Suicide Prevention Resources

1. Suicide Prevention Resources Presented by: Stephanie Belford, LGSW ASPEN Director

2. Objectives • Participants will review WV suicide statistics • Participants will be able to recognize risk factors for suicide • Participants will become familiar with a free suicide risk assessment • Participants will become familiar with classroom prevention resources

3. Why Is This Important? • Every 17 minutes another life is lost to suicide-taking the lives of more than 30,000 Americans every year • Every day 86 Americans take their own life • Suicide is now the 8th leading cause of death in America. • For young people 15-24 years old, suicide is the third leading cause of death

4. During our lifetime: • 20% of us will have a suicide within our immediate family. • 60% of us will personally know someone who dies by suicide.

5. Pieces of the Puzzle… • An average of one youth (ages 15-24) completes suicide every 2 hours and 2.1 minutes. • If suicides completed by youth under age 15 are included, that increases to an average of one every hour and 54.5 minutes.

6. How Does WV Compare? • WV ranked 16th in the nation with an overall suicide rate of 14.0 per 100,000 people. (CDC 2005) • Among youth ages 15-24, the suicide rate is 10 deaths per 100,000 people. • Most common method of suicide was firearms followed by suffocation.

7. WV Youth Suicide is the 2nd leading cause of death for WV Youth ages 15-24! It is the 3rd leading cause of death nationally.

8. Suicides by County 2000-2006 (ages 14-25) • Kanawha-39 suicides • Cabell- 17 suicides • Berkeley- 12 suicides • Fayette – 12 suicides • Marshall-12 suicides

9. Depression • As many as one in every 33 children and one in eight adolescents may have depression. (United States Center for Mental Health Services [CMHS], 1996) • Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next five years. (CMHS, 1996) • Two-thirds of children with mental health problems do not get the help they need. (CMHS, 1996) • About 2/3 of people who complete suicide are depressed at the time of their deaths

10. Particular Risk for Suicide • Extreme hopelessness • Lack of interest in activities • Heightened anxiety or panic attacks • Irritability and agitation • Global insomnia • Prior history of suicide attempts • Talk about suicide

11. Know the Danger Signals • Prior suicide attempts • Psychiatric problems • Substance Abuse • Contagion • History of family suicide attempts • Accessibility of firearms

12. Other Risk Factors • History of trauma or abuse • Loss of a relationship (friend, girlfriend/boyfriend, divorce of parents) • Lack of social support • Stigma associated with seeking help

13. Suicide Clues And Warning Signs The more clues and signs observed, the greater the risk. Take all signs seriously.

14. What about being with an individual kid? What should you do?

15. What to Do • Take it seriously-75% of all suicides had given some warning of their intentions • If you think that someone is suicidal, ask them about it • Be willing to listen and don’t show shock or disapproval • Be actively involved in seeking professional help • Avoid trying to explain away the feelings…don’t say things like “you have a lot to live for” or “you are just confused right now”

16. What is the ASAP-20 • Brief, user-friendly, structured clinical interview • Intended for use by mental health workers and/or school counselors to provide an initial objective assessment of adolescent suicidal risk • Classifies adolescent as either low, medium, or high risk • Organized into four domains: Historical, Clinical, Contextual, and Protective

17. History of Attempt • A suicide attempt is defined as an intentional, self-harming act with greater than zero probability of death (O’Carroll, et al., 1996).

18. Physical/Sexual Abuse • According to Brent (2001) “ongoing physical or sexual abuse is a particularly ominous precipitant… (p. 109)” for suicidal behavior. • The rating of physical and sexual abuse of the adolescent should involve three dimensions: frequency, duration, and intensity.

19. Antisocial Behavior • Adolescents displaying antisocial behaviors have an increased risk of suicide attempts. • The risk is particularly high if these individuals have encounters with the law (Marttunen et al., 1998).

20. Family History • Numerous studies have found that suicidal behavior in family members significantly increases the risk for adolescents attempting or completing suicide (Gould & Kramer, 2001; Goldman & Beardslee, 1999). • “Family” should include relatives outside the immediate family unit, such as grandparents. Aunts, uncles, and cousins should also be considered if interaction with the adolescent is frequent and significant to him/her.

21. Depression • In addition to questions about depressed mood, also inquire about other depressive symptoms, such as: • Disturbances in sleep and eating patterns • Complacency or lethargy • Social withdraw • Feelings of worthlessness

22. Hopelessness • Hopelessness, states Fremouw et al. (1990) is “especially indicative of suicide risk” (p. 65). • Hopelessness includes “feelings of despair, lack of control, and pessimism about the future” (Fremouw et al., 1990). • Hopelessness is a dominant characteristic of adolescent suicide attempters

23. Anger • Anger is prevalent in most adolescents, and many studies demonstrate that anger is correlated significantly with adolescent suicide. • The emotion of anger can be externalized and displayed as aggression. Conversely, anger can be internalized and manifested as depression (Myers et al, 1991).

24. Impulsivity • Research suggests that impulsivity may cause problem-solving deficits in suicidal adolescents. • Research by Horesh, Gotheif, Ofek, Weizman, and Apter (1999) demonstrate that impulsivity is a stronger risk factor of adolescent suicide for males than females.

25. Substance Abuse • Gould and Kramer (2001) suggest that substance abuse is the most significant difference between those who actually attempt suicide and those with suicidal ideation. • Suicide completions are the result of a combination of factors; however, studies have found that the most deadly combinations involve an element of substance abuse

26. Recent Loss • Interpersonal loss and conflict with peers or family may trigger adolescent suicide (Overholser & Spirito, 2003). • Interpersonal loss is operationalized as death of a loved one, the abandonment, divorce or separation of a parent, or a breakup from a romantic relationship.

27. Firearm Access • Firearms is the most frequent method for suicide. • Households that contain firearms are the strongest situational predictive factor of committing suicide, especially for adolescents who have made previous suicide attempts • 85% of WV homes have firearms

28. Family Dysfunction • Fremouw et al. (1990) state that “foremost among contributing environmental factors [for suicide risk] is the child’s family system” (p. 62). • Parents of children who attempt or commit suicide have significantly high rates of mood disorders, substance abuse, and psychopathology (Brent, 2001; Gould & Kramer, 2001

29. Peer Problems • Research has sited “interpersonal factors, and specifically difficulties in peer functioning, as precipitants to adolescents’ suicidal behavior” • Although minimal research has focused on this specific area, several studies have found relationships between suicidal behavior and social isolation, sexual orientation, and peer rejection

30. School/Legal Problems • Many studies have shown that there is an increased risk of suicide for those adolescents not in school and not working. • Difficulties in school and/or impending disciplinary crisis also increase the risk of suicide for some adolescents.

31. Contagion • Contagion is also referred to as imitation or cluster suicide • Contagion can be caused by the media or by peer groups • Contagion suicides normally occur within two weeks of the original suicide

32. Protective Factors • Reasons for Living • How does your faith view suicide? • What are your expectations about your life problems improving? • Do you think things will get better for you? • How important is your family to you? • Are you afraid of dying? • Current Treatment • Are you currently seeing a therapist, counselor, or psychologist? • If so, how long have you been in treatment?

33. Other Potential Classroom Aides • Jason Foundation Curriculum • Signs of Suicide (SOS) • Reconnecting Youth • CAST • Lifelines

34. Know Your Resources • National Suicide Lifeline 1-800-273-8255 • WV Council for the Prevention of Suicide • ASPEN Project

35. For More Information • www.suicidology.org • www.sprc.org • www.afsp.org • www.spanusa.org • www.wvaspen.com • www.wvsuicidecouncil.org

36. Bob Musick Executive Director WV Council for the Prevention of Suicide (304) 296-1731 Stephanie Belford Director Adolescent Suicide Prevention and Early Intervention Project (304) 399-1210 WV Contacts