Teen Suicide: Strategies for Prevention Melissa Schiff, MD, MPH University of Washington MCH Program Harborview Injury Prevention and Research Center Seattle, Washington Maternal and Child Public Health Leadership Training Program School of Public Health University of Washington Story of a Teen Suicide ML, a 16 year old boy, had recently moved to a new city and started a new school. ML had a hard time making new friends and had experienced some bullying at the new school. One Friday night, ML took out his father’s handgun and shot himself in the head. Question Using the chat feature, type in what you think is the single most common risk factor for teen suicide? Scope of Suicide Problem Risk Factors Outline Prevention Strategies Treatment for Depression 10 Leading Causes of Death by Age Group, United States – 2006 Teen Suicide Problem Counts Rates* Deaths 1718 5.79 Attempts 77,323 260.3 ED evaluations 30,595 103.0 Hospitalizations 19,224 64.7 * Per 100,000 CDC, WISQARS Teen Suicide Rates for Region 10 Rate / 100,000 CDC, WISQARS Suicide rates for ages 10+ years by County, 2000-2006 CDC, NCIPC Poll • What do you think is the most common method used in fatal suicide attempts? A. Hand guns B. Falls C. Suffocation D. Poisoning Percentage of Self-Harm Injuries, by Age Group, Disposition, and Mechanism, United States, 2002-2006 CDC, NCIPC Poll • Which gender is more likely to have fatal suicides? A. Male B. Female Suicide Rates* Among Persons Ages 10-24 Years, by Race/Ethnicity and Sex, United States, 2002-2006 Risk Factors • History of psychiatric disorders (90%), especially depression (50%) – Hopelessness – Impulsiveness, aggression – High emotional reactivity • Alcohol, substance abuse • Child maltreatment Risk Factors • Threats or actual physical violence – peer victimization • Sexual orientation • Parental separation, divorce, discord • Prior suicide attempt, family history of suicide Risk Factors • Access to lethal suicide methods – firearms, ammunition • Local epidemics of suicide Percentage* of U.S. High School Students Reporting Considering, Planning, or Attempting Suicide in the Past 12 Months, by Sex, United States, 2007 Youth Risk Behavior Survey YRBSS Data on Youth Suicide Teen Suicide Prevention Strategies • Early case finding • No-suicide contracts • Community assets • Peer counseling development • Population-based • Crisis hotlines screening • Early parental pathology • Restricting dispensing detection quantities • School awareness • Emetic products curriculum • Treatment compliance • Substitute less toxic • Non-pharmacological medications care • Surrogate roles models How to evaluate if prevention strategies effective? • Injury Prevention & Child Death Review teams (WA) – Review existing studies – Evidence-based suicide prevention strategies • Suicide Prevention Resource Center – Evidence-Based Practices Project Teen Suicide Prevention Strategies • 22 strategies reviewed • Panel of experts • Rate study design • Make recommendations on evidence • 3 strategies recommended Teen Suicide Prevention Strategies • 1 strategy appears harmful Effective Prevention Strategies • Skills Training • Assessment and Referral Training • Media Guidelines Skills Training • Youth at risk of school failure, suicide, history of abuse • Development of skills – Interpersonal problem solving skills – Coping skills – Cognitive skills • Social support Skills Training • Reduce suicide risk factors • Outcomes evaluated by randomized controlled trials – Depression – Drug abuse – Attempted and completed suicides • Active intervention increased protective factors Assessment and Referral Training • 75% family, pediatric physicians treat childhood depression • Few receive adequate training • Less than half screen for suicide risk • Providers should be trained in assessment and referral for depressed patients Assessment and Referral Training • Training workshops for physicians – Depression recognition, treatment – Identification of suicidal patients • Improved treatment for depression; decreased suicide rates • Effects on provider education decrease over time • Additional studies in youth population needed Media Guidelines • “Suicide contagion” - media coverage of suicide events • Austria 1984-1987 - suicide deaths from subway trains • 1987 campaign • Subway suicides and non-fatal attempts declined by 80% Media Guidelines • Increase in suicide related to: – Increase in number of suicide stories – Particular death reported at length, multiple stories – Front page, broadcast coverage – Dramatic headlines Describe Treatment Avoid romanticizing suicide Sources, Advances Media Guidelines Story Recommendations: Present Balanced Life Trends, Myths, Picture + & - Warning Signs Poll Poll • Have any of your organizations worked with media on suicide reporting? A. Yes B. No Potentially Harmful Strategy Suicide awareness curriculum at schools – Teens to identify peers at-risk – Increase awareness, disclosure of suicidal behavior – Less mental health referral by peers – Negative reactions among those with history of suicide attempt Treatment of Depression / Suicidality • Few studies of interventions to reduce suicidal ideation, behaviors • Medications (SSRIs) – Antidepressants reduce suicidal ideation and depression – FDA restrictions on antidepressants for youth Treatment of Depression / Suicidality • Psychotherapy in teens – Interpersonal therapy – Cognitive behavioral therapy – Reduces depression symptoms • Limitations of studies of therapy Conclusions • Youth suicide rates mostly unchanged • Well-defined risk factors • Several suicide prevention strategies proven effective • Suicide awareness curriculum harmful • Additional strategies likely effective – more study needed References • Gould MS. J Am Acad Child Adolesc Psychiatry 2003;42:386-405 (Prevention strategy review) • Mann JJ. JAMA 2005;294:2064-2074 (Prevention strategy review) • Williams SB. Pediatrics 2009;123:e716-3 (Treatment for depression in youth) References • Suicide Prevention Resource Center EBBP http://www.sprc.org/featured_resources/bp r/ebpp.asp Open Discussion What Suicide Prevention Strategies do You Use in Your Agency?