Self-Destructive Behaviors: Definitions & Rates

1. _______________ Self-Destructive Behaviors:Definitions & Rates _______________ Prof. Matthew K. Nock

2. Public Health Context _______________

3. Suicide Rates (per 100,000) by Country: WHO 2005

4. Suicide Rates (per 100,000) by Country: WHO 2005

8. U.S. Suicide Rate by Age, Gender & Race _______________

9. U.S. Suicide Rate by Age, Gender & Race _______________

10. U.S. Suicide Rate by Age & Sex Over Time _______________

11. U.S. Suicide Rate by Region _______________

12. U.S. Suicide Rate by Age, Gender & Race _______________

13. U.S. Suicide Rate by Age, Gender & Race _______________

14. U.S. Suicide Rate by Age, Gender & Race _______________

15. U.S. Suicide Rate by Age, Gender & Race _______________

16. U.S. Suicide Rate by Method & Gender _______________

17. Death Rates of U.S. Youth _______________

18. Suicide Rates by Month _______________

19. Current Context _______________ • Suicide & NSSI are very difficult to predict & prevent

20. Classifying Self-Injurious Thoughts and Behaviors _______________ • Common terms: “suicidality” …“deliberate self-harm”… “parasuicide”… • More specific terms and definitions: • Suicide ideation: thoughts of intentionally ending one’s own life • Suicide plan: selection of method with some intent to act in the future • Suicide attempt: self-injurious behavior with intent to die • Non-suicidal self-injury (NSSI): self-injury with no intent to die Nock & Kessler (2006) J Abnormal Psychology Nock & Kazdin (2002) J Clinical Child & Adolescent Psychology

21. Epidemiology of Suicidal Outcomes _______________ • What is the prevalence of suicide ideation, plans, and attempts? • What are the onset, course, and risk factors?

22. Epidemiology of Suicidal Outcomes _______________ * * * * * * * * * * * * * * * * * * * * * * * * * *

23. Epidemiology of Suicidal Outcomes _______________ • What is the prevalence of suicide ideation, plans, and attempts? • What are the onset, course, and risk factors? • WHO World Mental Health Survey Initiative (Kessler et al): nationally representative survey in 28 countries (N ~ 250,000) Prevalence Estimate Range Suicide Ideation 9.2% (3.1China - 15.9New Zealand) Suicide Plan 3.1% (0.7Italy - 5.6New Zealand) Suicide Attempt 2.7% (0.9Italy - 5.0USA) N = 84,850; 17 Countries Nock et al. (2008). British Journal of Psychiatry

24. Epidemiology of Suicidal Outcomes _______________ • Although variability in prevalence of suicidal outcomes, there is consistency in: • Age-of-onset (AOO) of suicidal outcomes Nock et al. (2008). British Journal of Psychiatry

25. Epidemiology of Suicidal Outcomes _______________ Nock et al. (2008). British Journal of Psychiatry

26. Epidemiology of Suicidal Outcomes _______________ • Although variability in prevalence of suicidal outcomes, there is consistency in: • Age-of-onset (AOO) of suicidal outcomes • Conditional probabilities of transition from ideation to plans (33.6%) and attempts (29.0%) • Speed of transition from ideation to plans and attempts Nock et al. (2008). British Journal of Psychiatry

27. Epidemiology of Suicidal Outcomes _______________ Nock et al. (2008). British Journal of Psychiatry

28. Epidemiology of Suicidal Outcomes _______________ • Although variability in prevalence of suicidal outcomes, there is consistency in: • Age-of-onset (AOO) of suicidal outcomes • Conditional probabilities of transition from ideation to plans (33.6%) and attempts (29.0%) • Speed of transition from ideation to plans and attempts • Risk factors for suicide ideation, plans, and attempts • Female, younger age, unmarried • Presence of mental disorders Nock et al. (2008). British Journal of Psychiatry

29. Epidemiology of Suicidal Outcomes _______________ Nock et al. (2008). British Journal of Psychiatry

30. Predictors of Transition from Suicide Ideation to Attempt _______________ Prediction of first onset of suicide ideation and attempts in the NCS-R Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here. Nock et al. (2009). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally)

31. Predictors of Transition from Suicide Ideation to Attempt _______________ Prediction of first onset of suicide ideation and attempts in the NCS-R Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here. Nock et al. (2009). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally)

32. Predictors of Transition from Suicide Ideation to Attempt _______________ Prediction of first onset of suicide ideation and attempts in the NCS-R Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here. Nock et al. (2009). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally)

33. Self-Injury Rate by Sex _______________

34. Self-Injury Rate Over Time _______________

35. Rate of NSSI among U.S. Youth _______________ (Hilt, Nock, Lloyd-Richardson & Prinstein, 2008)

36. _______________ Self-Destructive Behaviors:Definitions & Rates _______________ Prof. Matthew K. Nock