Prof G Luke Larkin and Dr Annette Beautrais discuss strengthening protective factors & instilling hope in a webinar to mark World Suicide Prevention Day 2012. More information and video: http://www.spinz.org.nz/page/239-events-archive+webinar-for-world-suicide-prevention-day-2012

1. RLD SUICIDE PREVENTION DAY
STRENGTHENING PROTECTIVE FACTORS
INSTILLING HOPE
Gregory Luke Larkin MD MS MSPH FACEP
Lion Foundation Chair of Emergency Medicine
Annette Beautrais PhD
Senior Research Fellow
The University of Auckland, South Auckland Clinical School
l.larkin@auckland.ac.nz,
a.beautrais@auckland.ac.nz

2. AGENDA
 Magnitude of the Problem
 The Problem of Suicide in New Zealand
 Risk and Protective Factors
 Micro–level (Individual)
 Meso-level (Community, Organisation)
 Macro-level (State, National)
 Your questions

3. MAGNITUDE OF THE PROBLEM

4. WORLD SUICIDE RATES

5. MAGNITUDE OF THE PROBLEM
 >1 million deaths worldwide EVERY year - an under-
estimate
 51% of all violent deaths
 More deaths than all wars & homicides combined
 In any one year - 4% have thoughts of suicide, 1% plan
(WMHS)
 Overall rate of suicide has NOT declined in the past decade;

6. SUICIDE
 Under-counted
 Under-recognised
 Under-funded (prevention)
 Under-addressed
 Poorly understood
 PREVENTABLE in many cases

7. A DIFFICULT PUBLIC HEALTH PROBLEM
 In top 10 causes of death worldwide
 In top 3 causes of death in 15-35 age group
 Annual global rate - 16 per 100,000 people (3-4X higher in men)
 Despite considerable research & new knowledge, relatively little progress
in developing effective interventions
 By contrast, reductions in CVD, stroke, MVA, HIV/AIDS, homicide, cancers
 Suicide is a more difficult, complex problem than these issues.

8. PREDICTIONS
By 2020
 depression will be the 2nd major cause of YPLLs & DALYs
(after CVD)
 Suicides - estimated 1.5 million p.a. worldwide

9. SUICIDE IN NEW ZEALAND

10. NZ suicide deaths and rates
2004 2005 2006 2007 2008 2009 2010
Numbers
Total 486 511 524 483 497 506 522
Male 379 380 386 370 366 391 380
Female 109 131 138 113 131 115 142
Rates
Total 11.7 12.2 12.2 11.0 11.2 11.2 11.5
Male 18.6 18.6 18.5 17.4 16.9 17.8 16.0
Female 5.2 6.0 6.3 4.9 5.8 5.0 6.4

11. 0
5
10
15
20
25
30
1948
Rate
1950
1952
1954
1956
1958
1960
1962
1964
1966
1968
1970
1972
1974
1976
1978
Year
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Males
2008
Females
Suicide age-standardised rates, by sex, 1948-2010
2010

12. Suicide as a percentage of all deaths in that age group 2010
Percent
45
Males
Females
40
35
30
25
20
15
10
5
0
5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+
Five-year age group

13. Suicide age-specific death rates, by 5-year age group, 2010
Rate
60
Males
Females
50
40
30
20
10
0
15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+
Five-year age group

14. Māori and non-Māori suicide rates, by sex 1996-2010
Rate
35
Māori males
Māori females
30 Non-Māori males
Non-Māori females
25
20
15
10
5
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year

15. Methods of NZ suicide deaths 2010
Submersion (drowning)
1.5%
Firearms and explosives
8.0%
Cutting and piercing
instrument
1.7%
Hanging, strangulation Jumping from high place
and suffocation 1.7%
60.5%
Other and unspecified
means
3.3%
Poisoning – liquids and
solids
11.9%
Poisoning – gases and
vapours
11.3%

16. New Zealand Suicide Prevention Strategy
http://www.moh.govt.nz/moh.nsf/indexmh/suicidepr
evention-strategyandplan#strategy

17. NZ - SUICIDE PREVENTION STRATEGY
NZSPS – 7 goals
 promote mental health & wellbeing
 improve care of people with mental disorders associated with suicidal
behaviours
 improve care of attempters
 reduce access to means of suicide
 promote safe reporting & portrayal of suicidal behaviour by the
media
 provide postvention support
 expand evidence about rates, causes & effective interventions.

18. RISK & PROTECTIVE FACTORS
19

20. MICRO-LEVEL RISK FACTORS
 Genetic vulnerabilities
 Psychiatric illness
 Impulsivity
 Aggression
 Hopelessness
 Previous suicide attempts
 Poor coping skills
 Physical illness/injury, TBI, PTSD
 Sexual orientation

21. MICRO-LEVEL PREVENTION STRATEGIES
Individual interventions
 Psychotherapy, medication, psychosocial support
 Diet, exercise
 Building coping skills, resiliency (e.g. anger/conflict
management), optimism, wellness
 Impulsivity/anger management
 Cyber, phone, txt msg interventions
 Medication, appointment reminders
 Tailored safety planning

22. PROTECTIVE FACTORS – HEALTH
Micro-level (Individual) activities
 Acute distress or crisis
 Engage with health services
 Keep appointments
 Take medications and follow treatments as prescribed
 Have a safety plan, & follow it when you encounter difficulties
 Ensure you are safe
 If things don’t get better, ask for help
 Ask for help and support from family, friends, health services
 Go to the ED or local Psych Emergency Services
 Call helplines - Free 0800 543 354;
 If immediate danger - call 111

23. PROTECTIVE FACTORS - PSYCHOLOGICAL
Most people exposed to difficult life experiences do not die by
suicide. Likely explained by differences in protective factors:
 Resilience - ability to cope with, and adjust to adversity
 A sense of self-worth and self-efficacy
 Effective coping and problem-solving skills
 Outward focus (serving others)
 Adaptive help-seeking behaviour
 Life satisfaction
 A positive therapeutic relationship

24. PROTECTIVE FACTORS – HEALTH
Micro-level (Individual) activities
 Specific daily wellbeing practices
 Diet
 Keep a gratitude journal
 Keep a hope box
 Make plans, set challenges for yourself
 Volunteer activities – help others
 Pets - responsibility/exercise
 Ensure social contact
 Take up hobbies, exercise, interests

25. PROTECTIVE FACTORS – HEALTH
Most people who die by suicide are depressed but not taking
effective antidepressants
 Many not diagnosed
 Of those diagnosed, many are untreated or under-treated
 Many more do not take their meds as prescribed.
YET
 There are effective medications and therapies
 Educate primary care (GPs) to assess, treat and manage
depressed & suicidal patients
 Encourage help-seeking, adherence with treatments & meds

26. PROTECTIVE FACTORS - INDIVIDUAL & SOCIAL
 Social connectedness, good relationships with friends,
colleagues and neighbours
 Social support from other people
 Marriage - men; children for women (but cannot prescribe!)
 Religious/spiritual beliefs

27. MESO-LEVEL RISK FACTORS
 Relationship, legal, financial, disciplinary problems
 Physical and emotional abuse, neglect, bullying
 Family violence
 Parental psychopathology
 Unemployment
 Social isolation
 Academic pressures
 Institutional settings (prisons, services, schools)
 Clusters and contagion
 Healthcare settings (inpatient units)

28. MESO-LEVEL STRATEGIES
 Institutional strategies
 Education, screening, skills building, gatekeeper support
 Psychosocial interventions
 Anti-bullying, IPV screening, parenting/family support, crisis lines,
social support
 Primary care screening, assessment, education
 Healthcare settings (EDs, inpatient units)
 Community settings
 Cluster management, postvention/bereavement support,
workplace support

29. MACRO-LEVEL RISK FACTORS
 Public laws/policies (e.g. drug & alcohol access)
 Season/weather
 Disasters (long term)
 Media over-reporting
 Cyber-exposure; cyber bullying;
 Social disintegration, individualism, materialism
 Globalisation, macro-economic restructuring
 Cultural differences/isolation

30. MACRO-LEVEL STRATEGIES
 Community, state, national policy interventions
 Means restrictions
 Drugs/alcohol policies
 Media guidelines
 Health & wellness promotion
 Social policies & employment
 Health literacy, destigmatisation
 Public service messages
 Media and cyber-based programmes

31. PROTECTIVE FACTORS – MEANS RESTRICTION
 Suicidal behaviour is often ambivalent & impulsive, and/or
contemplated when someone is intoxicated
 May not be pursued if access to a favoured method or a
particular site of suicide is thwarted.
 Therefore restricting access to means of suicide is a very
effective protection against suicide
 Shown for domestic gas, VEG, metro railway systems, guns,
bridges, jumping sites, medications - prescribed & OTC

32. RE-INSTALLING BARRIERS
33
Grafton Bridge, Auckland, New Zealand
 Removal of safety barriers in place 60 yrs led to a 5.6-fold increase in Ss
from the bridge – 3 Ss in the 4 years prior to removal, 19 Ss in 5 yrs after
removal.
 Reinstatement of barriers eliminated Ss from the bridge and appears to
have decreased Ss by jumping the city. No increase in Ss by jumping from
other sites. Beautrais et al, 2010

33. SUICIDES AT GRAFTON BRIDGE
34
19
3
0
1992-1995 1997-2001 2002-Present

34. STRENGTHENING PROTECTIVE FACTORS & INSTILLING HOPE
WINNING WAYS TO WELLBEING

36. ADVANCING SUICIDE PREVENTION
INSTILLING HOPE
 We now have a sufficient body of evidence and data about
risk & protective factors for suicide.
 The time to convert that evidence into effective programmes
is NOW.
 Requires sustained investment in funding, training &
development of a suicide research & prevention workforce,
and in IT, regulatory & funding infrastructures which support
suicide prevention
 The present absence of strong evidence for effective
programmes is a call for action

38. KEYNOTE SPEAKERS
CONFERENCE SPEAKERS
Professor Sir Peter Gluckman Professor Jane Pirkis
Prime Minister's Science Adviser, New Zealand University of Melbourne, Australia
Professor Eric Caine Professor David Fergusson
University of Rochester School of Medicine University of Otago, Christchurch New Zealand
Rochester, NY, USA
Professor G Luke Larkin
Paul Kelly The University of Auckland, New Zealand
CEO, Console Ireland
Assoc. Professor Sally Merry
Dr John Crawshaw The University of Auckland, New Zealand
Director of Mental Health, Ministry of Health, New
Zealand Dr Shyamala Nada-Raja
University of Otago, Dunedin, New Zealand
Di Grennell
Te Puni Kokiri, New Zealand Dr Jemaima Tiatia
Centre for Pacific Studies The University of Auckland,
Professor Helen Christensen New Zealand
Executive Director, Black Dog Institute, Sydney, &
Professor of Mental Health, University of New South Sandra Palmer & Eliza Snelgar,
Wales, Australia Community Postvention Response Service (CPRS),
CASA, New Zealand
Professor Simon Hatcher University of
Ottawa, Canada
Dr Nik Coupe

39. CONFERENCE TOPICS
TOPICS
 The science of suicide  New Zealand suicide
prevention prevention policy
 Suicide clusters  Pacific suicide prevention
 e-health and suicide  The Emergency Department
prevention as a site for suicide
prevention
 Suicide as a public health
problem  Pathways to suicide
 Postvention  Public/private partnerships
in suicide prevention
 Māori and suicide
prevention

40. SUICIDE PREVENTION 2012: IDEAS, INNOVATION, IMPLEMENTATION
FRIDAY SEPTEMBER 28TH, 2012
8.30am to 5pm
ELLERSLIE EVENT CENTRE
www.suicideprevention2012.weebly.com