Ask the question: Preventing youth suicide Jeff Kerber, Ph.D. LMFT Clinic & Program Administrator Counseling & Psychiatry
Preventing Youth Suicide Takeaways… 1. Understand the Challenge – Perspective from some stats and facts. – Separate Myths from Facts. 2. Understand Risk . 3. Prevention – Gatekeeping. What to do. – Identify/review high risk factors – Ask the question . 2
Preventing Youth Suicide Statistics • Approximately 40,000 people in the U.S. die by suicide each year. About every 13 minutes someone in this country ends his/her life. Under- reported NASH – what about U? National 2017 YRBS results indicate, of 9 th – 12 th grade respondents: • – Considered = 17.2% – Made plan = 13.4% – Attempted = 7.4% Suicide is the 2 nd leading cause of death in U.S. for people aged • 10-24 (CDC, 2015) More teens die by suicide then by cancer, heart disease, AIDS, birth defects, stroke, pneumonia and flu – combined. 2nd leading cause of death among 15 – 19 year olds in Iowa (behind • car accident and in front of homicide). Approximately 4,500 U.S. youth die by suicide each year (CDC, • 2014) 3
Preventing Youth Suicide Statistics • Deaths by suicide – 2016 per age (CDC, Fatal Injury Report): – General US pop 13.42 / 100,000 (very stable 80+ yrs) – > 85 white males 49.8 / 100,000 – > 65 all 14 / 100,000 – 15 – 24 13.15 / 100,000 (highest rate of increase 07-16) .73 / 100,000 – < 15 • By State in 2016 – Iowa 14.6 / 100,000 vs. US rate 13.42 / 100,000 • Teenage girls 3x more likely to attempt; boys 2x more likely to complete (YRBS, 2015) • GLBTQ (gay, lesbian, bi, trans, queer) youth are 4x’s more likely, and questioning youth are 3 times more likely, to attempt suicide as their heterosexual peers. • 4 out of every 5 attempters gave clear warning sign (YRBS, 2017) 4
Preventing Youth Suicide Iowa Youth Survey 12,236 respondents • IYS Polk Co (2016) – Yes – “seriously thought about killing myself?” 10% (442) of 6 th grade respondents • 14% (571) of 8 th grade respondents • 17% (529) of 11 th grade respondents • • IYS Polk Co (2016) – Yes – “tried to kill myself?” 3% (132) of 6 th grade respondents • 5% (204) of 8 th grade respondents • 5% (155) of 11 th grade respondents • 5
Preventing Youth Suicide Suicide Facts Completed Suicide and Psychiatric Diagnosis Psychological autopsy research conducted in various • countries over almost 50 years report very similar outcomes: ▪ 90% of people who die by suicide are suffering from one or more psychiatric disorders: ▪ Major Depressive Disorder ▪ Bipolar Disorder, Depressive phase ▪ Alcohol or Substance Abuse* ▪ Schizophrenia ▪ Personality Disorders such as Borderline PD *Primary diagnoses in youth suicides. 6
Preventing Youth Suicide Suicide Facts Even though most people give warning signs of their intent; communication about suicide is often NOT made to professionals. In one psychological autopsy study, only 18% of completers told • professionals of intentions. Zero Suicide – we aren’t asking the right question. – 50% of completers had seen PCP within 30 days – higher for middle aged white males. In a study of suicidal deaths in hospitals: • ▪ 77% denied intent on last communication ▪ 28% had “no suicide” contracts with their caregivers Research does not support the use of “no-harm contracts” (NHC) • as a method of preventing suicide. Research does support developing safety plans with suicidal pts. • 7
Preventing Youth Suicide Myth vs. Fact • MYTH: People who threaten suicide don't complete suicide. • FACT: The vast majority of people who die by suicide have given signals or warnings to family and friends of their intentions. Always take comments about suicide seriously. 8
Preventing Youth Suicide Myth vs. Fact • MYTH: Suicidal youth are fully intent on dying. • FACT : Many people who attempt suicide are unsure if they want to live or die, they experience “suicidal ambivalence.” Rather, people are trying to relieve unbearable mental pain. They may see suicide as a way out of their pain and suffering. Youth often complete due to impulsive action vs. intent. 9
Preventing Youth Suicide Myth vs. Fact • MYTH: Asking a depressed youth/person about suicide will increase risk to complete suicide. • FACT: Research and clinical experience is clear that people thinking about suicide are not at greater risk when asked to talk about it. Talking, or asking the question; does not increase likelihood of attempt. 10
Preventing Youth Suicide Prevention Critical tasks: 1. Identify - confidently identify high risk youth. 2. Respond – ask the question and connect with high risk youth, persuade them to get help. 3. Get help – connect or refer to appropriate resources. 11
Preventing Youth Suicide Gatekeeper Training – QPR QPR (Question, Persuade, and Refer) Training for Suicide Prevention is a 1-2 hour educational program designed to teach lay and professional "gatekeepers" the warning signs of a suicide crisis and how to respond. Gatekeepers can include anyone who is positioned to recognize neighbors, teachers, coaches, caseworkers, police officers). and refer someone at risk of suicide (e.g., parents, friends, The process follows three steps: (1) Question the individual's desire or intent regarding suicide, (2) Persuade the person to seek and accept help, and (3) Refer the person to appropriate resources. . 12
Preventing Youth Suicide Understanding Risk Putting the pieces together… Goal. Translate the facts and stats into a functional understanding of risk . Risk is dynamic, not static. It changes for • people and depending on how we respond. Several important elements of a persons • risk for suicide include understanding: – Mental Health – Depression – Environment, or context of their lives, both real and perceived. 13
Preventing Youth Suicide Risk – Mental Health Psychiatric Disorders Most common psychiatric risk factors resulting in suicide: • Depression* – • Major Depression • Bipolar Depression Anxiety Disorders, e.g. PTSD, OCD – Alcohol / drug abuse and dependence – Post partum dep – women esp w/psychotic features – SMI – e.g. Schizophrenia, paranoid type – Developmental Psychology: • Maturational imbalance – teen reward focused behavior outpaces inhibitory control. – Pre-frontal cortex is not fully developed – women looking at 20/21 men 24/25. – Too much acceleration without fully developed braking system, leads to emotionally impulsive actions. * Especially when combined with alcohol and drug abuse and conduct d/o. 14
Preventing Youth Suicide Risk - Depression Depressed Mood &/or Loss of Interest – min 2 wks & different from baseline + (4) SIGECAPS • Sleep • Interests & isolation • Guilt – self esteem (shame – blame self for trauma) • Energy levels • Concentration • Appetite • Psychomotor agitation • Suicide Ideation - Plans - Methods 15
Preventing Youth Suicide Risk – Environment Means/Context/Relational Risk Factors – Easy access to lethal means Top three methods used by young people include: firearm, • suffocation, poisoning Younger children – running into traffic • CALM – Counseling on Access to Lethal Means • Loss - Recent death or breakup – lacking perspective – Affluence – stems resilience – little experience with frustration, – disappointment, delayed gratification, altered perspective. Recent surveys of law enforcement academies - graduating officers expect to • work daytime hours, no overnight and Holidays off. Social media – relational influence contributes to perception and – experience of isolation, e.g. “everybody hates you.” We can’t control others use of social media – we can control access and use of the device. 16
Preventing Youth Suicide Risk – Environment Means/Context/Relational Risk Factors – Gender – males more often complete – females internalization leads to increased attempts – Prolonged stress – external locus of control. Bullied – academic struggle – violence at home – Contagion - Local clusters of suicide that have a "contagious influence“ – Trauma history - family distress – separation or divorce – Adverse Childhood Experiences - ACES 17
Preventing Youth Suicide Prevention – What to do… Learn to look for risk factors: • – Mental health disorders, e.g. depression. – Environmental, e.g. lethal means – Trauma history, e.g. family/relational changes, divorce, ACES – Precipitating event, e.g. bullying Past Attempts – already “crossed the • line” (40-50% more likely to attempt – descends over time – NIMH). – NSSI – Non Suicidal Self Injury – phys pain releases brain chemicals provides temp relief of mental pain Take it seriously 50 – 75% of people who • complete gave some warning sign to friends/ family (AFSP). 18
Recommend
More recommend
