青少年自殺率上升, 談兒童與青少年自殺的警訊。

最黑暗的冬日清晨

作為一名兒童與青少年精神科醫師，我曾陪伴許多家庭度過他們人生中最糟糕的日子。

某個十二月的清晨，天尚未亮，我在急診室見到一名15歲的華裔美國男孩——一位全優生——前一晚曾企圖結束自己的生命。他選擇的方式令人心驚膽戰且複雜。首先，他吞下整瓶阿得拉爾 (Adderall)，希望藥物過量能迅速結束生命。然而，這並未如他預期般迅速起效。接著，他拿起刀割開自己的手腕和前臂——仍未死亡。最後，在極度絕望中，他脫掉全身衣物，爬到戶外雪地裡，躺在冰冷的地面上，試圖凍死自己。接下來的情況只能說是一種命運、諷刺與神意的奇特混合——早先服下過量阿得拉爾 (Adderall) 所帶來的高度興奮，使他的身體新陳代謝保持在高水平，讓他在寒冷中生存下來，贏得寶貴的時間，直到他的父親早晨來叫他起床上學，驚覺他不見人影，才在雪地裡找到他。

我記得他坐在病床上，瑟瑟發抖，眼睛睜得大大的，身上蓋著無數層醫院毛毯，手臂上插著溫熱的鹽水靜脈注射管。他的聲音低沉而空洞：「我只是覺得沒有人會聽……好像我說的話都沒用。」後來他聲音哽咽地補充：「我覺得自己在他們眼裡是隱形的……好像爸媽只在乎我的成績，而不在乎我這個人。」他的父母悲痛欲絕，淚水奪眶而出，第一次真正意識到自己對兒子的期望是多麼沉重，以及自己曾忽略或未察覺兒子痛苦的微妙跡象。在那一刻，一個聰明、努力的孩子被逼到生命邊緣的危險、恐懼與悲劇變得格外真實。這名男孩的故事並非孤例——許多青少年，尤其是在面臨強烈學業期待與文化壓力時，默默承受類似的內心掙扎。但這也展示了一個關鍵事實：主動關心，直接詢問自殺想法，並真正傾聽，可以拯救生命。

兒童與青少年的自殺想法其實比許多人想像的更普遍

根據美國疾病控制與預防中心（CDC）的資料，自殺是美國青少年死亡的主要原因之一。在這些統計背後，是那些往往成績優異、善良、幽默且備受愛護的孩子——卻在內心默默承受巨大壓力。
兒童與青少年自殺想法可能呈現的樣貌
自殺意念不一定會以戲劇性的宣言或明顯的自我傷害表現出來。很多時候，它很微妙。
有些青少年描述自己感到疲憊，而非明顯悲傷。一名16歲青少年曾對我說：「我不是想死，我只是每天都不想再這樣感受下去。」另一個說：「感覺好像其他人都有生活手冊，而我錯過那一天。」
在年紀較小的孩子身上，他們的語言可能更具體。我曾聽過孩子說：「我希望我可以消失」或「如果我被車撞到，也沒關係。」這些話有時被視為博取關注或誇張行為，但事實上，它們是溝通。

其他警訊可能包括：

• 遠離朋友或曾經喜歡的活動
• 贈送珍貴物品
• 情緒易怒或暴躁頻率增加
• 睡眠或食慾改變
• 嚴重憂鬱後突然平靜
• 談論、書寫或繪畫與死亡相關的內容

我曾評估過一名13歲女孩，她變得異常沉默。她的成績仍然很高，也依舊參加小提琴練習。從外表看，一切似乎「正常」。當我私下詢問她的真實情況時，她尖聲回我：「我只是厭倦了總是當好孩子！」事實上，她已經秘密自傷好幾個月。

害怕詢問

家長有時告訴我：「我怕問會讓孩子萌生念頭。」研究——以及我的臨床經驗——顯示情況正好相反。直接問：「你有想傷害自己嗎？」往往會帶來明顯的舒緩。這傳達的是關心，而非建議。我見過家長平靜而直接問這句話時，孩子的肩膀放鬆了。多位患者曾對我說：「當媽媽終於問了，我覺得她真正看見了我。」迴避問題不會保護孩子，反而可能加深孤立感。直接詢問可以開啟拯救生命的對話之門。

亞洲裔美國青少年：脆弱且常保持沉默的群體

雖然自殺影響各種背景的青少年，但不同社群有其獨特面向。根據 CDC 和其他公共衛生研究機構的全國調查，亞洲裔美國青少年報告憂鬱症狀與自殺意念的比率相當高。部分研究發現，亞洲裔美國青少年女性尤其報告自殺想法的比例高於其他種族和族群的同齡人。
在亞洲裔美國社群——包括華裔美國家庭——有一些特有的風險因素值得注意。
學業壓力過高是常見壓力來源。我曾接觸許多華裔青少年，他們形容自己的價值與學業成績緊密相連。一位成績優異的學生曾告訴我：「如果我沒考上頂尖學校，父母的付出都白費了。」尤其是在移民家庭中，孩子害怕讓父母失望的心理可能極為沉重。
文化上的情緒克制期待也可能影響心理健康。在一些家庭中，心理困擾會被輕描淡寫或被視為軟弱。一名青少年曾向我坦言：「我們家不談感受，只談成績。」另一名則說：「我告訴父母我很沮喪，他們說我不懂感恩。」當父母或至親否認孩子的個人痛苦，可能加劇憂鬱想法。
許多亞洲裔家庭深具支持與保護，但當高期待、心理健康污名與社會壓力交錯時，一些青少年可能感到進退兩難——在家裡被視為「過於美式」，在學校又被視為「過於亞洲」。青春期本就是身份認同形成的時期，而被家人誤解、被同儕排斥，甚至經歷種族歧視或社會排斥，都可能加劇孤立感。

青少年談自殺想法

在安全環境下，青少年往往以成人意想不到的方式描述自殺思維。

• 「感覺有個聲音說，大家沒有我會更好。」
• 「我上網查怎麼做，但我並不真的想死，我只是想停止痛苦。」
• 「我以為沒有人會當真看我。」
• 「我試過一次，但沒成功，我覺得自己很蠢，所以沒告訴任何人。」
• 「我只是希望有人注意我。」

一名17歲幸存的青少年曾悄聲告訴我：「剛做完那件事，我立刻後悔，明白自己想活下去，但我不知道怎麼收回。」這句話充分說明早期介入的重要性。在這類緊急情況下，立即撥打 911 或前往最近的醫院急診室，是最關鍵的下一步。
家長與照護者能做什麼
最重要的步驟是創造誠實對話的空間。這意味著多傾聽而非說教，即便不理解，也要確認孩子的感受，並避免立刻解決問題。

• 與其說「你這麼優秀」，不如說「這一定很沉重，我很高興你告訴我。」
• 如果孩子表達自殺念頭，每次都要認真對待。不要以為只是階段性行為。請立即尋求專業幫助。

若孩子有自殺意念，與兒科醫師、家庭醫師、治療師、心理學家或精神科醫師諮詢至關重要。這些專業人員可以評估風險、制定安全計畫，並在適當情況下提供治療或藥物。對憂鬱、焦慮、創傷或其他潛在疾病的早期治療，能顯著降低自殺風險。
如遇迫在眉睫的危險——例如有具體計畫、接觸致命工具，或剛完成自殺企圖——應立即撥打 911 聯繫緊急服務。

專業治療的角色

治療能提供青少年調節強烈情緒、挑戰扭曲想法、建立心理韌性的工具。循證治療如認知行為療法（CBT）與辯證行為療法（DBT）已被證實能降低青少年自殺行為。若憂鬱或其他精神疾病需要，藥物治療也可能拯救生命。我自己和其他醫師都見過曾無法想像未來的青少年，透過適當治療與支持逐漸重拾希望。
青少年與家長可利用的危機資源
除了當地緊急服務，還有全國性資源全年無休。

• 危機簡訊線（Crisis Text Line）：可簡訊 HOME 至 741741 與受過訓練的即時危機諮詢員連線。對於不方便電話通話的人特別有幫助。
• 青少年及關心的家長也可撥打或簡訊 988 聯繫美國自殺與危機熱線，全天候提供保密支援。

我經常告訴家庭：使用這些服務不是過度反應，而是主動的關懷。

希望之光

我見過悲劇，也見過奇蹟。
我想起那名12歲女孩，她曾告訴我：「我以為自己撐不到高中。」去年，她寄來了畢業照。
我想起那名15歲的華裔美國男孩，在那個冬晨的病房裡——他幸存自殺企圖，最終就讀常春藤盟校，如今正在學習心理學，希望幫助曾經孤單、掙扎的他人。
我也想起那些走進我診所、以為自己失敗的家長——他們最強大的行動，是親身出現、直接提問、全程陪伴。
如果你是閱讀本文的家長，感到害怕，請知道：恐懼往往是愛的表現。問出那個問題。傾聽答案。及早尋求幫助。
如果你是一名正在掙扎的青少年，請記住：一時的強烈感受不會決定你整個未來。總有人——父母、兄弟姊妹、朋友、同儕、老師、治療師和醫生——愛你，願意陪伴你書寫未來的故事。

自殺念頭在孤獨與寒冷中滋生，在他人光與溫暖中逐漸消退。
能拯救生命的問題是：「我在這裡——你願意告訴我發生了什麼嗎？」

The Question That Can Save a Life

Youth suicide is rising. A child psychiatrist speaks on the warning signs of child and adolescent suicide.

The Darkest Winter Morning

As a child and adolescent psychiatrist, I have sat with many families on the worst days of their lives.

One December morning, hours before sunrise, I met a 15-year-old Chinese-American boy in the emergency department – a straight-A student who had tried to take his own life the night before. The method he had chosen was terrifyingly complex. First, he swallowed an entire bottle of Adderall, hoping the overdose would end him quickly. When that failed to work as quickly as he had imagined, he took a knife and slashed his wrists and forearms – yet still, death did not come. In a final, desperate act, he stripped off all his clothes and crawled out naked into the snow outside, lying on the frozen ground in the winter cold, trying to freeze to death. What came next could only be described as a combination of fate, irony, and God – his body, now hyper-energized by the stimulant effects of his earlier Adderall overdose, kept his metabolism high enough to keep him alive, buying precious hours until his father came to wake him for school and, alarmed by his absence, discovered him in the snow.

I remember him sitting on the hospital bed, shivering, eyes wide, with countless layers of hospital blankets covering him and a warm saline IV in his arm. His voice was quiet and empty – “I just felt like no one would ever listen… like nothing I said mattered.” Later he added, his voice breaking, “I felt invisible to them… like my parents only cared about my grades, not about me.” His parents were inconsolable, tears streaming down their faces, realizing for the first time how heavy their expectations had weighed on their son, and how they had missed the subtle signs of his pain. In that moment, the danger, the fear, and the tragedy of an intelligent, hardworking child being pushed to the edge became painfully real. This boy’s story is not unique—many adolescents, especially those juggling intense academic expectations and cultural pressures, face similar silent battles. But it also demonstrates a crucial truth: reaching out, asking directly about suicidal thoughts, and truly listening can be life-saving.

Suicidal thoughts in children and adolescents are far more common than many people realize. According to the Centers for Disease Control and Prevention (CDC), suicide is one of the leading causes of death among youth in the United States. Behind those statistics are children who are often high-achieving, kind, funny, and deeply loved—yet silently overwhelmed.

What Suicidal Thoughts Can Look Like in Children and Teens

Suicidal ideation does not always present as dramatic declarations or visible self-harm. Often, it is subtle.

Some teens describe feeling exhausted rather than overtly sad. One 16-year-old once told me, “It’s not that I want to die. I just don’t want to keep feeling like this every day.” Another said, “It feels like everyone else got a manual for life, and I missed that day.”

In younger children, the language may be more concrete. I have heard statements like, “I wish I could disappear,” or “If I got hit by a car, it wouldn’t matter.” These comments are sometimes brushed aside as attention-seeking or dramatic. They are not – they are communication.

Other warning signs can include:

• Withdrawal from friends or activities they once enjoyed
• Giving away prized possessions
• Frequently increased irritability or rage
• Changes in sleep or appetite
• Sudden calmness after a period of severe depression
• Talking, writing, or drawing about death

I once evaluated a 13-year-old who had become unusually quiet. Her grades were still high. She was still attending violin practice. From the outside, everything looked “fine.” When I asked privately how she was really doing, she snapped back at me, “I’m just tired of being the good kid all the time!” She had been cutting herself in secret for months.

The Fear of Asking

Parents sometimes tell me, “I was afraid to ask in case I put the idea in their head.” Research—and my clinical experience—show the opposite. Asking directly, “Are you thinking about hurting yourself?” often brings visible relief. It communicates care, not suggestion. I have seen shoulders drop when a parent asks that question calmly and directly. More than one patient has told me, “When my mom finally asked, I felt like she actually saw me.” Avoiding the question does not protect children. It can reinforce their isolation. Asking directly can open the door to lifesaving conversation.

Asian-American Adolescents: A Vulnerable and Often Silent Group

While suicide affects youth across all backgrounds, there are important nuances among different communities. Data from national surveys, including reports from the Centers for Disease Control and Prevention and other public health research bodies, show that Asian-American adolescents report significant rates of depressive symptoms and suicidal ideation. Some studies have found that Asian-American teenage girls, in particular, report higher rates of suicidal thoughts compared to peers in other racial and ethnic groups.
Within Asian-American communities—including Chinese-American families—there can be unique risk factors that deserve thoughtful attention.

High academic pressure is one commonly cited stressor. I have worked with many Chinese-American adolescents who describe feeling that their worth is tied to performance. One high-achieving student once told me, “If I don’t get into a top school, everything my parents sacrificed is for nothing.” The fear of disappointing family can be overwhelming, especially in households where parents immigrated and endured tremendous hardship.

Cultural expectations around emotional restraint can also play a role. In some families, mental health struggles are minimized or framed as weakness. A teen once confided, “We don’t talk about feelings in my house. We talk about grades.” Another said, “When I tell my parents I’m depressed, they tell me I’m ungrateful.” This dismissal of one’s very personal experience of suffering, especially by a parent or loved one, can exacerbate depressive thoughts.

Many Asian-American families are deeply supportive and protective. But when high expectations, stigma about mental health, and social stress intersect, some adolescents feel trapped between worlds – being considered “too American” at home, and “too Asian” at school. Adolescence is already a time of identity formation, and feeling misunderstood by family or rejected by peers, as well as experiences of racism or social exclusion, can often compound these pressures and create feelings of profound isolation.

What Teens Say About Their Suicidal Thoughts

When given a safe space, adolescents often describe their suicidal thinking in ways that surprise adults.

• “It’s like a voice that says everyone would be better off without me.”
• “I Googled how to do it, but I didn’t really want to die. I just wanted the pain to stop.”
• “I didn’t think anyone would take me seriously.”
• “I tried once, but when it didn’t work, I felt stupid. So I didn’t tell anyone.”
• “I just wanted someone to notice me.”

One 17-year-old who survived an attempt told me quietly, “Right after I did it, I immediately regretted it and realized I wanted to live. But I didn’t know how to undo it.” That sentence alone underscores why early intervention is so critical. In emergency cases such as these, immediately calling emergency services by dialing 911, or heading to the nearest hospital emergency room, is the most crucial next step.

What Parents and Caregivers Can Do

The most important step is to create space for honest conversation. This means listening more than lecturing, validating feelings even if you do not understand them, and avoiding immediate problem-solving.

• Instead of saying, “But you have so much going for you,” try, “That sounds incredibly heavy. I’m glad you told me.”
• If your child expresses suicidal thoughts, take them seriously every time. Do not assume it is a phase. Seek professional help promptly.

Speaking to a pediatrician, family doctor, therapist, psychologist, or psychiatrist is essential if a child is having suicidal ideations. These professionals can assess risk, develop a safety plan, and recommend therapy or medication when appropriate. Early treatment for depression, anxiety, trauma, or other underlying conditions can dramatically reduce suicide risk.

If there is imminent danger – such as a specific plan , access to lethal means, or immediately after a suicide attempt – emergency services should be contacted immediately by dialing 911.

The Role of Professional Treatment

Therapy provides adolescents with tools to regulate overwhelming emotions, challenge distorted thoughts, and build resilience. Evidence-based treatments such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) have been shown to reduce suicidal behaviors in youth. Medication, when indicated for depression or other psychiatric conditions, can also be lifesaving. Every physician, myself included, has seen teens who once could not imagine a future gradually regain hope with appropriate treatment and support.

Crisis Resources for Youth, Adolescents, and Parents

In addition to local emergency services, there are national resources available 24/7.

• The Crisis Text Line allows individuals to text HOME to 741741 to connect with a live, trained Crisis Counselor. This can be especially helpful for people who feel more comfortable texting than speaking on the phone.
• Youth and concerned parents can also call or text 988 to reach the Suicide & Crisis Lifeline in the United States, which provides confidential support around the clock.

I often tell families: using these services is not overreacting. It is proactive care.

The Light of Hope

I have seen tragedies, but I have also seen miracles.

I think of the 12-year-old girl who once told me, “I didn’t think I’d make it to high school,” who last year, sent the clinic a graduation photo.

I think of that 15-year-old Chinese-American boy in the hospital room on that winter morning – who did survive his suicide attempt, and did end up attending an Ivy League university – who is now studying to become a psychologist to reach others who were once just like him, struggling alone and in silence.

And I think of the many parents who walked into my office terrified they had failed, only to learn that showing up, asking directly, and staying present were the most powerful steps they could take.

If you are a parent reading this and feeling afraid, know that fear is often a sign of love. Ask the question. Listen to the answer. Seek help early.

If you are a young person struggling, please know: the intensity of one single moment does not define your entire future. There are people out there – parents, siblings, friends, peers, teachers, therapists, and doctors – who love you and want to see how your story unfolds in the future.

Suicidal thoughts thrive in the dark and cold of solitude. They fade in the light and warmth of others.

The question that can save a life is: “I’m here – can you tell me what’s going on?”

李霸醫師 – Dr. Bob Lee