Adolescent Suicide:Adolescent Suicide:Prevalence; Circumstance; Prevalence; Circumstance;

and Conditions of and Conditions of RecognitionRecognition

Barri Sky Faucett, MA

ASPEN Project Director

SUICIDESUICIDE

Intentional Self-Inflicted Intentional Self-Inflicted DeathDeath

Just the FactsJust the Facts•Every 13.7 minutes another life is lost to Every 13.7 minutes another life is lost to suicide, taking the lives of more than 38,364 suicide, taking the lives of more than 38,364 Americans every year.Americans every year.

•Every day 105.8 Americans take their own life Every day 105.8 Americans take their own life

•Suicide is now the 10th leading cause of Suicide is now the 10th leading cause of death in America; Homicide is 15death in America; Homicide is 15thth. . •For young people 15-24 years old, suicide For young people 15-24 years old, suicide is the third leading cause of death.is the third leading cause of death.

OUR YouthOUR Youth In 2010, there were 4,600 In 2010, there were 4,600

reported youth suicides in the reported youth suicides in the United States. United States.

Each day there are Each day there are approximately 12 youth suicidesapproximately 12 youth suicides

Most common method is Most common method is firearms followed by firearms followed by suffocationssuffocations

Males complete 4 times more Males complete 4 times more than females; females attempt than females; females attempt four times more than males. four times more than males.

1 out of every 53 high school 1 out of every 53 high school students (1.9 percent) students (1.9 percent) reported having made a reported having made a suicide attempt that was suicide attempt that was serious enough to be treated serious enough to be treated medically (CDC, 2010a).medically (CDC, 2010a).

Approximately 1 out of every Approximately 1 out of every 15 high school students 15 high school students attempts suicide each year attempts suicide each year (CDC, 2010a). (CDC, 2010a).

For every completed suicide, For every completed suicide, there are 100-200 attempts there are 100-200 attempts among adolescents. among adolescents.

Suicide Attempts

Suicide in AdolescentsSuicide in Adolescents Research shows that most adolescent Research shows that most adolescent

suicides occur after school hours and suicides occur after school hours and in the teen’s homesin the teen’s homes

Most adolescent suicides are Most adolescent suicides are precipitated by interpersonal conflictprecipitated by interpersonal conflict

Within a typical high school classroom, Within a typical high school classroom, it is likely that three students (one boy it is likely that three students (one boy and two girls) have made a suicide and two girls) have made a suicide attempt within the last year. attempt within the last year.

Suicide in AdolescentsSuicide in Adolescents

•Since GLS WV ranks 40Since GLS WV ranks 40thth in the nation in the nation with a rate with a rate of 8.9/100,000 vs. the national average of 10.5 (CDC 2010).

How Does WV Compare?How Does WV Compare?

WV YouthWV Youth

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

24!24!

Barbour

Berkeley

Boone

Braxton

Brooke

CabellClay

Fayette

Gilmer

Grant

Greenbrier

Hampshire

Hancock

Hardy

Harrison

Jackson

Kanawha

Lewis

Lincoln

Logan

McDowell

Marion

Mason

Mercer

Mineral

Mingo

Monongalia

Monroe

Morgan

Nicholas

Ohio

Pendleton

Pocahontas

Preston

Putnam

Raleigh

Randolph

Ritchie

Roane

Summers

Taylor

Tucker

Tyler

Upshur

Wayne

Webster

Wetzel

Wirt

Wood

Wyoming

JeffersonPleasantsDodd-ridge

Cal-houn

4 (12.26)

4 (12.56)

7 (10.81))

12 (29.79)

Marshall

10 (3.97)

5 (26.13)

4 (19.02)

2 (10.22)

3 (15.30)

4 (34.13))

2 (12.97)

2 (16.07)

3 (20.28)

7 (20.00))2 (7.78)

3 (18.15)

11 (9.89)

2 (20.60)

3 (26.51)

18 (10.32)4 (30.34)

47 (20.96))

9 (20.92)

2 (6.79)

10 (10.55)

2 (13.69)3 (8.81)

8 (20.23))

6 (9.75)

West Virginia Suicides by countyAges 15-242000-2009

Rate per 100,000 Population

WV Average Rate 13.2/100,000320 Deaths by Suicide

18.15 – 46.92

12.26 – 16.39

10.07 – 11.34

0.00 – 9.89

Suicide:

A PREVENTABLE DEATH IN OUR STATE

5 (46.92)

12 (160.5)

4 (14.53)

2 (22.25)

2 (6.68)

1 (13.19)

5 (15.89)

6 (16.39)

1 (9.88)

3 (9.01)

1 (5.34)0 (0.00)

16 (27.19)

13 (15.36)

1 (3.47)

3 (8.30)

3 (10.07)

4 (10.52)

10 (16.14)

11 (12.38)

0 (0.00)

1 (13.66)

10 (9.68)

5 (9.63)

0 (0.00)

2 (11.34)

Percentage of students who seriously considered attempting suicide during the 12 months before the

survey. (9th- 12th )

Year US WV

2011 15.8 13.0

Percentage of students who made a plan regarding how they would attempt suicide

Year US WV

2011 12.8 10.1

Percentage of students who attempted suicide one or more times during the 12 months before the survey.

Year US WV

2011 7.8 5.5

2011 West Virginia2011 West VirginiaYouth Risk Behavior SurveyYouth Risk Behavior Survey

Identity ConfusionIdentity Confusion

Erickson Developmental Stage- Erickson Developmental Stage-

Learning Identity Versus Identity Learning Identity Versus Identity Confusion (Fidelity)Confusion (Fidelity)

Learning Intimacy Versus Isolation Learning Intimacy Versus Isolation (Love)(Love)

The Teenage BrainThe Teenage Brain

Adolescence is a time of Adolescence is a time of profound brain growth.profound brain growth.

Greatest changes to the Greatest changes to the brain that are responsible brain that are responsible for impulse control, for impulse control, decision making, decision making, planning, organization, planning, organization, and emotion occur in and emotion occur in adolescence (prefrontal adolescence (prefrontal cortex). cortex).

Do not reach full maturity Do not reach full maturity until age 25. until age 25.

What do teens deal with?What do teens deal with? Increased school pressures as they progress through higher grades

Possibly first romantic relationships

Exploring increased independence and identity

Experimenting with substance use

Puberty and Hormone fluctuation

Bullying

Peer ProblemsPeer Problems

Several studies have found Several studies have found relationships between suicidal relationships between suicidal behavior and social isolation, behavior and social isolation, sexual orientation, and peer sexual orientation, and peer rejection.rejection.

70% of suicide completions 70% of suicide completions and attempts occur following and attempts occur following the loss or conflict with family the loss or conflict with family and peers. and peers.

Lesbian, Gay, and Bisexual Lesbian, Gay, and Bisexual youth are 1 ½ - 7 times more youth are 1 ½ - 7 times more likely to have reported ideation.likely to have reported ideation.

LGB Youth in multiple studies LGB Youth in multiple studies are found to be 3-4 times more are found to be 3-4 times more likely to attempt suicide. likely to attempt suicide.

58% of LGB youth who had 58% of LGB youth who had attempted suicide reported they attempted suicide reported they really hoped to die vs. 33% of really hoped to die vs. 33% of heterosexuals who attempted heterosexuals who attempted and reported really hoping to and reported really hoping to die. die.

Have elevated risk factors and Have elevated risk factors and lower protective factorslower protective factors

Sexual IdentificationSexual Identification

Bullying: 3 defining characteristics:

1.Intentional—behavior is deliberately harmful or threatening

2. Repeated—a bully targets the same victim again and again

3 .Power Imbalanced—a bully chooses victims he or she perceives as vulnerable

YRBHS, 2011 (9YRBHS, 2011 (9thth-12-12thth))

Percentage of students who reported being bullied on school property

Year US WV

2011 20.1 18.6

Percentage of students who have ever been electronically bullied.

Year US WV

2011 16.2 15.5

Percentage of students felt sad or hopeless for greater than 2 weeks so that they stopped some

general activities.

Year US WV

2011 28.5 24.5

CyberspaceCyberspace

CYBERSPACE is the new environment where "

youth are forming communities.

Cyber bullyingCyber bullying

93% of teens ages 12-17 are on the Internet.

75% of teens own a cell phone.

A typical teen sends about >100 text messages a day.

Most teen cell phone users make just 1-5 calls per day.

82% of online teens ages 14-17 are on social network sites

What makes Cyberbullying What makes Cyberbullying different?different?

DistanceDistance 24/724/7 Multiple methodsMultiple methods

Text messages; Text messages; video clips; video clips; Websites; Social Websites; Social Media; IM; Emails; Media; IM; Emails; Chat roomsChat rooms

AnonymousAnonymous Expanded AudienceExpanded Audience

Bullying effectsBullying effects Withdraws socially; has few or no Withdraws socially; has few or no

friends.friends. Feels isolated, alone, and sad.Feels isolated, alone, and sad. Feels picked on or persecuted. Feels picked on or persecuted. Feels rejected and not liked.Feels rejected and not liked. Complains frequently of illness.Complains frequently of illness. Doesn’t want to go to school; Doesn’t want to go to school;

avoids some classes or skips avoids some classes or skips school.school.

Brings home damaged Brings home damaged possessions or reports them “lost.” possessions or reports them “lost.”

Cries easily; displays mood Cries easily; displays mood swings and talks about swings and talks about hopelessness. Has poor social hopelessness. Has poor social skills.skills.

Talks about running away/suicide. Talks about running away/suicide.

Bullying risks for suicide:Bullying risks for suicide:

Verbal Verbal PhysicalPhysical RelationalRelational

Both victims and perpetrators of bullying are at a higher risk for suicide than their peers. Children who are both victims and perpetrators of bullying are at the highest risk

One study found that victims of cyberbullying had higher levels of depression than victims of face-to-face bullying

Bullying and SuicideBullying and Suicide

BillyBilly PhoebePhoebe HopeHope MeganMegan

SUICIDE: Myth or FactSUICIDE: Myth or Fact

Confronting a person about suicide will only make Confronting a person about suicide will only make them angry and increase the risk of suicidethem angry and increase the risk of suicide..

• Asking someone directly about suicidal intent Asking someone directly about suicidal intent lowers anxiety, opens up communication and lowers anxiety, opens up communication and lowers the risk of an impulsive act lowers the risk of an impulsive act

Myth or FactMyth or Fact

•Those who talk about suicide Those who talk about suicide don’t do don’t do it.it.

• People who talk about People who talk about suicide may suicide may

try, or even complete, an act try, or even complete, an act of of self-destruction.self-destruction.

Myth or FactMyth or Fact

•If a suicidal youth tells a friend, If a suicidal youth tells a friend, the the friend will access help.friend will access help.

•Most young people do not tell Most young people do not tell an an adultadult

•Risk Factors- characteristics that will may it more likely that an individual will consider, attempt, or die by suicide

•Warning Signs- behaviors that indicate signs of immediate risk

•Protective Factors- characteristics that make it less likely that individuals will consider, attempt, or die by suicide.

SUICIDE- Risk Factors, Warning Signs, Protective

Factors

Risk Factors- IS PATH WARM

IdeationIdeation Substance AbuseSubstance Abuse PurposelessnessPurposelessness AnxietyAnxiety TrappedTrapped HopelessnessHopelessness WithdrawalWithdrawal AngerAnger RecklessnessRecklessness Mood ChangesMood Changes

Problems that increase Suicide RiskProblems that increase Suicide Risk

Prior suicide attemptsPrior suicide attempts Mental health disordersMental health disorders History of trauma or abuseHistory of trauma or abuse Family history of suicideFamily history of suicide Lack of social supportLack of social support

•Major physical illnesses

•Losses

•Bullying

•Easy access to lethal means

•Local clusters of suicide

Situations that increase suicide riskSituations that increase suicide risk

Firearms are used in 58% Firearms are used in 58% of successful suicidesof successful suicides

The rate of completed The rate of completed suicides is fives times suicides is fives times higher in houses with higher in houses with firearms. firearms.

Firearms are even more Firearms are even more prevalent in suicides prevalent in suicides involving alcohol. involving alcohol.

65% of WV homes have 65% of WV homes have firearms.firearms.

Access to means

Acquiring a gun or stockpiling pillsAcquiring a gun or stockpiling pills Talking about wanting to die or kill Talking about wanting to die or kill

oneselfoneself Impulsivity/increased risk takingImpulsivity/increased risk taking Giving away prized possessionsGiving away prized possessions Self-destructive acts (i.e., cutting)Self-destructive acts (i.e., cutting) Increased drug or alcohol abuseIncreased drug or alcohol abuse Talking about no reason to liveTalking about no reason to live

Warning Signs:Warning Signs:

Protective FactorsProtective Factors •Treatment for MH/SA, physical disorders

•Increased access to interventions

•Restricted access to highly lethal means

•Strong connections to family and community support

•Strong problem-solving and conflict resolution skills

•Cultural and religious beliefs that discourage suicide and support self-preservation.

““I’m tired of life, I just can’t go on.”I’m tired of life, I just can’t go on.” ““My family would be better off without My family would be better off without

me.”me.” ““Who cares if I’m dead anyway.”Who cares if I’m dead anyway.” ““I just want out.”I just want out.” ““I won’t be around much longer.”I won’t be around much longer.” ““Pretty soon you won’t have to worry Pretty soon you won’t have to worry

aboutabout me.” me.”

Indirect or “Coded” Verbal Indirect or “Coded” Verbal Clues:Clues:

What to Do for the IndividualWhat to Do for the Individual

Take it seriouslyTake it seriously Almost 80% of all suicides had Almost 80% of all suicides had

given some warning of their given some warning of their intentionsintentions

Ask DirectlyAsk DirectlyIf you think that someone is If you think that someone is

suicidal, ask them about itsuicidal, ask them about it

If in doubt, don’t wait, ask the question If the person is reluctant, be persistent Talk to the person alone in a private setting Allow the person to talk freely Give yourself plenty of time Have your resources handy; QPR Card, phone numbers,

counselor’s name and any other information that might help

Remember: How you ask the question is less important than that you ask it

Tips for Asking the QuestionTips for Asking the Question

What to do – Be GenuineWhat to do – Be Genuine

Be Genuine Be Genuine •Listen and don’t show shock or Listen and don’t show shock or disapprovaldisapproval

•Show that you care, it is more Show that you care, it is more important important than saying “the right thing.”than saying “the right thing.”

•Avoid trying to explain away the Avoid trying to explain away the feelings…(saying things like “you have feelings…(saying things like “you have a lot to live for” or “you are just a lot to live for” or “you are just confused right now”)confused right now”)

What to Do What to Do

Stay ThereStay There Don’t leave them alone. Don’t leave them alone.

Seek HelpSeek Help -Be actively -Be actively involved in seeking involved in seeking professional helpprofessional help

Plan for SafetyPlan for Safety

KEEP SAFE AgreementKEEP SAFE Agreement Safety Contact (s)Safety Contact (s) Safe/no use of alcohol Safe/no use of alcohol

and drugsand drugs Link to resourcesLink to resources Disable the suicide planDisable the suicide plan Link to servicesLink to services Plan for LifePlan for Life

Potential Assessments

Patient Health Questionnaire Modified for Patient Health Questionnaire Modified for Teens (PHQ-9 Modified)Teens (PHQ-9 Modified) 12-18 years of age12-18 years of age Less than five minutes to complete and scoreLess than five minutes to complete and score

Adolescent Suicide Assessment Protocol Adolescent Suicide Assessment Protocol (ASAP-20)(ASAP-20) Semi- structured clinical interviewSemi- structured clinical interview Addresses 20 items associated with suicide Addresses 20 items associated with suicide

riskrisk

OfferingsOfferings SOS Curriculums/ASPEN Workshop for StudentsSOS Curriculums/ASPEN Workshop for Students

Evidence-Based Middle School and High School Evidence-Based Middle School and High School programsprograms

Brief Introductory TrainingBrief Introductory Training 25 minute Video25 minute Video Guided DiscussionGuided Discussion Screening InstrumentScreening Instrument

Jason Foundation KitsJason Foundation Kits Orientation towards suicide preventionOrientation towards suicide prevention ASK CARE TELL cards for studentsASK CARE TELL cards for students

ASPEN Offerings cont.ASPEN Offerings cont. ASPEN Presentation for your schools:ASPEN Presentation for your schools:

Presentation- 35 minutes workshop for studentsPresentation- 35 minutes workshop for students Video Viewing- 13 minute movie regarding adolescent Video Viewing- 13 minute movie regarding adolescent

suicide suicide Depression Screening- with active parental consentDepression Screening- with active parental consent ASAP-20 Follow-up for at-risk youthASAP-20 Follow-up for at-risk youth

Postvention services:Postvention services: Response support to school systemsResponse support to school systems Sudden Traumatic Loss Toolkit Sudden Traumatic Loss Toolkit

Trainings Trainings Awareness and QPRAwareness and QPR

Adolescent Suicide Adolescent Suicide Assessment Protocol Assessment Protocol

(ASAP-20)(ASAP-20)

PCP Toolkit TrainingPCP Toolkit Training

Implementation of Suicide Implementation of Suicide Prevention ToolkitPrevention Toolkit

Applied Suicide Intervention Applied Suicide Intervention Support Training (ASIST)Support Training (ASIST)

www.suicidology.org www.sprc.org www.afsp.org www.spanusa.org www.wvaspen.com www.wvsuicidecouncil.org www.jasonfoundation.org www.jedfoundation.org

For More InformationFor More Information

WV ContactsWV Contacts

Bob MusickBob MusickExecutive DirectorExecutive Director

WV Council for the Prevention WV Council for the Prevention of Suicideof Suicide

(304) 296-1731(304) 296-1731bmusick@valleyhealthcare.orgbmusick@valleyhealthcare.org

Barri Faucett, MABarri Faucett, MAProject DirectorProject Director

(304)-341-0511 ext 1691(304)-341-0511 ext 1691 (304)-415-5787(304)-415-5787

barri.faucett@prestera.orgbarri.faucett@prestera.org