known medical cause such as headaches, nausea, skin issues, vision problems or stomachaches.

Having suicidal thoughts was defined by answering “yes” or “somewhat yes” to the question “Do you currently think that you should not be alive?” at age 16.

Participants who experienced social withdrawal and somatic symptoms throughout adolescence were around two to three times more likely to experience suicidal thoughts at age 16, the study found.

The findings match what Dr. John Duffy, a Chicago-based psychologist who wasn’t involved in the study, has seen in his practice, he said via email.

“That is, teenagers that I’ve worked with who are socially withdrawn and experienced somatic symptoms — anxiety, in particular — early in adolescence have a far greater risk for suicidal ideation in mid and late adolescence,” added Duffy, author of “Rescuing Our Sons.” “This is undeniably true and a really strong argument for early intervention.”

The study is also helpful for parents and mental health professionals as it confirms more risk factors for teen suicide, which those groups are concerned about, said Dr. Christopher Willard, a teaching associate in psychiatry at Harvard Medical School in Boston and author of “Growing Up Mindful.” Willard wasn’t involved in the study.

Explaining the findings

The authors acknowledged a few important limitations of their work, including the lack of information about genetics and adverse childhood experiences. Additionally, psychological and behavioral symptoms were reported by caregivers, not the adolescents themselves.

But the link between social withdrawal and suicidal thoughts could be explained by the “loss of protective social connections,” according to the study.

“As human beings, we are wired for social connection,” Willard said. “When it’s neutral or positive, it lifts us up, it helps our mental health, it helps us have something to live for. It gives us perspective.”

Having a support network can make mental health issues feel more manageable, he added. The lack of these things can sometimes influence how kids feel about themselves as the brain develops at an early age, resulting in a negative perspective that persists over time.

Regarding the association between somatic symptoms and suicidal thoughts, psychological distress can manifest physically, especially in “cultures that inhibit emotional expression,” the authors said.

In his practice, Duffy has found the findings to be especially true among boys and young men, he said. “I think that’s due in large part to the fact that girls are imbued early with a rich, emotional language that boys continue to lack even today.”

The cultural hypothesis is also relevant among children of color, who tend to experience somatic symptoms more than White kids, Willard said — “so (the study) may help us even better identify underserved and overlooked groups of kids who are really suffering and at risk,” he added.

What parents and guardians can do

Social withdrawal by choice is typically more concerning than being withdrawn because of exclusion by other kids, Willard said. But don’t interpret them withdrawing from you as a point of concern since that’s developmentally normal, and they may be replacing you with more time with peers.

You also shouldn’t assume “that the withdrawn symptoms are not a problem because the child has always been shy and prefers to be alone,” Ando said.

But if your children say they’re hanging out with friends or at a school club but you find out that’s not the case, it could mean they’re not only socially withdrawn but also embarrassed to tell you. A teacher or supervisor may be able to clue you in to this behavior as well as help your kid get more socially involved.

If your children are isolated because of other kids, try signing them up for out-of-school activities, Willard suggested.

“If you hear a lot of complaints about aches and pains, it doesn’t (automatically) mean your child is suicidal,” Willard said. “But you might want to ask a bit about how they are feeling overall, whether they have things they are looking forward to and so forth.”

When it comes to whether your child is suicidal, keep an eye out for symptoms such as extreme mood swings, hopelessness, the giving away of cherished belongings, or obsession with death.

Seeking professional help early as a preventive approach to deeper issues later is important, Duffy said.

While help from mental health professionals can be critical, Willard said, don’t underestimate the power of your child finding a good friend in a kind peer, sports coach or family friend.

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