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					Suicide Prevention

     Presented by:
Stephanie Belford, LGSW
    ASPEN Director
•   Participants will review WV suicide
•   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
       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
• For young people 15-24 years old, suicide is the
  third leading cause of death
          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.
      Pieces of the Puzzle…
• An average of one youth (ages 15-24)
  completes suicide every 2 hours and 2.1
• If suicides completed by youth under age
  15 are included, that increases to an
  average of one every hour and 54.5
    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.
          WV Youth

Suicide is the 2nd leading cause of
 death for WV Youth ages 15-24!

It is the 3rd leading cause of death
           Suicides by County
         2000-2006 (ages 14-25)
•   Kanawha-39 suicides
•   Cabell- 17 suicides
•   Berkeley- 12 suicides
•   Fayette – 12 suicides
•   Marshall-12 suicides
• 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
      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
       Know the Danger Signals
•   Prior suicide attempts
•   Psychiatric problems
•   Substance Abuse
•   Contagion
•   History of family suicide attempts
•   Accessibility of firearms
          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
Suicide Clues And Warning

            The more clues and signs
          observed, the greater the risk.
             Take all signs seriously.
What about being with an
     individual kid?
           What should you do?
                 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
• 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”
         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
          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).
      Physical/Sexual Abuse
• According to Brent (2001) “ongoing
  physical or sexual abuse is a particularly
  ominous precipitant… (p. 109)” for suicidal
• The rating of physical and sexual abuse of
  the adolescent should involve three
  dimensions: frequency, duration, and
         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).
              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.
• 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
• 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
• Anger is prevalent in most adolescents,
  and many studies demonstrate that anger
  is correlated significantly with adolescent
• The emotion of anger can be externalized
  and displayed as aggression. Conversely,
  anger can be internalized and manifested
  as depression (Myers et al, 1991).
• Research suggests that impulsivity may
  cause problem-solving deficits in suicidal
• Research by Horesh, Gotheif, Ofek,
  Weizman, and Apter (1999) demonstrate
  that impulsivity is a stronger risk factor of
  adolescent suicide for males than females.
          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
• 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
              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.
           Firearm Access
• Firearms is the most frequent method for
• 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
         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
            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
    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.
• 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
           Protective Factors
• Reasons for Living
  – How does your faith view suicide?
  – What are your expectations about your life problems
  – 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
  – If so, how long have you been in treatment?
    Other Potential Classroom Aides
•   Jason Foundation Curriculum
•   Signs of Suicide (SOS)
•   Reconnecting Youth
•   CAST
•   Lifelines
      Know Your Resources
• National Suicide
• WV Council for the
  Prevention of
• ASPEN Project
         For More Information
              WV Contacts
Bob Musick                Stephanie Belford
Executive Director        Director
WV Council for the        Adolescent Suicide
  Prevention of Suicide     Prevention and Early
(304) 296-1731              Intervention Project
                          (304) 399-1210