Jacklyn McCarthy NSRF

1. Harnessing the potential of existing data towards preventing suicide and self-harm among children and young people in Ireland Jacklyn McCarthy NSRF

2. National Suicide Research Foundation Research Strategy General objective: To produce a nationally and internationally recognised body of reliable knowledge from a multidisciplinary perspective on the risk and protective factors associated with suicidal behaviour. I Epidemiology of deliberate self harm and suicide II Efficacy of intervention and prevention programmes for deliberate self harm and suicide

3. Suicide and medically treated deliberate self harm in Ireland - The tip of the iceberg Suicide ca 500 p.a. Deliberate self harm medically treated ca. 12,000 p.a. “ “Hidden” cases of Deliberate self harm ca. 60,000 p.a.

4. Where does this data come from? WHO and Irish Central Statistics Office Suicide Data Suicide National Registry of Deliberate Self Harm Deliberate self harm hospital treated ‘Hidden’ cases of deliberate self harm and related mental health problems SEYLE and CASE School-based Survey

5. Suicide in Ireland and in other EU countries Based on WHO data accessed on 31 March 2011. Data are for 2004-2008 except for Belgium (1999).

6. Suicide in Ireland by age, 2004-2009

7. Suicide rate of 15-24 year-olds in Ireland and in other EU countries Based on WHO data accessed on 31 March 2011. Data are for 2004-2008 except for Belgium (1999).

8. Suicidal behaviour in young people • 300% increase in youth suicide worldwide, since the 1950’s • Approx 13,500 young people die by suicide in Europe each year • 100-200 episodes of deliberate self-harm (DSH) per suicide

9. Suicidal Behaviour in young people • Psychological and psychiatric conditions: • Depression • Anxiety • Emotional & behavioural difficulties • Risk behaviours: • Peer victimisation • Risky sexual behaviour • Deliberate self-harm • Physical inactivity • Poor nutrition

10. Saving and Empowering Young Lives in EuropePromoting health through the prevention of risk-taking and self-destructive behaviour

11. Austria Estonia France Germany Hungary Ireland Israel Italy Romania Slovenia Spain Sweden SEYLEA health promoting programme for adolescents in European Schools

12. Project Aims • Compile an epidemiological database on the mental health and well-being of European adolescents • Interventions • Evaluate Interventions • Recommend health-promoting models

13. European Sample • Schools: • 296 approached • 178 accepted • 60% response rate • Students: • 28,837 approached • 14,115 consented • 12,395 baseline • 43% response rate • 5,529 boys (44.8%) / 6,800 girls ( 54.9%)

14. Irish Sample • Schools: • 21 approached • 17 accepted • 81% response rate • Students: • 1,722 approached • 1,112 baseline • 65% response rate • 601 boys (54%) / 495 girls (44.5%)

15. Measures Baseline and follow-ups: WHO-Five Beck Depression Inventory (BDI) Paykel Suicide Scale (PSS) Global School-based Student Health Survey (GSHS) Strengths and Difficulties Questionnaire (SDQ) European Values Study Questionnaire (EVS) Specific SEYLE questions

16. SEYLE Intervention Arms • Youth focused suicide prevention strategies: • Teacher training (QPR) • Awareness Training • Professional Screening • Minimal Intervention • All questionnaires screening for possible cases • All students given SEYLE contact card

17. SEYLE Interventions Arm 1 QPR (4 schools): Arm 2 Awareness (4 schools): Arm 3 Prof screen (4 schools): Arm 4 Minimal Intervention (5 schools):

19. Teacher Training in QPR QPR – Question, Persuade and Refer Question somebody displaying warning signs Persuade them to seek help Refer to appropriate health services

20. Professional Screening All questionnaires screened Young people who met defined threshold invited to attend clinical interview Depressive symptoms Symptoms of anxiety Drug and alcohol use School attendance

21. Awareness Intervention ‘Affect and Improve the way you feel’

22. Awareness Intervention 1. Lecture/Role-play topics Awareness about choices Awareness about feelings and how to manage stress and crises situations Awareness about depression and suicidal thoughts 2. Posters and Booklet Awareness of mental health Self-Help advice Stress and crisis Depression and suicidal thoughts Helping a troubled friend Getting Advice: Who to contact

23. Minimal Intervention Complete questionnaires Receive contact cards Posters Awareness of mental health Self-Help advice Stress and crisis Depression and suicidal thoughts Helping a troubled friend Getting Advice: Who to contact

24. Preliminary results: Baseline follow-up (Nov 2009) Total numbers: 1,112 Total number of “cases” identified: 78 Facilitator phone: 2 contacts 3 month follow-up (March 2010) All schools participated: Total numbers: 1,006 Total number of “cases” identified: 35 Facilitator phone: 6 contacts 1 year follow-up (Dec 2010) All schools participated: Total numbers: 982 Total number of “cases” identified: 50 Facilitator phone: 6 contacts

25. Papers in Preparation

26. Irish young people with concerns regarding their sexual orientationLGB n=58 Non-LGB n=1054 • Risky Behaviours: • Physical assault 40% (23) vs.8% (85) • sexual assault 16% (9) vs. 1% (11) • Relationships: peer relationships, less engaged with parents, more sexually active • Psychological difficulties: higher depression, anxiety, emotional symptoms • Suicidal behaviour:higher level of suicidal ideation,suicide attempts 29% (16) vs. 2% (20)

27. Suicidal behaviour, risk behaviours and related mental heath difficulties in a sample of sexually assaulted Irish adolescentsSA=20 Non-SA=1092 • Marked relationship difficulties: peer, parental, romantic • Maladaptive coping strategies: alcohol, drugs, smoking • Almost half of this group attempted suicide 45% (9) vs. 3% (24) • Much more likely to have seriously considered or planned taking their own life 47% (9) vs. 6% (55)

28. Screening and assessment of Irish adolescents for suicidal behaviour in a school-based setting • 78 emergency cases (7%) • 29 of these attended interview (37%) • Cases at baseline: higher anxiety & lower well-being • Cases at 3 month follow-up: lower depressive & anxiety symptoms higher well-being • Most Irish adolescents identified by screening as being at high-risk of suicidal behaviour will not avail of an assessment by a psychiatrist • No evidence of increased risk from screening

29. International Paper – Adolescent risk behaviours • At-risk students: Israel, Germany, France, and Slovenia • Low-risk students: Ireland and Italy • Attending clinical interview: • High participation rates – Spain, Estonia • Low rates were reported in Ireland • Number of referrals: • Lowest - Hungary and Italy • Highest - Austria and Ireland

30. International Paper – Mental Health Literacy • Mental health literacy among European schoolteachers needs improvement to enable them to adequately fulfil the gatekeeper role • Discrepancies between the countries determine potential routes for mental health prevention and promotion in schools • Irish teachers knowledge and understanding of mental health varied greatly • Irish teacher reported confidence in crisis plans surrounding suicide

31. Contact us National Suicide Research Foundation, 1 Perrott Avenue, College Road, Cork. Tel: 021 4277 499 Email: seyle.nsrf@iol.ie Web: www.seyle.org Dr. Helen Keeley Dr. Paul Corcoran Dr. Carmel McAuliffe Jacklyn McCarthy Padraig Cotter