Teen Suicide: Strategies for Prevention

Teen Suicide: Strategies for Prevention Melissa Schiff, MD, MPH University of Washington MCH Program Harborview Injury Prevention and Research Center Seattle, Washington Maternal and Child Public Health Leadership Training Program School of Public Health University of Washington

Story of a Teen Suicide ML, a 16 year old boy, had recently moved to a new city and started a new school. ML had a hard time making new friends and had experienced some bullying at the new school. One Friday night, ML took out his father’s handgun and shot himself in the head.

Question Using the chat feature, type in what you think is the single most common risk factor for teen suicide?

Scope of Suicide Problem Risk Factors Prevention Strategies Treatment for Depression Outline

10 Leading Causes of Death by Age Group,United States – 2006

Teen Suicide Problem * Per 100,000 CDC, WISQARS

Teen Suicide Rates for Region 10 Rate / 100,000 CDC, WISQARS

Suicide rates for ages 10+ years by County, 2000-2006 CDC, NCIPC

Poll • What do you think is the most common method used in fatal suicide attempts? A. Hand guns B. Falls C. Suffocation D. Poisoning

Percentage of Self-Harm Injuries, by Age Group, Disposition, and Mechanism, United States, 2002-2006 CDC, NCIPC

Poll • Which gender is more likely to have fatal suicides? A. Male B. Female

Suicide Rates* Among Persons Ages 10-24 Years, by Race/Ethnicity and Sex, United States, 2002-2006

Risk Factors • History of psychiatric disorders (90%), especially depression (50%) • Hopelessness • Impulsiveness, aggression • High emotional reactivity • Alcohol, substance abuse • Child maltreatment

Risk Factors • Threats or actual physical violence – peer victimization • Sexual orientation • Parental separation, divorce, discord • Prior suicide attempt, family history of suicide

Risk Factors • Access to lethal suicide methods – firearms, ammunition • Local epidemics of suicide

Percentage* of U.S. High School Students Reporting Considering, Planning, or Attempting Suicide in the Past 12 Months, by Sex, United States, 2007 Youth Risk Behavior Survey

YRBSS Data on Youth Suicide

Early case finding Community assets development Crisis hotlines Early parental pathology detection Emetic products Treatment compliance Non-pharmacological care No-suicide contracts Peer counseling Population-based screening Restricting dispensing quantities School awareness curriculum Substitute less toxic medications Surrogate roles models Teen Suicide Prevention Strategies

How to evaluate if prevention strategies effective? • Injury Prevention & Child Death Review teams (WA) • Review existing studies • Evidence-based suicide prevention strategies • Suicide Prevention Resource Center • Evidence-Based Practices Project

Teen Suicide Prevention Strategies • 22 strategies reviewed • Panel of experts • Rate study design • Make recommendations on evidence • 3 strategies recommended

Teen Suicide Prevention Strategies • 1 strategy appears harmful

Effective Prevention Strategies • Skills Training • Assessment and Referral Training • Media Guidelines

Skills Training • Youth at risk of school failure, suicide, history of abuse • Development of skills • Interpersonal problem solving skills • Coping skills • Cognitive skills • Social support

Skills Training • Reduce suicide risk factors • Outcomes evaluated by randomized controlled trials • Depression • Drug abuse • Attempted and completed suicides • Active intervention increased protective factors

Assessment and Referral Training • 75% family, pediatric physicians treat childhood depression • Few receive adequate training • Less than half screen for suicide risk • Providers should be trained in assessment and referral for depressed patients

Assessment and Referral Training • Training workshops for physicians • Depression recognition, treatment • Identification of suicidal patients • Improved treatment for depression; decreased suicide rates • Effects on provider education decrease over time • Additional studies in youth population needed

Media Guidelines • “Suicide contagion” - media coverage of suicide events • Austria 1984-1987 - suicide deaths from subway trains • 1987 campaign • Subway suicides and non-fatal attempts declined by 80%

Media Guidelines • Increase in suicide related to: • Increase in number of suicide stories • Particular death reported at length, multiple stories • Front page, broadcast coverage • Dramatic headlines

Media Guidelines Describe Treatment Sources, Advances Avoid romanticizing suicide Story Recommendations: Trends, Myths, Warning Signs Present Balanced Life Picture + & -

Poll Poll • Have any of your organizations worked with media on suicide reporting? A. Yes B. No

Potentially Harmful Strategy Suicide awareness curriculum at schools • Teens to identify peers at-risk • Increase awareness, disclosure of suicidal behavior • Less mental health referral by peers • Negative reactions among those with history of suicide attempt

Treatment of Depression / Suicidality • Few studies of interventions to reduce suicidal ideation, behaviors • Medications (SSRIs) • Antidepressants reduce suicidal ideation and depression • FDA restrictions on antidepressants for youth

Treatment of Depression / Suicidality • Psychotherapy in teens • Interpersonal therapy • Cognitive behavioral therapy • Reduces depression symptoms • Limitations of studies of therapy

Conclusions • Youth suicide rates mostly unchanged • Well-defined risk factors • Several suicide prevention strategies proven effective • Suicide awareness curriculum harmful • Additional strategies likely effective – more study needed

References • Gould MS. J Am Acad Child Adolesc Psychiatry 2003;42:386-405 (Prevention strategy review) • Mann JJ. JAMA 2005;294:2064-2074 (Prevention strategy review) • Williams SB. Pediatrics 2009;123:e716-3 (Treatment for depression in youth)

References • Suicide Prevention Resource Center EBBP http://www.sprc.org/featured_resources/bpr/ebpp.asp

Open Discussion What Suicide Prevention Strategies do You Use in Your Agency?

Teen Suicide: Strategies for Prevention