Upload
nizana
View
41
Download
0
Tags:
Embed Size (px)
DESCRIPTION
STOP Suicide DC Department of Mental Health. Julie Goldstein Grumet, PhD Project Director. SAMHSA Grants. Linking Adolescents at Risk of Suicide to Mental Health Services: 2005-2009 State/Tribal Youth Suicide Prevention Grant: 2009-2012. Facts and Statistics. - PowerPoint PPT Presentation
Citation preview
STOP Suicide DC Department of Mental Health
Julie Goldstein Grumet, PhD
Project Director
SAMHSA Grants
Linking Adolescents at Risk of Suicide to Mental Health Services: 2005-2009
State/Tribal Youth Suicide Prevention Grant: 2009-2012
Facts and Statistics Suicide accounts for 13% of all adolescent deaths Most suicides result from
untreated depression 3rd leading cause of death for
youth (15-24 years) 1 in 5 teens seriously consider
suicide For every suicide, 6-8 peoples’
lives impacted GLBT individuals 3x more likely
to attempt
Risk Factors for Youth Suicide
Strongest Predictors Previous suicide attempt Current talk of suicide/making a plan Strong wish to die/preoccupied with
death(i.e., thoughts, music, reading) Depression (hopelessness, withdrawal) Substance use Recent attempt by friend or family
member
Being expelled from school /fired from job Family problems/alienation Loss of any major relationship Death of a friend or family member,
especially if by suicide Diagnosis of a serious or terminal illness Financial problems (either their own or
within the family) Sudden loss of freedom/fear of punishment Feeling embarrassed or humiliated in front
of peers Victim of assault or bullying
Other Risk Factors
Warning Signs Threatening suicide Getting a gun or stockpiling pills – accessing
means Purposeless – no reasons for living Anxiety or agitation Impulsivity/increased risk taking Insomnia Unexplained anger, aggression, irritability Substance abuse – excessive or increased Hopelessness Withdrawal from friends/family/society Recklessness – risky acts/unthinking Mood changes
“STOP” (School-Based Teen Outreach
Program) for Suicide: Goals
Increase number of adolescents identified as at risk and assessed for suicide
Enhance ability of mental health providers to identify and assess for risk of suicide
Improve coordination of care provided to students at risk for suicide and families
Improve family/caregiver education and access to MH services
STOP Suicide Project: Components
Screening for students Columbia University TeenScreen
Teacher/Staff/Parent Gatekeeper Training
Question, Persuade, Refer (QPR) Gatekeeper Training
Classroom based prevention program
Signs of Suicide (SOS)
DC Public Schools
Approximately 70,000 youth under age 18 in DC Approximately 20,000 youth enrolled in public middle
schools and high schools (does not include charter) 79% African American; 12% Hispanic; 7% Caucasian 68% graduation rate 19% truancy rate 70% free and reduced lunch 49% passed DC CAS for elementary reading and math
(DC CAS); 40% passed secondary math; 41% passed secondary reading (taken in Grades 3-8 and 10)
D.C. Suicide Statistics 16th leading cause of death for residents 18 youth suicides between 2000-2008 (age
11-24) (OCME)
Lowest suicide rate in country
But so many risk factors!
Risk FactorsD.C. exceeds national average for: Childhood death rate Youth under 18 whose parents do not have full time jobs Youth living in a single parent household Youth who live in poverty Youth dropout Violent crime is three times national average 3% residents have HIV 3rd highest jurisdiction for abuse/neglect High gang involvement
(Sources: Annie E. Casey Foundation, 2008; Children’s Bureau of the Administration on Child, Youth, and Families, 2004; FBI, 2003; HIV Office of the Department of Health, 2009)
The Youth Risk Behavior Survey (High School Youth) (CDC, 2007)
In the past 12 months (In D.C.) 29% felt sad or hopeless for 2 weeks (27%) 15% have seriously considered suicide (15%) 11% have made a plan (12%) 7% have made an attempt (12%)* 2% required emergency room care (4%)
Youth Risk Behavior Survey (Middle School Youth) (DCPS, 2007)
24% report suicidal ideation 13% made a plan 13% tried to kill themselves
DMH TeenScreen Program 2005-2008 Public and public charter schools Primarily screened in schools with DMH School
Mental Health Clinician (we are in approx. 58 schools)
Staff included Project Director/PI; Evaluator; Case Manager (for one year)
6th – 12th graders Active consent
DC DMH TeenScreen 22 screening days (2005-2008) 13 middle schools; 9 high schools Approximately 5700 consent forms distributed 1021 returned (18%) (range of 4% to 95%) 96 (9%) parents refused consent 34 (3%) youth refused assent on day of screen 126 (12%) absent or sick on screening days 786 youth screened total
A Word About Consent Handed out at Back-to-School Night, in class
multiple times Youth distributed consents Teachers called homes $5 gift cards to Target; movie passes, $5 gift card
to McDonald’s, Washington Wizards tickets, extra credit
Received greater percentage of consents when targeted smaller groups (one class, one teacher, one grade)
Consent was opt in or opt out Youth who were absent were not screened – letter
sent home 23% youth report never receiving the consent
form (though this isn’t possible) Town Hall Forums
Demographics 2/3 High School; 1/3 Middle School 60% Female; 40% Male 66% African American; 27% Latino; 7%
Other More 9th and 12th graders
Demographic Characteristics of Youth Overall and for Youth Who Screened Positive for any Mental Health Issue Using TeenScreen All Youth
Screened Positively Screened Youth-Total
High School Overall
Positive High School
Middle School Overall
Positive Middle School
Total 786 37% (N=293)
503 35% (N=178)
283 41% (N=115)
Race Black
66% (N=516)
64% (N=188)
61% (N=309)
60% (N=106)
73% (N=208) 70% (N=80)
Latino
27% (N=212)
26% (N=75) 31% (N=158)
31% (N=55) 19% (N=53) 17% (N=20)
Other or Mixed
7% (N=58) 10% (N=30) 7% (N=36) 10% (N=17) 8% (N=22) 13% (N=15)
Gender Male 40%
(N=313) 32% (N=95) 37%
(N=186) 30% (N=54) 45% (N=127) 36% (N=41)
Female 60% (N=473)
68% (N=198)
63% (N=317)
70% (N=124)
55% (N=156) 64% (N=74)
Grade 6 9% (N=71) 9% (N=25) N/A N/A 25% (N=71) 22% (N=25) 7 12% (N=95) 16% (N=47) N/A N/A 34% (N=95) 41% (N=47) 8 15%
(N=116) 15% (N=43) N/A N/A 41% (N=117) 37% (N=43)
9 20% (N=160)
18% (N=53) 32% (N=160)
30% (N=53) N/A N/A
10 14% (N=112)
14% (N=41) 22% (N=112)
23% (N=41) N/A N/A
11 12% (N=91) 11% (N=32) 18% (N=91) 18% (N=32) N/A N/A 12 18%
(N=140) 18% (N=52) 28%
(N=140) 29% (N=52) N/A N/A
Results 37% youth screened positive overall 13% report thoughts of killing themselves in past
three months 10% report making a suicide attempt 6% unhappy or sad in last three months 10% irritable or in bad mood 1-2% anxious, withdrawn, substance abuse issues
Results for High School Youth (N=503)
35% HS youth screened positive
All HS youth: 10% reported suicidal ideation 11% reported a previous attempt 19% bad or very bad problem with anger 12% reported feeling unhappy or sad Less than 1% reported problems with drugs or alcohol
Of those who screened positive for anything: Anger and depression two biggest issues (41% and
30%, respectively)
Results for Middle School Youth (N=283)
41% of MS youth screened positive
All MS youth: 17% reported suicidal ideation 8% reported making a suicide attempt 14% reported feeling unhappy or sad 25% reported anger/irritability 1% problems with substances
Of those who screened positive for anything: Anger and depression also biggest issues (48% and 31%) 17% reported anxiety 14% reported problems with friends
Results of TeenScreen for All Youth
0
0.05
0.1
0.15
0.2
0.25
Anxiou
s
With
draw
n
Depre
ssed
Anger
Subst
ance
Abu
se
Friend
Tro
uble
s
Suicid
al Tho
ught
s
Suicid
e Atte
mpt
Symptom* N=786
Pe
rce
nta
ge Male
Female
HSMS
Risk Factors for Current Suicidal Ideation in an Urban Population*
HS Youth with Suicidal Ideation 47% made a previous attempt 47% problems with depression
or anger 24% problems with anxiety 12% troubles with friendship 8% withdrawing from others 6% substance abuse
MS Youth with Suicidal Ideation 34% made a previous attempt 51% feel depressed 72% report problems with
anger 32% problems with anxiety 24% have difficulties with
friends 28% withdrawing from others 7% drug or alcohol problems
*small N
Comorbid Mental Health Issues in High School Youth Who Report Suicide Ideation or History of a Suicide Attempt Using TeenScreen
0
0.050.1
0.15
0.2
0.250.3
0.35
0.40.45
0.5
Anxiou
s
With
drawn
Depre
ssed
Anger
Substa
nce A
buse
Friend
Tro
ubles
Symptom* N=70
Per
cen
tag
e
Suicidal Ideation
Suicide Attempt
Comorbid Mental Health Issues in Middle School Youth Who Report Suicidal Ideation or History of a Suicide Attempt Using TeenScreen
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Anxiou
s
With
drawn
Depre
ssed
Anger
Substa
nce A
buse
Friend
Tro
ubles
Symptom* N=38
Per
cen
tag
e
Suicidal Ideation
Suicide Attempt
So Who is at Risk? Anger is a huge risk factor followed by depression Substance abuse is not endorsed by this population Previous attempt is a risk factor for current suicidality MS youth with current ideation seem to be more
socially isolated HS girls 136% more likely than HS boys to report
suicidality (OR=2.36, CI=1.35; 4.13, p<.05)
Girls more likely than boys to endorse any suicidal behaviors
Greater percentage of MS youth report suicidal thoughts Greater percentage of HS youth report attempts
A Word About Attempts Most were not objectively “lethal” Impulsive Issues with self-report: Youth reported more than
just past three months Most had never told anyone before
Suicide Among Urban Youth Lack of appropriate coping skills Depression likely exhibited as a behavioral issue Lack of access to treatment No diagnosis Long waiting lists Inability of caregivers/pediatricians/teachers to
recognize Minimization/Stigma
Referrals33% needed a referral; 5% needed no referral2% immediate evaluation to hospital/private provider
Where did they go? 47% to SMHP 23% to other school personnel 20% to outpatient providers 2% to other services
Did they go? 52% kept one appointment after one month post-screen 68% kept one appointment by six months post-screen
Parent Satisfaction Surveys Attempted to contact all parents
of positively screened youth 17% (N=43) took survey;
received gift card 81% felt consent form was easy
to understand 79% would recommend
screening to others On average, youth met with
counselor 3 times (range 1-15; mode=2)
Parent Identified Components that Assisted with the Linkage
Benefits to providing school-based suicide prevention screening and treatment
Emotional issues greatly interfere with academic success
Prevention programs – find them early!
Youth have often never told anyone before
Helps to raise awareness/reduce stigma
Parents more likely to follow through – youth get the services
Challenges to Implementing School-based Suicide Prevention Program
Lack of parental consent School activities/access to youth can change quickly – field
trips, class or school wide tests, fire drills, absent youth, substitute teachers, hall walkers
Hard to get in touch with some parents post-screening Parents minimize the results Youth minimize the results Lack of appropriate staff to administer, follow up Lack of good local referral sites – school personnel
inundated Long waiting periods screening to treatment Language barriers Principals don’t want to endorse screening; prevention
more palatable
Recent Publications Brown, M. and Goldstein Grumet, J. (April 2009). School
based suicide prevention with African American youth in an urban setting. Professional Psychology: Research and Practice, (40) 2, 111-117.
Helpful websites www.suicidology.org
(American Association of Suicidology) www.mentalhealth.org/suicideprevention
(National Strategy on Suicide Prevention) www.sprc.org
(Suicide Prevention Resource Center) www.QPRinstitute.org
(QPR Gatekeeper Training) www.teenscreen.org
(Columbia University TeenScreen Project)