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Pptpresentation
1. More than Sad:
Suicide Prevention Education for
Teachers and Other School Personnel
American Foundation for Suicide Prevention
120 Wall Street, 29th Floor
New York, NY 10005
212.363.3500
www.afsp.org
2. Introduction
to the Program
Program goals
Increase understanding of:
1.
1.
Problem of youth suicide
Suicide risk factors
Treatment and prevention of suicidal behavior in adolescents
Increase knowledge of warning signs of youth suicide so
those who work with teens are better prepared to identify
and refer at-risk students
2
3. Understanding the
Problem of Suicide
In 2010, 38,364 people in the U.S. died by suicide
U.S. suicide rate = 12.1 (12 suicides for every 100,000 people)
4,867 people under age 25 died by suicide (12.7% of total)
Suicide rate for youth (ages 15-24) = 10.1
Suicide is the 3rd leading cause of death for adolescents and
young adults (ages 15–24)
3
7. Youth Suicide Rates
by Race/Ethnicity (Ages 15-24)
Ethnic Group
Suicide Rate per
100,000
American Indian/Alaskan Native
20.9 per 100,000
White
11.4 per 100,000
Asian/Pacific Islander
7.3 per 100,000
Black
6.6 per 100,000
Hispanic
4.7 per 100,000
*Number of suicides per 100,000
population, 2010
7
8. Suicide Attempts
Each year, 150,000 youth aged 10-24 receive medical care for
self-inflicted injuries
30x the number who die by suicide
9.3% of girls and 4.6% of boys in grades 9-12 report attempting
suicide in last 12 months
Reports of suicide attempts are 2-6x more frequent among
youth who identify as gay, lesbian or bisexual, than among
heterosexual youth; no data on GLB suicide deaths
8
9. Suicidal Ideation
“Ideation” – thinking about or planning for suicide
About 14% of students in grades 9-12 – 1 of every 7 – report
seriously considering suicide in the past year
About 11% – 1 of every 9 – report making a suicide plan
9
10. How Can
Teachers Help?
Key tasks
Identification of at-risk students
Referral for assessment and evaluation, according to school’s
protocol or policy
Teachers and other school personnel must know how to
recognize “risk” in youth
10
11. Film, More Than Sad:
Preventing Teen Suicide
Provides an overview of mental disorders in teens that may
end in suicide
Identifies behaviors that suggest a student may be at risk
Discusses steps that teacher and other personnel can take to
ensure that these students get help
Introduces concepts that will be discussed in later sections of
this program
11
13. Risk Factors
for Teen Suicide
Key suicide risk factor for all age groups is an undiagnosed,
untreated or ineffectively treated mental disorder
90% of people who die by suicide have a mental disorder
In teens, suicide risk is most clearly linked to 7 mental
disorders, often with overlapping symptoms:
Major Depressive Disorder
Conduct Disorder
Bipolar Disorder
Eating Disorders
Generalized Anxiety Disorder
Schizophrenia
Substance Use Disorders
13
14. Major Depressive
Disorder (MDD)
Key symptoms in teens are sad, depressed, angry or irritable
mood and lack of interest or pleasure in activities the teen used
to enjoy, lasting at least 2 weeks
Other symptoms
Changes in appetite
Sleep disturbances
Inability to concentrate
Slowed or agitated movement
Recurrent thoughts of death
Fatigue/loss of energy
Worthlessness/guilt
or suicide, self-harm behavior
Symptoms represent a clear change from normal and are
generally observed in several different contexts
14
15. Facts
about MDD
8-12% of teens suffer from major depression
MDD is more common in females than males
MDD is caused by changes in brain chemistry that may result
from stressful life events, but also from genetic or other
internal factors
MDD may occur in teens who are appear to “have it all”
MDD in teens is often expressed through physical complaints
(stomach distress, headaches)
MDD is the mental disorder most frequently associated with
suicide in both teens and adults
15
16. Bipolar Disorder
“Manic-depression” – alternating episodes of depression and
mania
Manic symptoms
Inflated self-esteem/grandiosity
Decreased need for sleep
Talking much more than usual
Flight of ideas
Distractibility
Agitated speech/movement
Involvement in risky activities
Manic symptoms last at least 1 week and cause clear social,
academic or work impairment
In many cases, manic symptoms are less severe or
“hypomanic”
16
17. Facts about
Bipolar Disorder
Bipolar disorder usually begins with depressive episode; can
lead to misdiagnosis
Bipolar disorder is less common than depression in both
teens and adults
Unlike depression, occurs as frequently in boys as in girls
Conveys especially high risk for suicide
Suicide risk highest
- during depressive rather than manic episodes
- when rapid “cycling” of manic and depressive symptoms occurs
- in “mixed” episodes (depressive and manic symptoms present at
same time)
17
18. Generalized
Anxiety Disorder (GAD)
Key characteristic of GAD is excessive, uncontrolled worry,
occurring more days than not for a period of 6 months (e.g.,
persistent worry about tests, speaking in class)
Symptoms
Restlessness/keyed up
Being easily fatigued
Muscle tension
Difficulty concentrating
Irritability
Sleep disturbances
GAD is one of many different anxiety disorders that may affect
teens – e.g., social anxiety disorder, obsessive-compulsive
disorder, panic disorder. All anxiety disorders share an
anxious, fearful mood, leading to other symptoms and
disability
18
19. Facts
about GAD
Girls are more likely than boys to have GAD
Teens who are “perfectionists” may be especially vulnerable
Severe anxiety is often part of depression in teens
Like depression, anxiety is often expressed through physical
symptoms (racing heart, shortness of breath)
Overwhelming anxiety can lead teens to feel they can’t go on
and to thinking about or planning for suicide
19
20. Substance
Use Disorders
Two main types: substance dependence and substance
abuse
Each involves maladaptive pattern of drug or alcohol use over
12 months, leading to significant impairment or distress
Symptoms of substance dependence
Increasing tolerance of the substance
Withdrawal effects when not used
Taking larger amounts, over a longer period, than intended
Persistent desire or unsuccessful efforts to cut down use
Spending considerable time obtaining, using or recovering from the
substance
Giving up activities because of the substance use
Continued use despite knowing it is causing problems
20
21. Substance
Use Disorders…
Symptoms of substance abuse
Failing to fulfill major role obligations because of substance use
Recurrent substance use in physically hazardous situations
Recurrent substance-related legal problems
Continued use despite persistent social or interpersonal problems
caused by effects of substance use
Substance dependence and abuse may exist as a single
disorder or in addition to another mental disorder, such as
major depression or an anxiety disorder
21
22. Facts about
Substance Use Disorders
Alcohol use disorders are especially common among teens,
often beginning with the desire to be part of a peer group
Although commonly used to cope with stress, depression or
anxiety, alcohol almost always worsens these problems
Other effects of alcohol and other drugs on teens
Increased irritability and anger
Relationship problems (peers and family)
Sleep disturbances
Reduced concentration and ability to cope with stress
Family conflict over substance use
Legal problems
Increased suicide risk due to decreased inhibition and increased
impulsivity
22
23. Conduct Disorder
Repetitive, persistent pattern in children or adolescents of
violating rights of others, rules or social norms; occurs over 12
months and results in significant impairment in functioning
Symptoms
Bullying/threatening others
Physical fights
Using a weapon
Physical cruelty to people
Physical cruelty to animals
Mugging, shoplifting, stealing
Forced sexual activity
Fire-setting
Destroying property
Breaking into houses/cars
Lying/conning others
Staying out all night
Running away from home
Frequent school truancy
23
24. Facts about
Conduct Disorder
Dislike of conduct-disordered youth because of their antisocial behavior may impede recognition of this serious mental
disorder
There is a strong genetic component to the aggressiveness
seen in conduct disorder
Much more frequent in boys than in girls
Frequently overlaps with AD/HD, depression and substance
use disorder
Associated with high rates of suicidal ideation, suicide
attempts and completed suicide
24
25. Eating Disorders
Two main types: anorexia nervosa and bulimia nervosa
Symptoms of anorexia nervosa
Refusal to maintain body weight at minimally normal level for age
and height
Intense fear of gaining weight
Disturbance in how body weight or shape is experienced, or denial
of low body weight
In females, delay of menarche or cessation of menstrual cycles
25
26. Eating Disorders…
Symptoms of bulimia nervosa
Recurrent episodes of uncontrollable binge eating (at least 2x per
week for 3 months)
Recurrent inappropriate behaviors to compensate for binge eating
and avoid gaining weight (e.g., vomiting, misuse of laxatives,
excessive exercise)
Self-evaluation unduly influenced by body shape and weight
Eating disorders are strongly linked to other mental disorders,
especially depression and anxiety
26
27. Facts about
Eating Disorders
Far more common among females than among males
Women aged 15-24 with an eating disorder have a suicide
rate 60 times the expected rate for young women overall
People with eating disorders tend to use particularly violent
suicide methods
Other characteristics that contribute to lethality of suicide
attempts
Typically begin between ages 13 and 20
10-20% of people with anorexia nervosa die prematurely,
often by suicide
Perfectionistic, obsessive, secretive, socially isolated
Low weight, electrolyte abnormalities
27
28. Schizophrenia
Schizophrenia is a psychotic disorder that causes people to
have difficulty interpreting reality
Two sets of symptoms- positive and negative; both are
abnormal
Positive symptoms
Delusions (fixed false beliefs, e.g., that others are controlling one’s
thoughts, or are trying to cause one harm)
Hallucinations (fixed false sensory perceptions, e.g. hearing voices,
seeing or smelling things that are not there in reality)
Disorganized or incoherent speech
Excessive, purposeless movements, or catatonic, immobile behavior
28
29. Schizophrenia…
Negative symptoms
Low energy or motivation
Lack of emotion
Difficulty expressing thoughts or elaborating responses
Difficulty integrating thoughts, feelings and behavior
Blank facial expression
Social withdrawal, isolation
Inappropriate social skills
29
30. Facts about
Schizophrenia
Affects both males and females
Typically begins to develop in very late adolescence or early
adulthood
Earlier onset in males (ages 15-25) than in females (ages 2535)
Strongly linked to genetic factors
People with schizophrenia have very high rates of suicidal
behavior
40% make one or more suicide attempts
10% die by suicide
30
31. Other Individual
Suicide Risk Factors
Impulsivity
Contributes to suicidal behavior, especially in context of depression
or bipolar disorder
Associated with dysregulated brain chemistry; may explain why some
teens with these disorders engage in suicidal behaviors while others
do not
Family History
Many mental disorders run in families, due to genetic factors
Suicide attempts and completed suicide are more frequent in teens
with a relative who has attempted or died by suicide
Prior Suicide Attempt
30-40% of teens who die by suicide have made a prior attempt
31
32. Situational Factors
that Increase Suicide Risk
Although mental disorders are the most significant cause of
suicide in teens and adults, stressful life events and other
situational factors may trigger suicidal behavior
Among teens, such factors may include
Physical and sexual abuse
Death or other trauma in the family
Persistent serious family conflict
Traumatic break-ups of romantic relationships
Trouble with the law
School failures and other major disappointments
Bullying, harassment or victimization by peers
32
33. Situational Factors…
The majority of teens who have these experiences do NOT
become suicidal
In some teens, these stressful experiences can precipitate
depression, anxiety or another mental disorder, which in turn
increases suicide risk
Mental disorders themselves can precipitate stressful life
events, such as conflict with family and peers, relationship
break-ups or school failures, which then exacerbate the
underlying illness
33
34. Situational Factors
Most Relevant to Schools
History of Physical and Sexual Abuse
Controlling for other risk factors, including individual and parental
mental disorders, risk of suicide attempt is 5x greater in adolescents
with a history of physical abuse
Risk of suicide attempt is more than 7x greater among adolescents
with a history of sexual abuse
34
35. Situational Factors…
Bullying
Common problem in schools in the U.S. and abroad
Female victims and perpetrators may be especially vulnerable
Bullying likely leads to depression in other teens, increasing suicidal
behavior
Higher rates of depression, suicidal ideation and suicidal behavior
found in both victims and perpetrators of bullying
Pre-existing depression may explain suicidal behavior in some teens
involved in bullying
35
36. Situational Factors…
Sexual Orientation and Gender Identity
GLBT youth have elevated rates of depression compared to
heterosexual/straight youth, and report more frequent suicidal
ideation and behavior
Contributing factors include family rejection, high rates of alcohol or
drug use and social ostracism and bullying by peers
Trouble with the Law
Teens with a history of problems with the law have increased risk of
suicide attempts and completed suicide
Suicide in juvenile detention and correctional facilities is 4 times
greater than in overall youth population
36
37. Situational Factors…
Exposure to Suicide
Suicide risk is increased in teens exposed to another’s suicide
Social networking websites may increase exposure among teens
Can result in suicide “clusters”
Factors increasing “suicide contagion” include romanticized or
glamorized reports of the suicide and idealization of the suicide victim
Access to Firearms
Access to firearms increases suicide risk, especially among teens
with a mental disorder
37
38. Suicide
Warning Signs
Suicide risk factors endure over some period of time, while
warning signs signal imminent suicide risk
Clearest warning signs for suicide are behaviors that indicate
the person is thinking about or planning for suicide, or is
preoccupied or obsessed with death
Looking for ways to kill oneself (e.g., searching the internet for
methods, seeking access to firearms or other means for suicide)
Talking or writing about suicide
Talking or writing about death in a way that suggests preoccupation
38
39. Barriers to
Treatment of At-Risk Teens
Many at-risk teens do not get needed treatment, including an
estimated 2/3 of those with depression
Reasons
Neither teens nor the adults who are close to them recognize
symptoms as a treatable illness
Fear of what treatment might involve
Belief that nothing can help
Perception that seeking help is a sign of weakness or failure
Feeling too embarrassed to seek help
Belief that adults aren’t receptive to teens’ mental health problems
But – depression and other mental disorders CAN be
effectively treated
39
40. Facts
about Treatment
Some depressed teens show improvement in 4-6 weeks with
structured psychotherapy alone
Most others experience significant reduction of depressive
symptoms with antidepressant medication
Supplementary interventions – exercise, yoga, breathing
exercises, changes in diet – improve mood, relieve anxiety
and reduce stress that contributes to depression
Medication is usually essential in treating severe depression,
and other serious mental disorders (bipolar disorder,
schizophrenia, etc.)
40
41. Facts about
Antidepressant Medication
Medications work by restoring brain chemistry back to normal
Since 2004, FDA warning recommends close monitoring of
youth taking antidepressants for worsening of symptoms,
suicidal thoughts or behavior and other changes
60% of teens with major depression have suicidal thoughts
prior to getting treatment; 30% have made a suicide attempt
Risks of medication must be weighed against the risks of not
effectively treating depression
Most people experience positive changes; a small percentage
show agitation and abnormal behavior that may include
increased suicidal thinking and behavior
41
42. Summary Points
about Treatment
No single approach or medication works for all teens with a
mental disorder; sometimes different ones needs to be tried
But, studies show that 80% of depressed people can be
effectively treated
Mental disorders can recur, even if effectively treated at one
point in time
On-going monitoring by a physician or mental health
professional is advised
42
43. Identifying
At-Risk Students
Most adults are not trained to recognize signs of serious
mental disorders in teens
Symptoms are often misinterpreted or attributed to
Normal adolescent mood swings
Laziness
Poor attitude
Immaturity, etc., etc. …
The film, More Than Sad: Teen Depression, is designed for
teens but also helps adults understand what depression looks
like in adolescents and recognize the warning signs that a
teen may need help
43
45. Reducing Suicide
Risk in Schools
So far, we have emphasized two key suicide prevention tasks of
school personnel:
1.
Identify students whose behavior suggests presence of a
mental disorder
2.
Take necessary steps to insure that such students are referred
to a mental health professional for evaluation and treatment,
as needed
What else can schools do?
45
46. Recommended
Actions for Schools
Educate Students about Mental Disorders
Show and discuss film, More Than Sad: Teen Depression with
students
Use lesson plan in Facilitator’s Guide
Include school-based health or mental health professional
Educate Parents about Mental Disorders and Suicide Risk
Show and discuss both More Than Sad films at parent meeting
Recommend other resources for parents listed at end of manual
46
47. Recommended Actions…
Support School Safety and Reduce Bullying
Address sanctions for bullying and related behaviors in disciplinary
policies
Initiate programs to change school culture to be inclusive and support
student diversity
Support Gun Safety Programs
Partner with law enforcement, public health and community agencies
and parents to promote proper gun storage and reduce opportunities
for unsupervised access to firearms by youth
47
48. Concluding Steps
Review Additional Resources
Complete “Test Your Knowledge”
Complete Participant Feedback Form
THANK YOU FOR TAKING THIS OPPORTUNITY
TO LEARN MORE ABOUT TEEN SUICIDE
AND HOW YOU CAN PLAY A ROLE
IN ITS PREVENTION
48
Notas del editor
{"16":"Among adolescents aged 15-19, the suicide rate for boys is more than 4 times the rate for girls (11.1 vs.2.5).\nAmong young adults aged 20-24, the suicide rate for males is almost 6 times that for females (20.9 vs. 3.9).\nThis gender difference remains throughout the adult years, with males continuing to have a suicide rate at least 4 times that for females. \n","5":"In this next graph, we can see the trends in suicide rates over the last 20 years. \nSuicide rates among the youngest group (10-14 year-olds) have remained relatively constant over this period. However, rates among older adolescents (the middle line) and young adults (the top line) have shown a number of fluctuations.\n","44":"Following the film, refer participants to the page 29 of the manual, After the Viewing: Questions to Consider. Use these questions, as time allows, to engage participants in a group discussion. At the conclusion of the discussion, review together the Summary Points on pp. 30-31, which underscore the key messages that have been conveyed so far in the program. \n","11":"Let participants know that the material discussed in the film will be covered in more detail in later sections of the program, and that it is not necessary for them to take detailed notes as they watch it. Encourage them to make note of any questions they may have so that they can make sure to get them answered following the film. \n","39":"Refer participants to manual Section 4. What Treatments Are Available? \n","6":"This graph shows a comparison between suicide rates for males between the ages of 10 and 24 – the red line - and those for females of the same ages, which are shown on the blue line.\nAt age 13, we can see that there is little difference between the suicide rate for boys and that for girls. But by age 18, the boys’ rate is 5 times higher than the girls’ rate (15 suicides per 100,000 boys vs. 3 per 100,000 girls). This difference between the sexes remains through young adulthood, peaking at age 22, when the male suicide rate is more than 6 times the female rate.\n","45":"Refer participants to manual Section 6. How Else Can Schools Decrease Risk?\n","7":"White youth and American Indians have a suicide rate a little above the national average, and the other groups shown have rates below the national average for all youth. \n","13":"The next slides (#12-#36) refer to manual Section 3. What Puts Teens at Risk for Suicide? In this section, the key risk factors for teen suicide are discussed in greater detail, focusing in particular on mental disorders that occur among adolescents. \n","2":"Refer participants to the Introduction in their manual. Note that they can follow along in the manual as you highlight the main points of each section. Encourage them to jot any additional information you will provide in the margins. (Note: the Manual is currently being updated with the 2010 statistics)\n","8":"Note that the ratio of suicide attempts to suicide deaths declines as people get older.\n","14":"Refer participants to Section 3 of the manual for more detailed descriptions of all mental disorders discussed, and urge that they follow along in their manuals as the slides are presented. \n","3":"Refer participants to Section 1. How Big a Problem is Youth Suicide? \n2010 is the latest year for which suicide statistics are available. Note to trainer: This slide can be updated by going to CDC website: http://webapp.cdc.gov/sasweb/ncipc/mortrate10_sy.html \nSuicide rate is defined as the number of suicides that occur for every 100,000 people. Overall, the U.S. suicide rate in 2010 was of 12.1 (12.0 suicides for every 100,000 people in the U.S. population).\n","31":"Mention importance of being sensitive to family history when communicating with families of teens who mat have a mental disorder. \n","48":"Distribute copies of Test Your Knowledge and the Participant Feedback Form. Collect both forms after participants have completed them. Please forward Participant Feedback Forms to AFSP at the address listed on the form. \n","4":"This graph shows suicide rates across the lifespan (note that the small numbers below the horizontal line are ages, ranging from 10 years to 85 years). \n \nWe can see that suicide rates increase more dramatically during adolescence and early adulthood than during any other stage of the life cycle. \n \nHowever, suicide rates for adolescents and young adults are clearly less than those for people in the midlife and elder age groups.\n","43":"Refer participants to manual Section 5. How Can Teachers Identify At-Risk Students? In this section, you will be showing the second film, More Than Sad: Teen Depression.\n","10":"Refer participants to manual Section 2. How Can Teachers Help Prevent Youth Suicide? In this section you will be showing the first film, More Than Sad: Preventing Teen Suicide.\n"}