Adolescent Suicide: Prevalence; Circumstance; and Conditions of Recognition

1. Adolescent Suicide:Prevalence; Circumstance; and Conditions of Recognition Barri Sky Faucett, MA ASPEN Project Director

2. SUICIDE Intentional Self-Inflicted Death

3. Just the Facts • Every 13.7 minutes another life is lost to • suicide, taking the lives of more than 38,364 • Americans every year. • Every day 105.8 Americans take their own life • Suicide is now the 10th leading cause of • death in America; Homicide is 15th. • For young people 15-24 years old, suicide • is the third leading cause of death.

4. In 2010, there were 4,600 reported youth suicides in the United States. Each day there are approximately 12 youth suicides Most common method is firearms followed by suffocations Males complete 4 times more than females; females attempt four times more than males. OUR Youth

5. 1 out of every 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated medically (CDC, 2010a). Approximately 1 out of every 15 high school students attempts suicide each year (CDC, 2010a). For every completed suicide, there are 100-200 attempts among adolescents. Suicide Attempts

6. Suicide in Adolescents Suicide in Adolescents • Research shows that most adolescent suicides occur after school hours and in the teen’s homes • Most adolescent suicides are precipitated by interpersonal conflict • Within a typical high school classroom, it is likely that three students (one boy and two girls) have made a suicide attempt within the last year.

7. How Does WV Compare? • Since GLS WV ranks 40th in the nation with a rate of 8.9/100,000 vs. the national average of 10.5 (CDC 2010).

8. WV Youth Suicide is the 2nd leading cause of death for WV Youth ages 15-24!

9. Suicide: A PREVENTABLE DEATH IN OUR STATE West Virginia Suicides by county Ages 15-24 2000-2009 Rate per 100,000 Population Hancock 4 (12.26) Brooke 4 (12.56) Ohio WV Average Rate 13.2/100,000 320 Deaths by Suicide 7 (10.81)) Marshall 12 (29.79) Morgan Monongalia Wetzel 3 (15.30) 10 (3.97) 3 (18.15) Tyler Marion Preston Berkeley 5 (46.92) 11 (12.38) 6 (16.39) 11 (9.89) Pleasants Mineral Jefferson 0 (0.00) Harrison Taylor Hampshire Dodd- 13 (15.36) 7 (20.00)) 6 (9.75) ridge 5 (26.13) 2 (7.78) Wood Ritchie 1 (9.88) 10 (9.68) Grant 4 (34.13)) Barbour Tucker 1 (13.19) 2 (16.07) Hardy 4 (19.02) Wirt Lewis 3 (20.28) 1 (13.66) Gilmer Cal- 2 (10.22) houn 2 (12.97) Upshur Randolph Jackson 2 (22.25) 4 (10.52) 3 (8.30) Mason 3 (9.01) 3 (10.07) Roane Braxton Pendleton 1 (5.34) 2 (11.34) 0 (0.00) 18.15 – 46.92 Putnam Webster 10 (16.14) Clay Cabell 3 (26.51) 4 (30.34) 12.26 – 16.39 18 (10.32) Kanawha Nicholas Pocahontas 47 (20.96)) Lincoln 5 (15.89) 2 (20.60) 10.07 – 11.34 Wayne 4 (14.53) 5 (9.63) Boone Fayette 2 (6.79) 0.00 – 9.89 Greenbrier 16 (27.19) Logan 8 (20.23)) 9 (20.92) Raleigh Mingo 10 (10.55) Wyoming Summers Monroe 3 (8.81) 1 (3.47) 2 (13.69) 0 (0.00) Mercer McDowell 12 (160.5) 2 (6.68)

10. 2011 West VirginiaYouth Risk Behavior Survey

11. Identity Confusion • Erickson Developmental Stage- Learning Identity Versus Identity Confusion (Fidelity) Learning Intimacy Versus Isolation (Love)

12. The Teenage Brain • Adolescence is a time of profound brain growth. • Greatest changes to the brain that are responsible for impulse control, decision making, planning, organization, and emotion occur in adolescence (prefrontal cortex). • Do not reach full maturity until age 25.

13. 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

14. Peer Problems • Several studies have found relationships between suicidal behavior and social isolation, sexual orientation, and peer rejection. • 70% of suicide completions and attempts occur following the loss or conflict with family and peers.

15. Sexual Identification • Lesbian, Gay, and Bisexual youth are 1 ½ - 7 times more likely to have reported ideation. • LGB Youth in multiple studies are found to be 3-4 times more likely to attempt suicide. • 58% of LGB youth who had attempted suicide reported they really hoped to die vs. 33% of heterosexuals who attempted and reported really hoping to die. • Have elevated risk factors and lower protective factors

16. Bullying: 3 defining characteristics: • 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

17. YRBHS, 2011 (9th-12th)

18. Cyberspace CYBERSPACE is the new environment where " youth are forming communities.

19. Cyber 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

20. Distance 24/7 Multiple methods Text messages; video clips; Websites; Social Media; IM; Emails; Chat rooms Anonymous Expanded Audience What makes Cyberbullying different?

21. Withdraws socially; has few or no friends. Feels isolated, alone, and sad. Feels picked on or persecuted. Feels rejected and not liked. Complains frequently of illness. Doesn’t want to go to school; avoids some classes or skips school. Brings home damaged possessions or reports them “lost.” Cries easily; displays mood swings and talks about hopelessness. Has poor social skills. Talks about running away/suicide. Bullying effects

22. Verbal Physical Relational 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 risks for suicide:

23. Billy Phoebe Hope Megan Bullying and Suicide

24. SUICIDE: Myth or Fact • Confronting a person about suicide will only make them angry and increase the risk of suicide. • Asking someone directly about suicidal intent lowers anxiety, opens up communication and lowers the risk of an impulsive act

25. Myth or Fact • Those who talk about suicide don’t do • it. • People who talk about suicide may • try, or even complete, an act of • self-destruction.

26. Myth or Fact • If a suicidal youth tells a friend, the • friend will access help. • Most young people do not tell an • adult

27. SUICIDE- Risk Factors, Warning Signs, Protective Factors • 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.

28. Risk Factors- IS PATH WARM • Ideation • Substance Abuse • Purposelessness • Anxiety • Trapped • Hopelessness • Withdrawal • Anger • Recklessness • Mood Changes

29. Prior suicide attempts Mental health disorders History of trauma or abuse Family history of suicide Lack of social support Problems that increase Suicide Risk

30. Situations that increase suicide risk • Major physical illnesses • Losses • Bullying • Easy access to lethal means • Local clusters of suicide

31. Firearms are used in 58% of successful suicides The rate of completed suicides is fives times higher in houses with firearms. Firearms are even more prevalent in suicides involving alcohol. 65% of WV homes have firearms. Access to means

32. Warning Signs: • Acquiring a gun or stockpiling pills • Talking about wanting to die or kill oneself • Impulsivity/increased risk taking • Giving away prized possessions • Self-destructive acts (i.e., cutting) • Increased drug or alcohol abuse • Talking about no reason to live

33. Protective 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.

34. Indirect or “Coded” Verbal Clues: • “I’m tired of life, I just can’t go on.” • “My family would be better off without me.” • “Who cares if I’m dead anyway.” • “I just want out.” • “I won’t be around much longer.” • “Pretty soon you won’t have to worry about me.”

35. What to Do for the Individual • Take it seriously • Almost 80% of all suicides had given some warning of their intentions • Ask Directly • If you think that someone is suicidal, ask them about it

36. Tips for Asking the Question

37. What to do – Be Genuine • Be Genuine • Listen and don’t show shock or disapproval • Show that you care, it is more important • than saying “the right thing.” • Avoid trying to explain away the feelings…(saying things like “you have a lot to live for” or “you are just confused right now”)

38. What to Do • Stay There • Don’t leave them alone. • Seek Help -Be actively involved in seeking professional help

39. KEEP SAFE Agreement Safety Contact (s) Safe/no use of alcohol and drugs Link to resources Disable the suicide plan Link to services Plan for Life Plan for Safety

40. Potential Assessments • Patient Health Questionnaire Modified for Teens (PHQ-9 Modified) • 12-18 years of age • Less than five minutes to complete and score • Adolescent Suicide Assessment Protocol (ASAP-20) • Semi- structured clinical interview • Addresses 20 items associated with suicide risk

41. Offerings • SOS Curriculums/ASPEN Workshop for Students • Evidence-Based Middle School and High School programs • Brief Introductory Training • 25 minute Video • Guided Discussion • Screening Instrument • Jason Foundation Kits • Orientation towards suicide prevention • ASK CARE TELL cards for students

42. ASPEN Offerings cont. • ASPEN Presentation for your schools: • Presentation- 35 minutes workshop for students • Video Viewing- 13 minute movie regarding adolescent suicide • Depression Screening- with active parental consent • ASAP-20 Follow-up for at-risk youth • Postvention services: • Response support to school systems • Sudden Traumatic Loss Toolkit

43. Awareness and QPR Adolescent Suicide Assessment Protocol (ASAP-20) PCP Toolkit Training Implementation of Suicide Prevention Toolkit Applied Suicide Intervention Support Training (ASIST) Trainings

44. For More Information • www.suicidology.org • www.sprc.org • www.afsp.org • www.spanusa.org • www.wvaspen.com • www.wvsuicidecouncil.org • www.jasonfoundation.org • www.jedfoundation.org

45. WV Contacts Barri Faucett, MA Project Director (304)-341-0511 ext 1691 (304)-415-5787 barri.faucett@prestera.org Bob Musick Executive Director WV Council for the Prevention of Suicide (304) 296-1731 bmusick@valleyhealthcare.org