More than Sad: Suicide Prevention Education for Teachers and Other School Personnel
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More than Sad: Suicide Prevention Education for Teachers and Other School Personnel

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American Foundation for Suicide Prevention

American Foundation for Suicide Prevention

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  • Refer participants to the Introduction in their manual. Note that they can follow along in the manual as you highlight the main points of each section. Encourage them to jot any additional information you will provide in the margins. (Note: the Manual has been updated with the 2010 statistics)
  • Refer participants to Section 1. How Big a Problem is Youth Suicide? 2010 is the latest year for which suicide statistics are available. Note to trainer : This slide can be updated by going to CDC website: http://webapp.cdc.gov/sasweb/ncipc/mortrate10_sy.html Suicide rate is defined as the number of suicides that occur for every 100,000 people. Overall, the U.S. suicide rate in 2010 was of 12.1 (12.0 suicides for every 100,000 people in the U.S. population).
  • This graph shows suicide rates across the lifespan (note that the small numbers below the horizontal line are ages, ranging from 10 years to 85 years).   We can see that suicide rates increase more dramatically during adolescence and early adulthood than during any other stage of the life cycle.   However, suicide rates for adolescents and young adults are clearly less than those for people in the midlife and elder age groups.
  • In this next graph, we can see the trends in suicide rates over the last 20 years. Suicide rates among the youngest group (10-14 year-olds) have remained relatively constant over this period. However, rates among older adolescents (the middle line) and young adults (the top line) have shown a number of fluctuations.
  • This graph shows a comparison between suicide rates for males between the ages of 10 and 24 – the red line - and those for females of the same ages, which are shown on the blue line. At age 13, we can see that there is little difference between the suicide rate for boys and that for girls. But by age 18, the boys’ rate is 5 times higher than the girls’ rate (15 suicides per 100,000 boys vs. 3 per 100,000 girls). This difference between the sexes remains through young adulthood, peaking at age 22, when the male suicide rate is more than 6 times the female rate.
  • White youth and American Indians have a suicide rate a little above the national average, and the other groups shown have rates below the national average for all youth.
  • Note that the ratio of suicide attempts to suicide deaths declines as people get older.
  • Refer participants to manual Section 2. How Can Teachers Help Prevent Youth Suicide? In this section you will be showing the first film, More Than Sad: Preventing Teen Suicide.
  • Let participants know that the material discussed in the film will be covered in more detail in later sections of the program, and that it is not necessary for them to take detailed notes as they watch it. Encourage them to make note of any questions they may have so that they can make sure to get them answered following the film.
  • The next slides (#12-#36) refer to manual Section 3. What Puts Teens at Risk for Suicide? In this section, the key risk factors for teen suicide are discussed in greater detail, focusing in particular on mental disorders that occur among adolescents.
  • Refer participants to Section 3 of the manual for more detailed descriptions of all mental disorders discussed, and urge that they follow along in their manuals as the slides are presented.
  • Among adolescents aged 15-19, the suicide rate for boys is more than 4 times the rate for girls (11.1 vs.2.5). Among young adults aged 20-24, the suicide rate for males is almost 6 times that for females (20.9 vs. 3.9). This gender difference remains throughout the adult years, with males continuing to have a suicide rate at least 4 times that for females.
  • Mention importance of being sensitive to family history when communicating with families of teens who mat have a mental disorder.
  • Refer participants to manual Section 4. What Treatments Are Available?
  • Refer participants to manual Section 5. How Can Teachers Identify At-Risk Students? In this section, you will be showing the second film, More Than Sad: Teen Depression.
  • Following the film, refer participants to the page 29 of the manual, After the Viewing: Questions to Consider. Use these questions, as time allows, to engage participants in a group discussion. At the conclusion of the discussion, review together the Summary Points on pp. 30-31, which underscore the key messages that have been conveyed so far in the program.
  • Refer participants to manual Section 6. How Else Can Schools Decrease Risk?
  • Distribute copies of Test Your Knowledge and the Participant Feedback Form. Collect both forms after participants have completed them. Please forward Participant Feedback Forms to AFSP at the address listed on the form.

More than Sad: Suicide Prevention Education for Teachers and Other School Personnel More than Sad: Suicide Prevention Education for Teachers and Other School Personnel Presentation Transcript

  • More than Sad:More than Sad: Suicide Prevention Education forSuicide Prevention Education for Teachers and Other School PersonnelTeachers and Other School Personnel American Foundation for Suicide PreventionAmerican Foundation for Suicide Prevention 120 Wall Street, 29th Floor120 Wall Street, 29th Floor New York, NY 10005New York, NY 10005 212.363.3500212.363.3500 www.afsp.orgwww.afsp.org
  • 22 IntroductionIntroduction to the Programto the Program Program goalsProgram goals 1.1. Increase understanding of:Increase understanding of:  Problem of youth suicideProblem of youth suicide  Suicide risk factorsSuicide risk factors  Treatment and prevention of suicidal behavior in adolescentsTreatment and prevention of suicidal behavior in adolescents 1.1. Increase knowledge of warning signs of youth suicide soIncrease knowledge of warning signs of youth suicide so those who work with teens are better prepared tothose who work with teens are better prepared to identifyidentify andand refer at-risk studentsrefer at-risk students
  • 33 Understanding theUnderstanding the Problem of SuicideProblem of Suicide  In 2010, 38,364 people in the U.S. died by suicideIn 2010, 38,364 people in the U.S. died by suicide  U.S. suicide rate = 12.1 (12 suicides for every 100,000 people)U.S. suicide rate = 12.1 (12 suicides for every 100,000 people)  4,867 people under age 25 died by suicide (12.7% of total)4,867 people under age 25 died by suicide (12.7% of total)  Suicide rate for youth (ages 15-24) = 10.1Suicide rate for youth (ages 15-24) = 10.1  Suicide is the 3Suicide is the 3rdrd leading cause of death for adolescents andleading cause of death for adolescents and young adults (ages 15–24)young adults (ages 15–24)
  • 4444
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  • 7777 Youth Suicide RatesYouth Suicide Rates by Race/Ethnicityby Race/Ethnicity (Ages 15-24)(Ages 15-24) *Number of suicides per 100,000 population, 2010 Ethnic Group Suicide Rate per 100,000 American Indian/Alaskan Native 20.9 per 100,000 White 11.4 per 100,000 Asian/Pacific Islander 7.3 per 100,000 Black 6.6 per 100,000 Hispanic 4.7 per 100,000
  • 88 Suicide AttemptsSuicide Attempts  Each year,Each year, 150,000150,000 youth aged 10-24 receive medical care foryouth aged 10-24 receive medical care for self-inflicted injuriesself-inflicted injuries  30x30x the number who die by suicidethe number who die by suicide  9.3% of girls and 4.6% of boys in grades 9-12 report attempting suicide in last 12 months  Reports of suicide attempts are 2-6x more frequent among youth who identify as gay, lesbian or bisexual, than among heterosexual youth; no data on GLB suicide deaths
  • 99 Suicidal IdeationSuicidal Ideation  ““Ideation” – thinking about or planning for suicideIdeation” – thinking about or planning for suicide  AboutAbout 14%14% of students in grades 9-12 – 1 of every 7 – reportof students in grades 9-12 – 1 of every 7 – report seriously considering suicide in the past yearseriously considering suicide in the past year  AboutAbout 11%11% – 1 of every 9 – report making a suicide plan– 1 of every 9 – report making a suicide plan
  • 1010 How CanHow Can Teachers Help?Teachers Help? Key tasksKey tasks  IdentificationIdentification of at-risk studentsof at-risk students  ReferralReferral for assessment and evaluation, according to school’sfor assessment and evaluation, according to school’s protocol or policyprotocol or policy Teachers and other school personnel must know how toTeachers and other school personnel must know how to recognizerecognize “risk”“risk” in youthin youth
  • 1111 Film,Film, More Than Sad:More Than Sad: Preventing Teen SuicidePreventing Teen Suicide  Provides an overview of mental disorders in teens that mayProvides an overview of mental disorders in teens that may end in suicideend in suicide  Identifies behaviors that suggest a student may be at riskIdentifies behaviors that suggest a student may be at risk  Discusses steps that teacher and other personnel can take toDiscusses steps that teacher and other personnel can take to ensure that these students get helpensure that these students get help  Introduces concepts that will be discussed in later sections ofIntroduces concepts that will be discussed in later sections of this programthis program
  • 1212 Show film,Show film, More Than Sad: Preventing Teen SuicideMore Than Sad: Preventing Teen Suicide
  • 1313 Risk FactorsRisk Factors for Teen Suicidefor Teen Suicide  Key suicide risk factorKey suicide risk factor for all age groups is an undiagnosed,for all age groups is an undiagnosed, untreated or ineffectively treateduntreated or ineffectively treated mental disordermental disorder  90%90% of people who die by suicide have a mental disorderof people who die by suicide have a mental disorder  In teens, suicide risk is most clearly linked toIn teens, suicide risk is most clearly linked to 7 mental7 mental disordersdisorders, often with overlapping symptoms:, often with overlapping symptoms: Major Depressive DisorderMajor Depressive Disorder Conduct DisorderConduct Disorder Bipolar DisorderBipolar Disorder Eating DisordersEating Disorders Generalized Anxiety DisorderGeneralized Anxiety Disorder SchizophreniaSchizophrenia Substance Use DisordersSubstance Use Disorders
  • 1414 Major DepressiveMajor Depressive Disorder (MDD)Disorder (MDD)  Key symptoms in teens areKey symptoms in teens are sad, depressed, angry or irritablesad, depressed, angry or irritable moodmood andand lack of interest or pleasure in activities the teen usedlack of interest or pleasure in activities the teen used to enjoyto enjoy, lasting at least, lasting at least 2 weeks2 weeks  Other symptomsOther symptoms Changes in appetiteChanges in appetite Worthlessness/guiltWorthlessness/guilt Sleep disturbancesSleep disturbances Inability to concentrateInability to concentrate Slowed or agitated movementSlowed or agitated movement Recurrent thoughts of deathRecurrent thoughts of death Fatigue/loss of energyFatigue/loss of energy or suicide, self-harm behavioror suicide, self-harm behavior  Symptoms represent aSymptoms represent a clear changeclear change from normal and arefrom normal and are generally observed in severalgenerally observed in several different contextsdifferent contexts
  • 1515 FactsFacts about MDDabout MDD  8-12%8-12% of teens suffer from major depressionof teens suffer from major depression  MDD is more common inMDD is more common in femalesfemales than malesthan males  MDD is caused byMDD is caused by changes in brain chemistrychanges in brain chemistry that may resultthat may result from stressful life events, but also from genetic or otherfrom stressful life events, but also from genetic or other internal factorsinternal factors  MDD may occur in teens who are appear toMDD may occur in teens who are appear to “have it all”“have it all”  MDD in teens is often expressed throughMDD in teens is often expressed through physical complaintsphysical complaints (stomach distress, headaches)(stomach distress, headaches)  MDD is the mental disorderMDD is the mental disorder most frequently associated withmost frequently associated with suicidesuicide in both teens and adultsin both teens and adults
  • 1616 Bipolar DisorderBipolar Disorder  ““Manic-depression” –Manic-depression” – alternatingalternating episodes ofepisodes of depressiondepression andand maniamania  Manic symptomsManic symptoms Inflated self-esteem/grandiosityInflated self-esteem/grandiosity DistractibilityDistractibility Decreased need for sleepDecreased need for sleep Agitated speech/movementAgitated speech/movement Talking much more than usualTalking much more than usual Involvement in risky activitiesInvolvement in risky activities Flight of ideasFlight of ideas  Manic symptoms last at leastManic symptoms last at least 1 week1 week and cause clear social,and cause clear social, academic or work impairmentacademic or work impairment  In many cases, manic symptoms are less severe orIn many cases, manic symptoms are less severe or “hypomanic”“hypomanic”
  • 1717 Facts aboutFacts about Bipolar DisorderBipolar Disorder  Bipolar disorderBipolar disorder usually beginsusually begins with depressive episodewith depressive episode; can; can lead to misdiagnosislead to misdiagnosis  Bipolar disorder isBipolar disorder is less common than depressionless common than depression in bothin both teens and adultsteens and adults  Unlike depression,Unlike depression, occurs as frequently in boysoccurs as frequently in boys as in girlsas in girls  Conveys especiallyConveys especially high risk for suicidehigh risk for suicide  SuicideSuicide risk highestrisk highest - during depressive- during depressive rather than manic episodesrather than manic episodes - when rapid “cycling” of manic and depressive symptoms occurs- when rapid “cycling” of manic and depressive symptoms occurs - in “mixed” episodes (depressive and manic symptoms present at- in “mixed” episodes (depressive and manic symptoms present at same time)same time)
  • 1818 GeneralizedGeneralized Anxiety Disorder (GAD)Anxiety Disorder (GAD)  Key characteristic of GAD isKey characteristic of GAD is excessiveexcessive, uncontrolled worry, uncontrolled worry,, occurring more days than not for a period ofoccurring more days than not for a period of 6 months6 months (e.g.,(e.g., persistent worry about tests, speaking in class)persistent worry about tests, speaking in class)  SymptomsSymptoms Restlessness/keyed upRestlessness/keyed up IrritabilityIrritability Being easily fatiguedBeing easily fatigued Muscle tensionMuscle tension Difficulty concentratingDifficulty concentrating Sleep disturbancesSleep disturbances  GAD is one ofGAD is one of many different anxiety disordersmany different anxiety disorders that may affectthat may affect teens – e.g., social anxiety disorder, obsessive-compulsiveteens – e.g., social anxiety disorder, obsessive-compulsive disorder, panic disorder. All anxiety disorders share andisorder, panic disorder. All anxiety disorders share an anxious, fearful mood, leading to other symptoms andanxious, fearful mood, leading to other symptoms and disabilitydisability
  • 1919 FactsFacts about GADabout GAD  GirlsGirls are more likely than boys to have GADare more likely than boys to have GAD  Teens who areTeens who are “perfectionists”“perfectionists” may be especially vulnerablemay be especially vulnerable  Severe anxiety isSevere anxiety is often part of depressionoften part of depression in teensin teens  Like depression, anxiety is often expressed throughLike depression, anxiety is often expressed through physicalphysical symptomssymptoms (racing heart, shortness of breath)(racing heart, shortness of breath)  Overwhelming anxiety can lead teens to feel they can’t go onOverwhelming anxiety can lead teens to feel they can’t go on and toand to thinking about or planning for suicidethinking about or planning for suicide
  • 2020 SubstanceSubstance UseUse DisordersDisorders  Two main types:Two main types: substance dependencesubstance dependence andand substancesubstance abuseabuse  Each involvesEach involves maladaptive pattern of drug or alcohol usemaladaptive pattern of drug or alcohol use overover 12 months,12 months, leading to significantleading to significant impairmentimpairment oror distressdistress  Symptoms ofSymptoms of substance dependencesubstance dependence Increasing tolerance of the substanceIncreasing tolerance of the substance Withdrawal effects when not usedWithdrawal effects when not used Taking larger amounts, over a longer period, than intendedTaking larger amounts, over a longer period, than intended Persistent desire or unsuccessful efforts to cut down usePersistent desire or unsuccessful efforts to cut down use Spending considerable time obtaining, using or recovering from theSpending considerable time obtaining, using or recovering from the substancesubstance Giving up activities because of the substance useGiving up activities because of the substance use Continued use despite knowing it is causing problemsContinued use despite knowing it is causing problems
  • 2121 SubstanceSubstance UseUse Disorders…Disorders…  Symptoms ofSymptoms of substance abusesubstance abuse Failing to fulfill major role obligations because of substance useFailing to fulfill major role obligations because of substance use Recurrent substance use in physically hazardous situationsRecurrent substance use in physically hazardous situations Recurrent substance-related legal problemsRecurrent substance-related legal problems Continued use despite persistent social or interpersonal problemsContinued use despite persistent social or interpersonal problems caused by effects of substance usecaused by effects of substance use  Substance dependence and abuse may exist as a singleSubstance dependence and abuse may exist as a single disorder or in addition to another mental disorder, such asdisorder or in addition to another mental disorder, such as major depression or an anxiety disordermajor depression or an anxiety disorder
  • 2222 Facts aboutFacts about Substance Use DisordersSubstance Use Disorders  Alcohol use disorders are especially common among teens,Alcohol use disorders are especially common among teens, often beginning with the desire to be part of a peer groupoften beginning with the desire to be part of a peer group  Although commonly used to cope with stress, depression orAlthough commonly used to cope with stress, depression or anxiety, alcohol almost always worsens these problemsanxiety, alcohol almost always worsens these problems  Other effects of alcohol and other drugs on teensOther effects of alcohol and other drugs on teens Increased irritability and angerIncreased irritability and anger Relationship problems (peers and family)Relationship problems (peers and family) Sleep disturbancesSleep disturbances Reduced concentration and ability to cope with stressReduced concentration and ability to cope with stress Family conflict over substance useFamily conflict over substance use Legal problemsLegal problems Increased suicide riskIncreased suicide risk due todue to decreased inhibitiondecreased inhibition andand increasedincreased impulsivityimpulsivity
  • 2323 Conduct DisorderConduct Disorder  Repetitive, persistent pattern inRepetitive, persistent pattern in children or adolescentschildren or adolescents ofof violating rights of others, rules or social normsviolating rights of others, rules or social norms;; occurs overoccurs over 1212 monthsmonths and results in significantand results in significant impairment in functioningimpairment in functioning  SymptomsSymptoms Bullying/threatening othersBullying/threatening others Fire-settingFire-setting Physical fightsPhysical fights Destroying propertyDestroying property Using a weaponUsing a weapon Breaking into houses/carsBreaking into houses/cars Physical cruelty to peoplePhysical cruelty to people Lying/conning othersLying/conning others Physical cruelty to animalsPhysical cruelty to animals Staying out all nightStaying out all night Mugging, shoplifting, stealingMugging, shoplifting, stealing Running away from homeRunning away from home Forced sexual activityForced sexual activity Frequent school truancyFrequent school truancy
  • 2424 Facts aboutFacts about Conduct DisorderConduct Disorder  DislikeDislike of conduct-disordered youth because of their anti-of conduct-disordered youth because of their anti- social behavior maysocial behavior may impede recognitionimpede recognition of this serious mentalof this serious mental disorderdisorder  There is aThere is a strong genetic componentstrong genetic component to the aggressivenessto the aggressiveness seen in conduct disorderseen in conduct disorder  Much more frequent inMuch more frequent in boysboys than in girlsthan in girls  FrequentlyFrequently overlaps with AD/HD, depression and substanceoverlaps with AD/HD, depression and substance use disorderuse disorder  Associated withAssociated with high rates of suicidal ideation, suicidehigh rates of suicidal ideation, suicide attempts and completed suicideattempts and completed suicide
  • 2525 Eating DisordersEating Disorders  Two main types:Two main types: anorexia nervosaanorexia nervosa andand bulimia nervosabulimia nervosa  Symptoms ofSymptoms of anorexia nervosaanorexia nervosa Refusal to maintain body weight at minimally normal level for ageRefusal to maintain body weight at minimally normal level for age and heightand height Intense fear of gaining weightIntense fear of gaining weight Disturbance in how body weight or shape is experienced, or denialDisturbance in how body weight or shape is experienced, or denial of low body weightof low body weight In females, delay of menarche or cessation of menstrual cyclesIn females, delay of menarche or cessation of menstrual cycles
  • 2626 Eating Disorders…Eating Disorders…  Symptoms ofSymptoms of bulimia nervosabulimia nervosa Recurrent episodes of uncontrollable binge eating (at least 2x perRecurrent episodes of uncontrollable binge eating (at least 2x per week for 3 months)week for 3 months) Recurrent inappropriate behaviors to compensate for binge eatingRecurrent inappropriate behaviors to compensate for binge eating and avoid gaining weight (e.g., vomiting, misuse of laxatives,and avoid gaining weight (e.g., vomiting, misuse of laxatives, excessive exercise)excessive exercise) Self-evaluation unduly influenced by body shape and weightSelf-evaluation unduly influenced by body shape and weight  Eating disorders are strongly linked to other mental disorders,Eating disorders are strongly linked to other mental disorders, especially depression and anxietyespecially depression and anxiety
  • 2727 Facts aboutFacts about Eating DisordersEating Disorders  Far more common amongFar more common among femalesfemales than among malesthan among males  Typically begin betweenTypically begin between agesages 13 and 2013 and 20  10-20%10-20% of people with anorexia nervosaof people with anorexia nervosa die prematurelydie prematurely,, often by suicideoften by suicide  Women aged 15-24 with an eating disorder have aWomen aged 15-24 with an eating disorder have a suicidesuicide rate 60 times the expected raterate 60 times the expected rate for young women overallfor young women overall  People with eating disorders tend to use particularlyPeople with eating disorders tend to use particularly violentviolent suicide methodssuicide methods  Other characteristics that contribute to lethality of suicideOther characteristics that contribute to lethality of suicide attemptsattempts Perfectionistic, obsessive, secretive, socially isolatedPerfectionistic, obsessive, secretive, socially isolated Low weight, electrolyte abnormalitiesLow weight, electrolyte abnormalities
  • 2828 SchizophreniaSchizophrenia  Schizophrenia is a psychotic disorder that causes people toSchizophrenia is a psychotic disorder that causes people to havehave difficulty interpreting realitydifficulty interpreting reality  Two sets of symptoms-Two sets of symptoms- positivepositive andand negative; bothnegative; both areare abnormalabnormal  Positive symptomsPositive symptoms Delusions (fixed false beliefs, e.g., that others are controlling one’sDelusions (fixed false beliefs, e.g., that others are controlling one’s thoughts, or are trying to cause one harm)thoughts, or are trying to cause one harm) Hallucinations (fixed false sensory perceptions, e.g. hearing voices,Hallucinations (fixed false sensory perceptions, e.g. hearing voices, seeing or smelling things that are not there in reality)seeing or smelling things that are not there in reality) Disorganized or incoherent speechDisorganized or incoherent speech Excessive, purposeless movements, or catatonic, immobile behaviorExcessive, purposeless movements, or catatonic, immobile behavior
  • 2929 Schizophrenia…Schizophrenia…  Negative symptomsNegative symptoms Low energy or motivationLow energy or motivation Lack of emotionLack of emotion Difficulty expressing thoughts or elaborating responsesDifficulty expressing thoughts or elaborating responses Difficulty integrating thoughts, feelings and behaviorDifficulty integrating thoughts, feelings and behavior Blank facial expressionBlank facial expression Social withdrawal, isolationSocial withdrawal, isolation Inappropriate social skillsInappropriate social skills
  • 3030 Facts aboutFacts about SchizophreniaSchizophrenia  AffectsAffects both malesboth males andand femalesfemales  Typically begins to develop inTypically begins to develop in very late adolescence or earlyvery late adolescence or early adulthoodadulthood  Earlier onsetEarlier onset inin malesmales (ages 15-25) than in females (ages 25-(ages 15-25) than in females (ages 25- 35)35)  Strongly linked toStrongly linked to geneticgenetic factorsfactors  People with schizophrenia havePeople with schizophrenia have very high rates of suicidalvery high rates of suicidal behaviorbehavior 40% make one or more suicide attempts40% make one or more suicide attempts 10% die by suicide10% die by suicide
  • 3131 Other IndividualOther Individual Suicide Risk FactorsSuicide Risk Factors ImpulsivityImpulsivity  Contributes to suicidal behavior, especially in context of depressionContributes to suicidal behavior, especially in context of depression or bipolar disorderor bipolar disorder  Associated with dysregulated brain chemistry; may explain why someAssociated with dysregulated brain chemistry; may explain why some teens with these disorders engage in suicidal behaviors while othersteens with these disorders engage in suicidal behaviors while others do notdo not Family HistoryFamily History  Many mental disorders run in families, due to genetic factorsMany mental disorders run in families, due to genetic factors  Suicide attempts and completed suicide are more frequent in teensSuicide attempts and completed suicide are more frequent in teens with a relative who has attempted or died by suicidewith a relative who has attempted or died by suicide Prior Suicide AttemptPrior Suicide Attempt  30-40% of teens who die by suicide have made a prior attempt30-40% of teens who die by suicide have made a prior attempt
  • 3232 Situational FactorsSituational Factors that Increase Suicide Riskthat Increase Suicide Risk  Although mental disorders are the most significant cause ofAlthough mental disorders are the most significant cause of suicide in teens and adults,suicide in teens and adults, stressful life eventsstressful life events and otherand other situational factors maysituational factors may triggertrigger suicidal behaviorsuicidal behavior  Among teens, such factors may includeAmong teens, such factors may include Physical and sexual abusePhysical and sexual abuse Death or other trauma in the familyDeath or other trauma in the family Persistent serious family conflictPersistent serious family conflict Traumatic break-ups of romantic relationshipsTraumatic break-ups of romantic relationships Trouble with the lawTrouble with the law School failures and other major disappointmentsSchool failures and other major disappointments Bullying, harassment or victimization by peersBullying, harassment or victimization by peers
  • 3333 Situational Factors…Situational Factors…  The majority of teens who have these experiences doThe majority of teens who have these experiences do NOTNOT become suicidalbecome suicidal  In some teens, these stressful experiences can precipitateIn some teens, these stressful experiences can precipitate depression, anxiety or another mental disorder, which in turndepression, anxiety or another mental disorder, which in turn increases suicide riskincreases suicide risk  Mental disorders themselves can precipitate stressful lifeMental disorders themselves can precipitate stressful life events, such as conflict with family and peers, relationshipevents, such as conflict with family and peers, relationship break-ups or school failures, which then exacerbate thebreak-ups or school failures, which then exacerbate the underlying illnessunderlying illness
  • 3434 Situational FactorsSituational Factors Most Relevant to SchoolsMost Relevant to Schools History of Physical and Sexual AbuseHistory of Physical and Sexual Abuse  Controlling for other risk factors, including individual and parentalControlling for other risk factors, including individual and parental mental disorders, risk of suicide attempt ismental disorders, risk of suicide attempt is 5x greater5x greater in adolescentsin adolescents with a history ofwith a history of physical abusephysical abuse  Risk of suicide attempt is more thanRisk of suicide attempt is more than 7x greater7x greater among adolescentsamong adolescents with a history ofwith a history of sexual abusesexual abuse
  • 3535 Situational Factors…Situational Factors… BullyingBullying  Common problem in schools in the U.S. and abroadCommon problem in schools in the U.S. and abroad  Higher rates of depression, suicidal ideation and suicidal behaviorHigher rates of depression, suicidal ideation and suicidal behavior found in both victims and perpetrators of bullyingfound in both victims and perpetrators of bullying  Female victims and perpetrators may be especially vulnerableFemale victims and perpetrators may be especially vulnerable  Pre-existing depression may explain suicidal behavior in some teensPre-existing depression may explain suicidal behavior in some teens involved in bullyinginvolved in bullying  Bullying likely leads to depression in other teens, increasing suicidalBullying likely leads to depression in other teens, increasing suicidal behaviorbehavior
  • 3636 Situational Factors…Situational Factors… Sexual Orientation and Gender IdentitySexual Orientation and Gender Identity  GLBT youth have elevated rates of depression compared toGLBT youth have elevated rates of depression compared to heterosexual/straight youth, and report more frequent suicidalheterosexual/straight youth, and report more frequent suicidal ideation and behaviorideation and behavior  Contributing factors include family rejection, high rates of alcohol orContributing factors include family rejection, high rates of alcohol or drug use and social ostracism and bullying by peersdrug use and social ostracism and bullying by peers Trouble with the LawTrouble with the Law  Teens with a history of problems with the law have increased risk ofTeens with a history of problems with the law have increased risk of suicide attempts and completed suicidesuicide attempts and completed suicide  Suicide in juvenile detention and correctional facilities isSuicide in juvenile detention and correctional facilities is 4 times4 times greater than in overall youth populationgreater than in overall youth population
  • 3737 Situational Factors…Situational Factors… Exposure to SuicideExposure to Suicide  Suicide risk is increased in teens exposed to another’s suicideSuicide risk is increased in teens exposed to another’s suicide  Can result in suicide “clusters”Can result in suicide “clusters”  Factors increasing “suicide contagion” include romanticized orFactors increasing “suicide contagion” include romanticized or glamorized reports of the suicide and idealization of the suicide victimglamorized reports of the suicide and idealization of the suicide victim  Social networking websites may increase exposure among teensSocial networking websites may increase exposure among teens Access to FirearmsAccess to Firearms  Access to firearms increases suicide risk, especially among teensAccess to firearms increases suicide risk, especially among teens with a mental disorderwith a mental disorder
  • 3838 SuicideSuicide Warning SignsWarning Signs  SuicideSuicide risk factorsrisk factors endure over some period of time, whileendure over some period of time, while warning signswarning signs signalsignal imminent suicide riskimminent suicide risk  Clearest warning signs for suicide are behaviors that indicateClearest warning signs for suicide are behaviors that indicate the person is thinking about or planning for suicide, or isthe person is thinking about or planning for suicide, or is preoccupied or obsessed with deathpreoccupied or obsessed with death Looking for ways to kill oneself (e.g., searching the internet forLooking for ways to kill oneself (e.g., searching the internet for methods, seeking access to firearms or other means for suicide)methods, seeking access to firearms or other means for suicide) Talking or writing about suicideTalking or writing about suicide Talking or writing about death in a way that suggests preoccupationTalking or writing about death in a way that suggests preoccupation
  • 3939 Barriers toBarriers to Treatment of At-Risk TeensTreatment of At-Risk Teens  Many at-risk teens do not get needed treatment, including anMany at-risk teens do not get needed treatment, including an estimatedestimated 2/32/3 of those with depressionof those with depression  ReasonsReasons Neither teens nor the adults who are close to them recognizeNeither teens nor the adults who are close to them recognize symptoms as a treatable illnesssymptoms as a treatable illness Fear of what treatment might involveFear of what treatment might involve Belief that nothing can helpBelief that nothing can help Perception that seeking help is a sign of weakness or failurePerception that seeking help is a sign of weakness or failure Feeling too embarrassed to seek helpFeeling too embarrassed to seek help Belief that adults aren’t receptive to teens’ mental health problemsBelief that adults aren’t receptive to teens’ mental health problems  ButBut – depression and other mental disorders CAN be– depression and other mental disorders CAN be effectively treatedeffectively treated
  • 4040 FactsFacts about Treatmentabout Treatment  Some depressed teens show improvement in 4-6 weeks withSome depressed teens show improvement in 4-6 weeks with structuredstructured psychotherapypsychotherapy alonealone  Most others experience significant reduction of depressiveMost others experience significant reduction of depressive symptoms withsymptoms with antidepressant medicationantidepressant medication  SupplementarySupplementary interventionsinterventions – exercise, yoga, breathing– exercise, yoga, breathing exercises, changes in diet – improve mood, relieve anxietyexercises, changes in diet – improve mood, relieve anxiety and reduce stress that contributes to depressionand reduce stress that contributes to depression  Medication is usually essential in treating severe depression,Medication is usually essential in treating severe depression, and other serious mental disorders (bipolar disorder,and other serious mental disorders (bipolar disorder, schizophrenia, etc.)schizophrenia, etc.)
  • 4141 Facts aboutFacts about Antidepressant MedicationAntidepressant Medication  Medications work by restoring brain chemistry back to normalMedications work by restoring brain chemistry back to normal  Most people experienceMost people experience positive changespositive changes; a small percentage; a small percentage show agitation and abnormal behavior that may includeshow agitation and abnormal behavior that may include increased suicidal thinking and behaviorincreased suicidal thinking and behavior  Since 2004, FDA warning recommendsSince 2004, FDA warning recommends close monitoringclose monitoring ofof youth taking antidepressants for worsening of symptoms,youth taking antidepressants for worsening of symptoms, suicidal thoughts or behavior and other changessuicidal thoughts or behavior and other changes  60%60% of teens with major depression have suicidal thoughtsof teens with major depression have suicidal thoughts prior to getting treatment;prior to getting treatment; 30%30% have made a suicide attempthave made a suicide attempt  Risks of medication must be weighed against the risks of notRisks of medication must be weighed against the risks of not effectively treating depressioneffectively treating depression
  • 4242 Summary PointsSummary Points about Treatmentabout Treatment  No single approach or medication works for all teens with aNo single approach or medication works for all teens with a mental disorder; sometimes different ones needs to be triedmental disorder; sometimes different ones needs to be tried  But, studies show thatBut, studies show that 80%80% of depressed people can beof depressed people can be effectively treatedeffectively treated  Mental disorders can recur, even if effectively treated at oneMental disorders can recur, even if effectively treated at one point in timepoint in time  On-going monitoring by a physician or mental healthOn-going monitoring by a physician or mental health professional is advisedprofessional is advised
  • 4343 IdentifyingIdentifying At-Risk StudentsAt-Risk Students  Most adults are not trained to recognize signs of seriousMost adults are not trained to recognize signs of serious mental disorders in teensmental disorders in teens  Symptoms are often misinterpreted or attributed toSymptoms are often misinterpreted or attributed to Normal adolescent mood swingsNormal adolescent mood swings LazinessLaziness Poor attitudePoor attitude Immaturity, etc., etc. …Immaturity, etc., etc. …  The film,The film, More Than Sad: Teen DepressionMore Than Sad: Teen Depression, is designed for, is designed for teens but also helps adults understand what depression looksteens but also helps adults understand what depression looks like in adolescents and recognize the warning signs that alike in adolescents and recognize the warning signs that a teen may need helpteen may need help
  • 4444 Show and discuss film,Show and discuss film, More Than Sad: Teen DepressionMore Than Sad: Teen Depression
  • 4545 Reducing SuicideReducing Suicide Risk in SchoolsRisk in Schools So far, we have emphasized two key suicide prevention tasks ofSo far, we have emphasized two key suicide prevention tasks of school personnel:school personnel: 1.1. Identify students whose behavior suggests presence of aIdentify students whose behavior suggests presence of a mental disordermental disorder 2.2. Take necessary steps to insure that such students are referredTake necessary steps to insure that such students are referred to a mental health professional for evaluation and treatment,to a mental health professional for evaluation and treatment, as neededas needed What else can schools do?What else can schools do?
  • 4646 RecommendedRecommended Actions for SchoolsActions for Schools Educate Students about Mental DisordersEducate Students about Mental Disorders  Show and discuss film,Show and discuss film, More Than Sad: Teen DepressionMore Than Sad: Teen Depression withwith studentsstudents  Use lesson plan in Facilitator’s GuideUse lesson plan in Facilitator’s Guide  Include school-based health or mental health professionalInclude school-based health or mental health professional Educate Parents about Mental Disorders and Suicide RiskEducate Parents about Mental Disorders and Suicide Risk  ShowShow and discuss bothand discuss both More Than SadMore Than Sad films at parent meetingfilms at parent meeting  Recommend other resources for parents listed at end of manualRecommend other resources for parents listed at end of manual
  • 4747 Recommended Actions…Recommended Actions… Support School Safety and Reduce BullyingSupport School Safety and Reduce Bullying  Address sanctions for bullying and related behaviors in disciplinaryAddress sanctions for bullying and related behaviors in disciplinary policiespolicies  Initiate programs to change school culture to be inclusive and supportInitiate programs to change school culture to be inclusive and support student diversitystudent diversity Support Gun Safety ProgramsSupport Gun Safety Programs  Partner with law enforcement, public health and community agenciesPartner with law enforcement, public health and community agencies and parents to promote proper gun storage and reduce opportunitiesand parents to promote proper gun storage and reduce opportunities for unsupervised access to firearms by youthfor unsupervised access to firearms by youth
  • 4848 Concluding StepsConcluding Steps  Review Additional ResourcesReview Additional Resources  Complete “Test Your Knowledge”Complete “Test Your Knowledge”  Complete Participant Feedback FormComplete Participant Feedback Form THANK YOU FOR TAKING THIS OPPORTUNITYTHANK YOU FOR TAKING THIS OPPORTUNITY TO LEARN MORE ABOUT TEEN SUICIDETO LEARN MORE ABOUT TEEN SUICIDE AND HOW YOU CAN PLAY A ROLEAND HOW YOU CAN PLAY A ROLE IN ITS PREVENTIONIN ITS PREVENTION