It is impossible to accurately predict suicide because it is a "disease of the moment". While some suicides are deliberative, involve careful planning and may provide typical warning signs, such as giving away belongings and saying goodbyes, the majority of suicides are hastily decided-upon and involve little or no planning.

The acute period of heightened risk for suicidal behavior is often only minutes or hours long. In fact, one study (Simon 2005) found that one in four deliberated for less than five minutes!

A core trait of the highest risk mental disorders and amongst those who have completed suicide is impulsivity. Establishing a history of impulsivity is important in predicting which youth need intense supervision or immediate transfer to a safe place for treatment. Impulsivity can manifest as physical aggression, fights at home or school, and dangerous, risk-taking activities. Substance use can impair judgment and exacerbate impulsivity. An impulsive teen might act quickly on suicidal thoughts.

Warning signs of suicide to be alert to include changes in personality or behavior that might not be obviously related to suicide. When a teenager becomes sad, more withdrawn, more irritable, impulsive, anxious, tired, or apathetic-things that used to be fun aren't fun anymore-you should be concerned. Changes in sleep patterns or eating habits can also be red flags. Acting erratically, or recklessly is also a warning sign. If a teen starts making really poor judgments, increases drug use, or he starts doing things that are harmful to himself or other people, like bullying or fighting, it can be a sign that he is spinning out of control.

It is a common misperception that only a single event leads to suicide. A single event can be the straw that breaks the camel's back, but it is quite rare a single event prompts a suicide attempt.

Our goal must be to identify and detect symptoms as early as possible so we can get the teens most at risk the help they need. Better and more accurate screening for mental health disorders that can lead to suicide must be a priority.