Editor’s note: This article discusses suicide and suicidal ideation. If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.

Katherine Nugent thought her daughter was getting better.

Beloved at school, her 15-year-old daughter Isabel was a lauded artist, a star soccer player and a gifted poet. She’d struggled with depression before, and lived with chronic physical pain as a result of fibromyalgia, but she seemed in good spirits, Nugent says. She had upcoming plans to have a sleepover with friends and participate at an arts fundraiser for her high school.

So, when the Washington, D.C. math teacher heard her daughter’s alarm clock continue to ring one morning, she didn’t think anything of it.

“I don’t know why it didn’t strike me as weird that it was just ringing and ringing and ringing,” Nugent says. “The light was on in the bathroom, and I thought she was getting ready for school. And then I said, ‘Isabel,’ and she didn’t answer. And so I thought, ‘She must have her headphones on.’ And so I pushed the door, and it wouldn’t push open. And then it pushed open, and she was dead on the floor.”

Suicide can sometimes seem mysterious. It doesn’t have a set timeline. It isn’t linear. No matter what, it leaves loved ones struggling to piece together where things went wrong. When it happens with little to no warning or indication, it can feel especially devastating.

This unpredictable aspect of suicide is fraught, complicated and, often, misunderstood − and it’s something Nugent feels called to raise awareness about.

“It’s almost like it’s heart disease,” Nugent says. “Sometimes you have a heart attack and you survive and you get medicine and you get treatment, and you live the rest of your life. And sometimes, you then have another heart attack and another heart attack, and then you have one that kills you. And sometimes you live a long time, and there’s no sign of anything, and then you have a heart attack and you die. I think it’s much more complex than we understand.”

‘It was like she had a double life’

On the outside, Isabel seemed to be thriving. She had plenty of friends. Teachers loved her. Her life was replete with accomplishments across athletics, arts and academics. Many on campus admired her sense of style.

Her death in October 2023 shocked her school. More than 250 people attended her memorial. One boy, who had a severe disability, remarked how Isabel was one of the few people at school who befriended him.

“She was not like this fallen apart, depressed person,” Nugent says. “When you saw her at school, she was interacting. She was laughing. She was joking. She was engaged. And she told me she wasn’t depressed anymore.”

Isabel had attempted suicide previously when she was 13. When Nugent found out, she had Isabel hospitalized and took her to see mental health professionals.

A psychologist, Nugent says, found Isabel had an IQ of 160 − a score beyond the genius mark. Her self-esteem, however, faired much lower.

“She was in the 99.99th percentile in terms of her intelligence, and she was in the 2nd percentile in terms of her self-image,” Nugent says. “She just thought she was worthless.”

But Isabel seemed to be improving tremendously. She was taking medication and in therapy. Everybody thought she was better.

Nugent believes there may be a connection between Isabel’s depression and her internet use. She recalls how Isabel said she found comfort in reading stories about other people with similar struggles. At the time, Nugent thought her daughter meant fiction; now, she thinks Isabel may have been on online suicide forums, where people encourage others to end their lives and offer detailed instructions for doing so. Since Isabel’s death, Nugent has raised awareness about these sites and championed legislation to limit their reach.

Whatever Isabel was thinking, Nugent says, her daughter kept it to herself.

“It was like she had a double life that she didn’t tell anybody,” she says. “She didn’t tell any of her friends the day that she did it. She was laughing and talking with her friends at school, talking about huge plans to have a sleepover and go to March for the Arts that weekend.”

‘All mental health experiences are dynamic’

Dr. Christine Yu Moutier, a psychiatrist and chief medical officer at the American Foundation for Suicide Prevention, says one of the biggest misconceptions about suicide is that it’s straightforward − that people gradually become more and more depressed until they take their own lives.

The reality, she says, is far more complicated.

One reason for this, she says, is that suicide has several causes, and they’re not all external.

“It’s internal, biological, psychological, genetic,” Moutier says. “But the bottom line message is: Depression, and all mental health experiences, are dynamic. They are ever-changing and evolving.”

It’s also possible for someone who’s suicidal to improve in some areas while regressing in others. For instance, a depressed person may feel better in terms of their energy and sleep, but still have negative, ruminating thoughts. People may also relapse into suicidal thinking after long stretches of improvement.

The warning signs for suicide can be difficult to spot − and people who are suicidal may hide them well. That doesn’t mean people should give up on looking for them or that prevention is impossible; but it does mean people shouldn’t blame themselves for missing signs either.

“They’re not always the same,” Moutier says. “They’re not monolithic. They can be very subtle signs of behavior change and indications of hopelessness or suicidal thinking.”

Since Isabel’s death, Nugent says she’s found solace in a Facebook group for mothers who’ve lost children to suicide. They’re the only ones, she says, who really know what she’s going through.

“You’re supposed to get over it, and you never get over it,” she says. “I’ve lost a couple of friends. They just aren’t comfortable with it, or they don’t know what to say anymore. And I mean, I get that they don’t know. How could they? They have no idea. Or they sort of say things like, ‘Well, you sound better.’ And that’s the worst possible thing anybody could ever say to me  ‘You sound better.’”

Suicide Lifeline: If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 988 any time, day or night, or chat online.

Crisis Text Line provides free, 24/7, confidential support via text message to people in crisis when they text “HOME” to 741741.