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Suicidal Behavior in Adolescence

Suicidal Behavior in Adolescence. Completed Suicide: Rates/100,000 (N) by Gender & Ethnicity, Ages 15-19, 2003. U.S. Suicide Rates per 100,000 1990-2003, ages 15-24. Suicide rates by age group and sex United States, 1997. Source: Natl. Center for Health Statistics. International Comparisons.

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Suicidal Behavior in Adolescence

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  1. Suicidal Behavior in Adolescence

  2. Completed Suicide: Rates/100,000 (N) by Gender & Ethnicity, Ages 15-19, 2003

  3. U.S. Suicide Rates per 100,0001990-2003, ages 15-24

  4. Suicide rates by age group and sexUnited States, 1997 Source: Natl. Center for Health Statistics

  5. International Comparisons • Age 14 & under, US rate > 2x higher than other industrialized nations • Age 15-24, compared with 47 other nations, US rate at ~66th %ile. • Some nations, suicide rate is flat across age groups– Australia, Canada, Ireland, Costa Rica (i.e., does not increase with age).

  6. International Rates, C’t’d • Males with highest rates • in Russia 53.7/100,000, Lithuania (48.6), New Zealand (44.1) • Females with highest rates • Cuba 17.9, New Zealand 12.3, Singapore 11.6, Finland 8.4 • Greatest increases in suicide rates: • Males: 154% in Ireland, 95% New Zealand, 87% Northern Ireland, • Females: N. Ireland 213%, Israel 175%, , Norway 91% • Greatest Decreases: • Males: 45% Japan, 38% Czechoslovakia & Israel • Females: Denmark 87%, Costa Rica 65%, Japan 40%.

  7. Variation in US States (ages 10-19) • Alaska 20.74/100,000 • Wyoming, S. Dakota, Idaho, New Mexico, Montana, ranged from 9-12/100,000 • New Jersey, California, New York, Mass, 2-3/100,000 • Why?? • Population density/ social isolation • Rural states more poor • Lower access to mental health services

  8. Can We Predict Suicide? • No. • Why Not? • Low base rates (e.g., ages 15-19 in US, approx. 1,700 suicides, of pop. = 20 million). • Too many ‘false positives’ and ‘false negatives’ • But, we have identified risk factors which help to place youth into ‘risk zones’ • What we can do is assess risk in a reasonable, reliable, consistent manner, and document thoroughly

  9. Risk Factors, Predisposing Factors (Percentages) • Ethnic / racial differences: Females, 2003

  10. Risk Factors: Predisposing Factors • Ethnic / racial differences: Males, 2003

  11. Rates by Grade: Females, 2003

  12. Rates by Grade: Males, 2003

  13. Overlap of Suicide Attempts and Completed Suicide • Gender breakdown differs • Methods used differ • Most common method for completers: firearms, second most common = strangulation • For attempters, most common = self-poisoning • Considerable overlap for psychopathology, family history of psychopathology, precipitating events • Roughly one-third to one-half of completed suicides have made a previous attempt

  14. Presenting Symptoms • Psychiatric disorder present in 80-90% of youth suicides

  15. Symptoms, continued… • Depression • Depressed mood, plus other symptoms on “Student Interview Worksheet” • Irritable/grouchy mood • Hopelessness • Mania (Unusually happy/excited, energetic, sure of self for week or more) • Panic Attacks • Anger / agitation / impulsivity • Self report: of urgent emotion and need for relief; feeling out of control? If yes, how did you cope deal with that? • Objective: arguments, physical fights, risky behavior

  16. Risk Factors: Predisposing Factors 2 • Parental Psychopathology • Youth history of suicidal behavior • History of physical/sexual abuse, family violence, harsh discipline

  17. Risk Factors: Precipitant Stress • Recent significant loss • Major academic failure • Significant relationship conflict with family, friends, romantic partner • Unsolvable impasse

  18. Interpersonal Functions of Emotions in Suicidal Behavior • Poor family communication: • Avoid direct communication, including communication of emotions (Richman, Orbach, Pfeffer) • Use more indirect , avoidant actions (looks, gestures, walking out, ignoring). • Unexpressed hostility (Pfeffer 81). • Suicidal act is a desperate attempt to communicate

  19. Interpersonal Factors, Ctd. • Scapegoating: The “Expendable Child” (Sabbath,’69). • Parents perceive child as threat to their well-being, and wish (perhaps unconsciously) to be rid of child or for him/her to die. Child thus feels rejected and expendable. • Scapegoating: Parental Rejection: (e,g, Richman, Orbach, others) • One child (or other family member) must die, or fail, to ensure the success of other(s). • Parental rejection internalized by child, becomes self hatred. Child feels burdensome, or that s/he has no right to live.

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