suicidal-behavior-in-adolescents

1. SUICIDALBEHAVIORIN
CHILDRENAND
ADOLESCENTS
NADINEJKASLOW,PHD,ABPP
NKASLOW@EMORY
.EDU
2014 APAPRESIDENT

2. Setting the Stage
 What are the commonmythsabout
suicidein children and adolescents?
 If I suspectmychild isfeeling suicidal,
what shouldIdo?
 Howcanschoolsand communities
work together to prevent suicide?

3. Continuumof SuicidalBehavior
 Suicide - Death caused by self-directed injurious
behavior with any intent to die as a result of the
behavior
Note: T
erms“committed” suicide,“completedsuicide”and
“successfulsuicide”are not consideredunacceptable; preferred
termsare “death bysuicide”or "died by suicide"
 Suicideattempt:Anon-fatal self-directed potentially
injurious behavior (mayor maynot result in injury)
with any intent to die asresult of the behavior
 Suicidalideation: Thoughtsof suicidethat canrange
in severity from a vague wishto be dead to active
suicidal ideation with a specific plan and intent

4. Suicideisa SeriousProblem
 Myth – Suicidein youthisnot a problem
 Truth- Suicidein youngpeople isa seriousand
prevalent problem:
3rd leading causeof death for youngpeople ages 10-24
and accountsfor 20% of all deaths annually
T
opmethodsused- firearms, suffocation, poisoning

5. Suicidal Behavior: A Serious
Problem
 Boysare morelikely than girls to die from suicide
 Of the reported suicidesin the 10-24 age group, 81%
were males
 Girls attempt suicidemorethan boys,a particular
problem for girls from Latina backgrounds

6. Suicidal Behavior: A Serious
Problem
 Ratesof other suicidal behavior are high according to
a nationally-representative sampleof high school
students
15.8% seriously considered
attempting suicide
12.8% made a plan about how
they would attempt suicide
7.8% attempted suicide oneor more times
2.4% made a suicide attempt that resulted in an injury,
poisoning, or an overdose that required medical attention

7. Riskand Protective Factors
 Riskfactors – Increaselikelihood that a youngperson
will engage in suicidal behavior
Intrapersonal, Social/situational, Cultural/environmental
 Protective factors – Mitigate or eliminate risk
Intrapersonal, Social/situational, Cultural/environmental
 Considerthe balance between the two

8. RiskFactors:Intrapersonal
 Recentor seriousloss
 Mental disorders (particularly mooddisorders)
 Hopelessness,helplessness,guilt,worthlessness
 Previoussuicideattempt
 Alcohol and other substanceuse disorders
 Disciplinary problems
 High risk behaviors
 Sexual orientation confusion

9. RiskFactors:Social/Situational
 Recentor seriousloss(e.g., death, divorce, separation,
broken relationship; self-esteem; lossof interest in
friends, hobbies, or activities previously enjoyed)
 Family history of suicide
 Witnessingfamily violence
 Child abuseor neglect
 Lackof socialsupport
 Senseof isolation
 Victim of bullying or being
a bully

10. RiskFactors:Cultural/Environmental
 Accessto lethal means(i.e. firearms, pills)
 Stigma associated with asking for help
 Barriers to accessing services
Lackof bilingual service providers
Unreliable transportation
Financialcostsof services
 Cultural and religious beliefs (e.g., belief that suicide
isnoble resolution of a personal dilemma)

11. Protective Factors
 Skillsin problem solving,conflict
resolution and handling problems in
a non-violent way
 Strong connectionsto family, friends,
and community support
 Restricted accessto highly lethal
meansof suicide
 Cultural and religious beliefs that
discourage suicideand support self-
preservation

12. Protective Factors
 Easyaccessto a variety of clinical interventions
 Effective clinical care for mental, physical, and
substanceusedisorders
 Support through ongoing medical and mental health
care relationships

13. Warning Signs
 A warning sign does not mean automatically that a
person is going to attempt suicide, but it should be
responded to in a serious& thoughtful manner
 Donot dismissa threat asa cry forattention!
Whatkindsof warning
signsarecause
for concern?

14. Specific Warning Signs
 TalkingAbout Dying - Anymentionof dying,
disappearing, jumping, shooting oneself,or other
types of self harm
 Changein Personality - Sad, withdrawn, irritable,
anxious,tired, indecisive,or apathetic
 Changein Behavior- Difficulty concentratingon
school,work, or routine tasks
 Changein SleepPatterns- Insomnia,often with early
waking or oversleeping, nightmares
 Changein EatingHabits- Lossof appetite and
weight, overeating
 Fearof losingcontrol- Acting erratically, harming
self or others

15. HowToTalkWith Your Child
Talkin a calm,non-accusatory manner
Letthemknowyoulove and care
Conveyhowimportant they are toyou
Focusonconcernfor their well-being
Make statementsthat conveyyouhave
empathy for their stress
Encourageseekingprofessional help
Reassurethemthat they will not feel like
thisforever by utilizing appropriate help

16. PreventYourChild’sSuicidal Behavior
 Prioritize interacting with themin positive ways
 Increasetheir involvementin positiveexperiences
 Monitor appropriately your child’s whereabouts and
communications (i.e., texting, Facebook, Twitter) with
the goal of keeping them safe

17. PreventYourChild’sSuicidal Behavior
 Get involved and be aware your child's friends
 Communicateregularly with other parents in your
community
 Limityour child’s accessto guns,knives,alcohol,
prescription pills, and illegal drugs
 Communicateregularly with your child’s schoolto
ensureoptimal safety and care for your child in the
school setting

18. Help YourSuicidalChild
Talkwith your child about your concerns
and askdirectly about suicidal thoughts
Explain value of therapy and potential for
medication managementof symptoms
Addressyour concernswith other
important adults in your child’s life
Discussconcernswith your child’s doctor to
get appropriate mental health referrals
Talkwith people in the schoolwhocan
provide support and guidance

19. SeekProfessionalHelp
 Besafe, not sorry!
 T
akeappropriate action when
needed to protect your child
Feelthat somethingisnot right
Notice warning signsin your child
(including worsening signs)
 Recognizeif your child hasa lot of
risk factors for suicideand few
protective factors

20. SeekProfessionalHelp
 Finda mental health provider that hasexperience
with suicidal youth
 Choosea mental health provider with whomyou
and your child feel comfortable
 Participate actively in therapy with your child
 Call 911 or take your child to a hospital in caseof
an emergency
Suicidal thoughtsor behaviors are a mental health
emergency

21. Intervention Programs
 Psychotherapyisan important componentin the
managementof suicidal ideation and behaviors
 Thereare two documented effective
psychotherapies for treating thosewho
attempt suicide:
Cognitive behavior therapy (CBT)
Dialectical behavioral therapy (DBT)for youthdiagnosed
with borderline personality disorder and recurrent suicidal
ideation

22. Intervention Programs
 Thereare other promising interventions!
 Family therapy
 Medications

23. Partner with Schools& Community
 Toprevent suicide:
Work with schoolsto ensurethat educational
suicide prevention programs are offered
Collaborate with schoolsonthe development
of peer gatekeeper programs related to
identifying at-risk peers and encouraging
themto seekhelp
Work with local sectionsof national suicide
prevention organizations to haveoptimal
suicide prevention programming available in
your community

24. If YourChild Hasa SuicidalFriend
 Havea plan for
helping your child:
Tellyour teenagers that if a friend saysthat they are going
to kill themselves,they shouldinform a trusted adult (i.e.
parent, schoolnurse,or guidance counselor)to get
professional help for their friend
Assureyour child that it isnot their responsibility to decide if
their friend’s threat is credible
Remindthemnottokeepit a secret!

25. Immediate Prevention Help
 Available 24/7:
National Suicide PreventionLifeline:
www.suicidepreventionlifeline.org
1-800-273-TALK (8255)
TheTrevorProject, a national organization providing crisis
intervention and suicide prevention servicesto lesbian, gay,
bisexual, transgender, and questioning youth:
www.thetrevorproject.org/
1-866-488-7386

26. Online Prevention Resources
 National Associationof SchoolPsychologists:
www.nasponline.org/resources/crisis_safety/suicideprevention.
aspx
 AmericanAssociationof Suicidology: www.suicidology.org/
 AmericanFoundation for Suicide Prevention: www.afsp.org
 Society for the Preventionof T
eenSuicide: www.sptsusa.org/
 YouthSuicide PreventionProgram (YSPP):www.yspp.org

27. If YouLoseA Child ToSuicide
 Get support!
Remember in your time
of sorrow and sadness,
youare not alone
Reachout to family, friends, and other community members
Engagewith support groups, locally and nationally
(including on-line communities)
Honoryour loved oneand remember howthey lived
Volunteer to help other survivors
Participate in communityactivities to prevent suicide

28. Take Action!
 Formoreinformation onsuicidein children and
adolescents,
AmericanPsychologicalAssociation:
www.apa.org/topics/suicide
AmericanAssociationof Suicidology: www.suicidology.org/
FrequentlyAskedQuestions(FAQ)about T
eenSuicide
Prevention:
http://marinschools.org/SafeSchools/Documents/SMH/Suici
dePreventionFAQs.pdf

29. Questions?

30. References
1. Centersfor DiseaseControl and Prevention,
National Center for Injury Prevention and Control.
Web-based Injury StatisticsQuery and Reporting
System(WISQARS)[online]. (2010). [cited 2012
Oct 19] Available from
www.cdc.gov/injury/wisqars/index.html
2. Centersfor DiseaseControl and Prevention.Youth
risk behavior surveillance—United States,2011.
MMWR,Surveillance Summaries2012;61(no. SS-4).
Available from
www.cdc.gov/mmwr/pdf/ss/ss6104.pdf