Depression StatisticsResearch indicates that the onset ofdepression is occurring earlier in life todaythan in the pastIt often coexists with other mental healthproblems such as chronic anxiety anddisruptive behavior disorders.
Some Findings… Research through the University of Oregonestimates that 28% of all adolescents (ages 13-19) will experience at least one episode of majordepression.3-7% for ages 13-151-2% for children under age 13 Up to 7% of adolescents who develop majordepressive disorder may eventually commitsuicide
Some More Findings… Before puberty, boys and girls are equally likelyto develop depressive disorders By age 15, girls are twice as likely as boys tohave experienced a major depressive episode. Depression in adolescence, frequently co-occursw/ other disorders such as anxiety, disruptivebehavior, eating disorders or substance abuse.
Risk Factors for DepressionStressHaving experienced significant lossHaving attention, learning, and/or conductissuesExperiencing trauma, abuse, or a long-term illness or disabilityFamily history of depressionOther untreated psychological disorders
More Depression Risk FactorsPoor academic functioningPoor physical healthPoor coping and/or social skillsLow self-esteemBehavior ProblemsPoor School and Family ConnectednessSubstance Abuse
The Hard Reality: Suicide StatsAlthough youth suicide rates havedeclined slightly since 1992, it is still the 3rdleading cause of death among 10-24 yearolds—following homicide and automobileaccidents.The suicide rates for 10-14 year oldsincreased 196% between 1983-98.
More Suicide Statistics…Suicide rates among certainsubpopulations, such as Black males,White females, Asian youth, AmericanIndian youth, and sexual minority youthhave all increased.Hispanic students had the highest rates ofsuicidal ideation and behavior and weremore likely to attempt suicide
Suicide Statistics continued… Completed suicides are only part of the picture. It isestimated that for every youth who dies by suicide,100-200 youth attempt it—2-6% of children. In a typical high school classroom, it is likely thatthree students (1 boy, 2 girls) have attemptedsuicide in the past year. For every student who attempts suicide, only onereceives medical attention—the other two get upand go to school the next day.
A Prime Example:Megan Meier Story Video—Youtube.com
Depression: Signs & SymptomsCharacteristics that usually occur inchildren, adolescents, and adults include:Persistent sad and irritable moodLoss of interest or pleasure in activitiesonce enjoyedSignificant change in appetite/weightDifficulty sleeping or oversleepingPhysical signs of agitation or excessivelethargy/loss of energy
More Depression SignsFeelings of worthlessness/inappropriateguiltDifficulty concentratingRecurrent thoughts of death or suicide
Child Specific Signs of Depression Difficulty maintaining relationships Frequent vague, nonspecific physical complaints(headaches, stomachaches) Frequent absences from school or unusuallypoor school performance School refusal or excessive separation anxiety
More Child Specific Signs Outbursts of shouting, complaining, unexplainedirritability, or crying Chronic boredom or apathy Lack of interest in playing with friends Alcohol or drug abuse Reckless behavior
Depression: Child Specific Withdrawal, social isolation, and poorcommunication Excessive fear of or preoccupation with death Extreme sensitivity to rejection or failure Unusual temper tantrums, defiance, oroppositional behavior
Depression: Child Specific Regression (i.e., acting babyish, resumption ofwetting or soiling after toilet training) Increased risk-taking behavior Note: the presence of one (or even all) of thesesigns and symptoms do not necessarily signalclinical depression—but are causes or concernand may suggest the need for professionalevaluation.
Some PrecipitatingCircumstances for Suicide(Triggers):Breaking up with a boyfriend/girlfriendAcademic crisis or school failureFamily conflict/dysfunctionRejection by friendsAfter a natural disaster, schoolshooting, terrorist attack, etc.
More Triggers…Getting into trouble with authoritiesDeath of a loved one or significantperson/lossKnowing someone who died by suicideBullying or victimization
Triggers Continued… Abuse Trauma exposure Serious illness or injury Anniversary of the death of a loved one Forced or extended separation from friends orfamily
Who’s at risk for suicide??Situational Stress (i.e., family stress,traumatic death of a loved one, physical orsexual abuse, family violence, traumaticevent, etc.)Children who exhibit risk factors and whohave been directly impacted and/or bytragic events are most likely to considersuicide.
Who’s at risk??Environmental risks including thepresence of a firearm in the home,poverty, a family history of suicide, etc.Mental illness including depression,conduct disorders, emotional problems,and substance abuse
Gender Characteristics…Adolescent girls have higher rates ofdepression and are twice as likely tocarefully plan and attempt suicide.Boys are more likely to act impulsively andare almost 5 times as likely than femalesto die by suicide.
Warning Signs Suicide notes. These are a very real sign ofdanger and should be taken seriously. Threats. Threats may be direct statements (“Iwant to die.” “I am going to kill myself.”) or,unfortunately, indirect comments such as:(“The world would be better without me” “Nobodywill miss me anyway”).
Warning Signs-continuedThreats continued: Indirect clues byteenagers may be offered through joking orcomments in school assignments—particularly creative writing or artwork.Previous Attempts: Be very observant ofstudents who have tried suicide before asthey are likely to do it again.
More Warning Signs Depression: As previously mentioned,depressed students are more likely to commitsuicide. “Masked Depression”: Sometimes risk-takingbehaviors can include acts of aggression,gunplay, and alcohol/substance abuse. Whilethe student does not acted depressed, theirbehavior suggests that they aren’t concernedwith their own safety.
More Suicide Warning SignsFinal Arrangements: This takes on manyforms such as students giving away prizedpossessions.Efforts to hurt oneself: Self-Injurybehaviors are warning signs in bothchildren and teenagers. Commonbehaviors include running into traffic,jumping from heights, andscratching/cutting/marking the body.
More Suicide Warning Signs Inability to concentrate or think clearly: theseproblems may be reflected in classroombehavior, homework habits, academicperformance, household chores, evenconversation. Changes in physical habits and appearance:Include inability to sleep or sleeping all of thetime, sudden weight gain or loss, and/ordisinterest in appearance or hygiene.
More Warning Signs Sudden changes in personality, friends, and/orbehaviors: Parents, teachers, and friends areoften the best observers of sudden changes inbehavior—including withdrawing, skippingschool, loss in involvement in activities, andavoiding friends. Fascination w/ death and suicidal themes: Thesemight appear in classroom drawings, worksamples, journals, or homework.
Warning SignsPlan/Method/Access: A suicidal child oradolescent may show an increasedinterest in guns and other weapons. Theymay also seem in have increased accessto guns, pills, etc., and/or may talk aboutor hint at a suicide plan. The greater theplanning, the greater the potential forsuicide.
What can be done to help suicidalstudents?? Know the warning signs!! Review the warningsigns as needed. Do not be afraid to ask students about theirfeelings. Share your concerns with a school psychologist,administrator, or guidance counselor. Ask if your school has a crisis team and/or plan.
Children & Adolescents…Adolescents can cognitively understandthe concept of death. It is not clear thatthey internalize the end of their own lives—particularly younger adolescentsIt would not be uncommon for studentseven as old as 16 to view death asmagical, temporary, and reversible.
Children & Adolescents Unlike adolescents, children are less cognitivelyable to understand the concept of death and itsimplications. Contrary to popular belief, children andadolescents do not necessarily attempt suicideas a “cry for help”—the reasons they give aremore similar to adults Only 10% were trying to get attention
Children & Adolescents When asked, one-third of children andadolescents are asked, the main reason fortrying to kill themselves is they wanted to die Another third wanted to escape from a hopelesssituation or a horrible state of mind. Again, only 10% were trying to get attention Only 2% saw getting help as the chief reason fortrying suicide
Three Levels of Concern1) Suicidal Thinking:Means a person is thinking about suicidebut has no plan. About 3-4% of adolescentswill have considered suicide in the last twoweeks. These thoughts are much morelikely, and more likely to be serious, if thechild has previously made a suicide, isdepressed, or is pessimistic. Students whoare both depressed and have previouslyattempted suicide are likely to be seriouslythinking about suicide.
Three Levels of ConcernSuicidal Plans:Means that you are thinking about suicideand have a way to do it in mind.*Share examples/vignettes
Three Levels of Concern Suicide Attempts:Means you have actually tried to hurt yourself.These can be medically serious or not serious.They can be psychologically serious or not.About 40% of teenagers will have thought aboutsuicide for only a half hour or so before they trysomething. The most frequent reason for theseimpulsive suicide plans are relationshipproblems.*More examples/vignettes
Depression:What Adults Can Do to HelpStay in frequent contact w/ children andknow the warning signs of depressionParents, school personnel, and otheradults play key roles in monitoring theeffectiveness of and helping ensurecompliance with treatment plans.
What Schools Can DoFacilitate prevention, identification, andtreatment for depression in children andadolescents by:Developing a caring supportive schoolenvironment for children, parents, and facultyPreventing all forms of bullying, as avigorously enforced school policy.Establishing clear rules and enforce themfairlyHaving suicide and violence prevention plansin place and implement them.
What Depressed Teens Can Do(With Our Support):Try to make new friends. Healthyrelationships with peers are central toteens’ self-esteem and a social outlet.Participate in sports, job, school activities,or hobbies. Staying busy helps teensfocus on positive activities rather thannegative feelings or behaviors.
More for Depressed Teens…Join organizations that offer programs foryoung people. Special programs geared tothe needs of adolescents help developadditional interests.Ask a trusted adult for help. Whenproblems are too much to handle alone,teens should not be afraid to ask for help.
Suicide: Planning & Prevention Create a culture of connectedness in whichstudents (both at risk and their peers) trust andseek the help of school staff members.Encourage openness by taking all threatsseriously. Awareness Education; Screening; Crisis andmental health team coordination; collaborationwith community services; reliance on evidence-based strategies; and clear intervention and‘postvention’ protocols.
Suicide: Prevention/Intervention Assess Risk: (i.e., asking “Have you everthought about suicide?”; “Have you everattempted suicide?”; “Do you have a plan toharm yourself now?” Warn Parents: parents must be notified—withthe exception of when it appears the studentmight be a victim of parental abuse. Encouragetheir participation in prevention efforts. Offer tofollow through on referral efforts if they are notcomfortable doing so.
Suicide: Prevention/Intervention Provide Referrals: consider cultural,developmental, and sexuality issues whenmaking referrals—to help the student identifycaring adults at home and at school; appropriatecoping strategies; and community resources. Document and Follow-up: Principal needs to bein close contact with counseling personnel—especially when concerns regarding an‘anniversary date’ associated with youth suicide.
Suicide Postvention(After the Fact) Activate the school crisis team. Verify the deathand assess the impact on the school community(including staff members and parents). Contact the victim’s family to offer support anddetermine their preferences for studentoutreach, expressions of grief, and funeralarrangements/attendance Determine what and how information is to beshared. Tell the truth.
More Suicide Postvention… Inform students through discussion inclassrooms and smaller venues, not assembliesor school-wide announcements. Identify at-risk youth. Provide support andreferral when appropriate. Those at particularrisk to imitate suicidal behavior are those whomight have facilitated the suicide, failed torecognize or ignored the warning signs, or had arelationship or identify with the victim.
Suicide Postvention, continued… Focus on survivor coping and efforts to preventfurther suicides. This is a time for key preventioninformation. Emphasize that no one thing orperson is to blame and that help is available. Advocate for appropriate expressions ofmemorialization. Do not dedicate a memorial(e.g., tree plaque, or yearbook). Do contribute toa suicide prevention effort in the community orestablish a living memorial such as ascholarship or student assistance program.
Even more Suicide Postvention…Evaluate the crisis response.Media representatives should beencouraged to follow the AmericanAssociation of Suicidology guidelines.These guidelines recommend not makingthe suicide front page news or publishinga picture of the deceased, but insteademphasizing suicide prevention,recognition of warning signs, and where togo for help.
Resiliency Factors Family support and cohesion, including goodcommunication Peer support and close social networks School and community connectedness Cultural and religious beliefs that discouragesuicide and promote healthy living
More Resiliency FactorsAdaptive coping and problem solvingskills, including conflict resolutionGeneral life satisfaction, good self-esteem,sense of purposeEasy access to effective medical andmental health resources
Depression Resources• Merrell, K. W. (2001). Helping children overcomedepression and anxiety: A practical guide. New York:Guilford• National Institute of Mental Health. (2001). Depression inchildren and adolescents (Fact Sheet for Physicians).Bethesda, MD: Author• National Institute of Mental Health. (2001). Let’s talk aboutdepression [for teens]. Bethesda, MD: Author• Seeley, J., Rohde, P., Lewinsohn, P. & Clarke, G. (2002).Depression in youth: Epidemiology, identification, andintervention. In M. Shinn, H. Walker, & G. Stoner (Eds.),Interventions for academic and behavior problems II:Preventive and remedial approaches (pp. 885-912).Bethesda, MD: National Association of School
Suicide Resources on the Web American Association of Suicidology: www.suicidology.org American Foundation for Suicide Prevention. www.afsp.org Signs of Suicide (SOS). www.mentalhealthscreening.org Teen Screen Program. www.teenscreen.org Centers for Disease Control. www.cdc.gov National Suicide Hotline 1-800-SUICIDE
More Web Resources Save a Friend: Tips for Teens to Prevent Suicide.http://www.nasponline.org/resources/crisis_safety/savefriend_ Times of Tragedy: Preventing Suicide in TroubledChildren and Youth, Part I.http://www.nasponline.org/resources/crisis_safety/suicidept1_ National Association of Secondary School Principals,“Taking the Lead on Suicide Prevention and Interventionin the Schools.” www.nasponline.org/resources/principals/nassp2006.aspx This would be a valuable
More Web Resources American Academy for Child and AdolescentPsychiatry. www.aacap.org Depression and Bipolar support Alliance(DBSA). www.dballiance.org National Institute of Mental Health SuicidePrevention Resources.http://nimh.nih.gov/suicideprevention/_index.cfm National Mental Health Association.www.nmha.org
Web ResourcesSuicide Awareness/Voices of Education(SAVE). www.save.orgU.S. Department of Health and HumanServices, National Strategy on SuicidePrevention.http://www.mentalhealth.samhsa.gov/suicidepr
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