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Adolescent Depression and Suicide

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Adolescent Depression and Suicide Powered By Docstoc
					 Suicide Prevention, Intervention, and
      Postvention for Educators
        Southeast Nebraska Suicide Prevention Project
                            and
                   Robin Zagurski, LCSW
           University of Nebraska Medical Center




Supported by a grant from the Nebraska Healthcare Cash Fund
        Objectives for Educators
   Know symptoms of depression in adolescents
   Understand that suicide is a public health
    problem
   Identify ways to protect yourself and others
    from suicide
   Identify suicide risk factors
   Know the red light warning signs for suicide
    risk
   Are comfortable offering help to someone at
    risk for suicide
   Have resources for postvention after a student
    suicide
      Common terms used in this
           presentation
   Suicide – Intentionally taking one’s own life
   Suicide act or gesture – Actions to deliberately
    injure oneself or attempt to injure oneself without
    resulting in death.
   Suicide Behavior – Thoughts, plans, or actions
    which if implemented could result in death
   Postvention - An intervention after a suicide for
    the students, faculty and friends designed to
    facilitate grieving.
              Questions


Concerns


                          Worries


    Beliefs
Teen Depression
         Teenagers,
         especially young
         teens, may exhibit
         several symptoms
         of depression and
         yet be unaware
         that they are
         suffering from
         depression.
           Adolescent Depression
   Extreme sensitivity to rejection or failure
   Low self-esteem and feelings of guilt
 Frequent complaints of physical illnesses
  such as headaches and stomachaches
 Frequent absences from school or poor
  performance in school
 Threats or attempts to run away from home
 Major changes in eating or sleeping patterns
    (American Academy of Child and Adolescent Psychiatry, 8/98)
             Adolescent Depression
   Sad, blue, irritable and/or complains
    that nothing is fun anymore
   Trouble sleeping, low energy, poor
    appetite and trouble concentrating
   Socially withdrawn or performs more
    poorly in school
   Can be suicidal
    National Institute of Mental Health, Treatment of Adolescent Depression
    Study (TADS)
        Adolescent Anxiety
 Excessive  worries
 Worries about school performance
 Difficulty making friends
 Isolative
 Perfectionistic
 Rigid thinking and behavior patterns
 Phobias
          Suicidal Ideation
      (Hoberman and Garfinkel 1988)

In a study of 229 completed youth suicides:
 62% had made a suicidal statement
 45% had consumed alcohol within 12 hours
  of killing themselves
 76% had shown a decline in academic
  performance in the past year
          Teen Suicide in the U.S.
   There are 25 suicide attempts for every
    completion for our country as a whole
   There are between 100-200 teen attempts before
    completing suicide
   Girls attempt more often (3:1)
   Boys complete suicide more often (4:1)
   Every year approximately 2,000 teens suicide
    Journal of American Academy of Child and Adolescent Psychiatry,
    Practice Parameters, 2002
Although suicide is the 11th leading cause of death for
the overall population, it is the 3rd leading cause of death
for 15-24 year olds.
Nebraska Teen Suicide Statistics
            2001
In Nebraska:
 2 children between the ages of 10-
  14 killed themselves
 17 teens between the ages of 15-19
  killed themselves
 13 of those suicides were by
  gunshot
                   Cultural Factors
   African Americans currently have a
    lower rate of suicide than whites,
   The suicide rate of African-American
    adolescent and young adult males has
    been rising rapidly.
   Native American and Alaskan Native
    youth have a very high rate of suicide.
   Attempted suicide rates of Hispanic
    youth are greater than those of white
    and African-American youth.
    Journal of American Academy of Child and Adolescent Psychiatry,
    Practice Parameters, 2002
      Gay and Lesbian Youth
 There is no evidence gay or lesbian youth
  commit suicide more often than
  heterosexual teens.
 However, there is strong evidence that gay,
  lesbian and bisexual youths of both sexes
  are more likely to experience suicidal
  ideation and attempt suicide.
              Alcohol and Suicide
   Alcoholics have a suicide rate
    50 times higher than the
    general population
   Alcohol dependent persons
    make up 25% of all suicides
   18% of alcoholics eventually
    complete suicide
   States with the most restrictive
    policies toward alcohol have
    the lowest suicide rates (Lester,
    1993)
       Self-Injury vs. Suicide
  Self-injury is an attempt to alter one’s
  mood by inflicting physical harm on
  oneself:
 Carving
 Burning
 Scratching
 Branding
 Hitting
       Protection Against Suicide
             Green Light…Good to Go!

   Getting help for mental, physical and substance
    abuse disorders - Especially depression
   Restricted access to highly lethal methods of
    suicide – especially firearms
   An established relationship with a doctor,
    clergy, teacher, counselor or other professional
    who can help
   Connectedness to community, family, friends
   Learned skills in problem solving and non-
    violent conflict resolution
   Cultural/religious beliefs that discourage suicide
             Suicide Risk Factors
         Yellow Light – Proceed with Caution

   Mental disorders-particularly mood or eating
    disorders
   Substance abuse disorders
   Family history of suicide
   Hopelessness
   Impulsive and /or aggressive tendencies
   Barriers to accessing mental health treatment
   Divorced parents or poor family communication
            Suicide Risk Factors
         Yellow Light – Proceed with Caution

   Relational, social, work, or financial loss
   Physical illness
   Previous suicide act
   Easy access to lethal methods, especially
    guns
   Age, Culture, Lack of connectedness
   Exposure to sensational media reports of
    suicide
      Suicide Warning Signs
    Red Light – Stop – Get Help
•   Talking, reading, or writing about suicide/death.
•   Talking about feeling worthless or helpless.
•   Saying ―I’m going to kill myself,‖ ―I wish I was
    dead,‖ or ―I shouldn’t have been born.‖
•   Visiting or calling people to say goodbye.
•   Giving things away or returning borrowed items.
•   Self destructive or reckless behavior.
•   Significant change in behavior
•   Running away
         Suicide Warning Signs
       Red Light – Stop – Get Help
   Hopelessness – typical hopeless statements:
    – ―There’s no point in going on‖
    – ―I can’t take it anymore‖
    – ―I have nothing left to live for‖
    – ―I can’t stop the pain‖
    – ―I can’t live without _______‖
    – ―My life keeps getting worse and worse‖
    – ―I might as well kill myself‖
       Why should Schools be
            Involved?
 Children come into contact with more
  potential rescuers in the schools than in the
  community
 Children’s problems are often more
  apparent in the school than in the home
 Children from divorced and/or
  dysfunctional families are less likely to get
  help at home
                 Guetzloe, 1991
School Specific Signs of Distress
  Any sudden or dramatic change should be
  taken seriously, such as:
 An overall decline in grades
 Decrease in effort
 Misconduct in the classroom
 Unexplained or repeated absence or truancy
           Who Should Intervene?
    Not everyone who works with teenagers should
    work with a suicidal teenager.
   Know your limitations
   Get someone else to help if you:
    –   Are a recent suicide survivor
    –   Are experiencing suicidal thoughts yourself
    –   Are experiencing significant stress in your own life
    –   If you have negative personal feelings about the teen
    What do Educators Need to
             Know?
 There is no confidentiality when a child is
  talking about suicide
 Act immediately. Do not wait until class is
  over or until the end of the day.
 Take action even if you are not sure


http://www.nea.org/neatoday/0004/health.htm
  l
              What action?
 Immediately contact the school
  counselor/social worker or school
  administrator
 The school counselor/social worker or
  school administrator will then contact the
  student’s parents or guardian
 Keep the student under supervision at all
  times until someone else takes over.
        What Can YOU Say?

 I’m  glad you told me, I want to
  help.
 I’m glad you told me, and I am
  going to find someone to help you.
 I will stay with you until help
  arrives.
     What NOT to Say…


• ―It’s just a phase‖
• ―You’ll snap out of it‖
• ―Stop being so selfish‖
• ―You’re just trying to get attention‖
• ―Get over it‖
         What NOT to do….
 Don’t let them bargain you out of getting
  them help.
 Be careful with no-suicide contracts
 Don’t make coercive statements, such as
  ―unless you promise not to hurt yourself,
  you’ll have to go to the hospital‖
    Postvention after a Suicide
Goals:
 Return the school to its pre-crisis milieu
 Identify, refer, and/or assist students who
  may be at risk for depression, suicide, and
  other psychological problems due to their
  exposure and relationship to the victim
 Help students begin a healthy grieving
  process
     Kerr, Brent and McKain, 1997
    Guidelines for postvention with
               students
 Explain that it is normal to feel emotions
  such as shock, fear, sadness, guilt or anger.
 Let students know there is no ―right way‖ to
  feel after a suicide.
 Help to clarify facts about the suicide. Ask
  students to tell you what they have heard.
  Correct errors and rumors if necessary.
  Postvention Guidelines (cont)
 Stress that no one is to blame for the
  suicide. The victim alone made the
  decision to commit suicide.
 Focus on recovery of the survivors and
  alternate methods of dealing with
  problems.
 Rehearse possible condolence
  messages to the family.
     Kerr, Brent, McKain 1997
              Postvention
 Emphasize    that help is available to all
  students, not just to those students who
  are feeling suicidal.
 Make sure students know where to go
  to get help for themselves or for a
  friend who is depressed or suicidal.
                Kerr, Brent, McKain 1997
 What NOT to do after a suicide:
 Do not put in a permanent memorial for the
  person who killed themselves. (i.e., no tree
  planting, plaques, etc.)
 Do not glorify the death by having large
  memorial services with lots of fanfare.
  The Southeast Nebraska Suicide
        Prevention Project
Lead Agency:
 Blue Valley Mental Health Center


Project Partners:
 Bryan/LGH Medical Center
 Community Mental Health Center of
  Lancaster County
                     Resources
  The Yellow Ribbon Program
www.yellowribbon.org
 The National Suicide Hopeline
1-800-SUICIDE
 BryanLGH Counseling Center
481-5991
 BryanLGH 24-hour Mental Health Assistance Nurse
475-1011 OR 1-800-742-7845
 AFSP Teen Suicide Prevention Kit
1-888-333-AFSP
 American Association of Suicidology www.suicidology.org
 Postvention Guideline Resources
 Services   for Teens at Risk (STAR):
 http://www.wpic.pitt.edu/research/star/default.htm
 Postvention Standards Guidelines: A guide for
 a school’s response in the aftermath of a
 sudden death. Kerr, Mary Margaret, Ed.D.,
 Brent, David A., M.D., McKain, Brian,
 M.S.N.. Star Center Publications, 3rd Edition.
     School Curriculum Caveat
According to the American Academy of Child
  Psychiatry:
 Teaching entire courses on suicide to groups of
  students should be discouraged as it appears to
  activate suicidal ideation in disturbed adolescents.
 Courses on teaching problem solving, social skills,
  conflict resolution, and reporting skills are helpful
  in preventing suicide in teens.
 School Curriculum Suggestions
The National Education Association suggests:
 Don’t sensationalize or normalize suicide
 General education programs that teach the facts,
  warning signs, and risk factors associated with
  suicide do impart knowledge.
 Treat suicide prevention within a broader mental
  health focus—including work on enhancing
  coping skills and dealing with risk factor issues
  like substance abuse.
      Steps parents can take
1. Get your child help (medical or mental
   health professional)
2. Support your child (listen, avoid undue
   criticism, remain connected)
3. Become informed (library, local support
   group, Internet)
4. Restrict access to firearms
     Carol Watkins, M.D.
        Steps teens can take

1. Take your friend’s actions seriously
2. Encourage your friend to seek
   professional help, accompany if necessary
3. Talk to an adult you trust. Don’t be alone
   in helping your friend. Carol Watkins, M.D.
4. Don’t keep the secret.

				
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