Suicide 101

The Case of J.S. At the time of initial evaluation, J.S. was 12 years old. J.S. is Native American. Living with his legal guardian, who is a minister. Under guardianship due to instability and at least alcoholism of mother. Paternity disputed and never involved.

The Case of J.S. Presents with Depression. Troubles sleeping. Excessive Guilt. Poor concentration. Suicidal ideation: to jump off of a building. No prior suicide attempts. Most of life in foster care with guardian, though multiple attempts at reunification.

The Case of J.S. Diagnosed with Fetal Alcohol Effects. Learning Disorder in Math. ADHD. PTSD from Physical and Emotional Abuse while in mother’s custody. Possible Hallucinations- tells therapist he sees ghosts.

The case of J.S. Reactive Attachment Disorder and suspicious of males, acts out when guardian searches for jobs. Already one Inpatient and one Partial Hospital Stay for Suicidal Ideation (initial eval for follow-up). On meds for Depression and ADHD.

Epidemiology of Suicide by Age

Epidemiology of Youth Suicide

Epidemiology of U.S. Suicide All Ages Source: CDC web-site

Correlation of Suicide with Psychiatric Illness With Permission, Charles Nemeroff, MD, PhD

Epidemiology of U.S. Suicide All Ages

Risk Associated with Sexual Identity With Permission, Charles Nemeroff, MD, PhD

Risk Associated with Sexual Identity Source: CDC web-site

Risk Factors for Suicide Source: CDC web-site

Risk Associated with Season Source: CDC web-site

Risk Associated with Season for Youth

Risk Factors for Suicide Source: CDC web-site

The case of J.S. By age 16, had multiple incidents of self-harmful and suicidal behavior and was using alcohol and marijuana and placed in residential treatment By age 17 had a suicide attempt related to being “outed”, identified self as bisexual with a both fantasy and physical experience

Youth Risk Behavior Survey (YRBS) 2017

YRBS 2017 ND Suicide Attempts

Risk Associated with Sexual Identity

YRBS 2017 ND Alcohol ND Ranks #3 out of 39 states at 16.4% AZ #1 at 17.9% and VT #2 at 16.9% Median is 13.1%

The case of J.S. By age 17 had suicide/self-harm attempts including attempted hangings related to cyber-bullying Had self-harm and suicide attempts in coordination with peers through electronic communication (suicide pacts & contagion effects)

YRBS 2017 ND Cyber-Bullying The Risk of Cyber-Bullying is Double if they are identified as Gay, Lesbian or Bi-Sexual

Suicide Contagion Impact of Media on Reporting Suicide Suicide Clusters Impact on Adolescents of Exposure to a Suicidal Peer

Impact of Media on Reporting Suicide Research into the impact of media stories about suicide has demonstrated an increase in suicide rates after both nonfictional and fictional stories about suicide. Nonfictional reporting a more powerful effect Suicide rates go up following an increase in the frequency of stories about suicide Gould and Lake, The contagion of Suicidal Behavior, 2013, NIH web-site

Impact of Media on Reporting Suicide Suicide rates go down following a decrease in the frequency of stories about suicide A dose-response relationship between the quantity of reporting on completed suicide and subsequent suicide rates has consistently been demonstrated Gould and Lake, The contagion of Suicidal Behavior, 2013, NIH web-site

Impact of Media on Reporting Suicide Changes in suicide rates following media reports are more pronounced in regions where a higher proportion of the population is exposed The prevalence of Internet users, with access to Internet stories about suicide, has been associated with general population suicide rates in males, but not females Gould and Lake, The contagion of Suicidal Behavior, 2013, NIH web-site

Suicide Clusters A suicide cluster is an excessive number of suicides occurring in close temporal and/or geographical Clusters occur primarily among teenagers and young adults, with between 1 percent and 5 percent of teen suicides occurring in clusters A case-control study of two teen suicide clusters in Texas indicated that the clusters included teens who had close personal relationships with others in the cluster, as well as teens from the same community who were not directly acquainted with one another Gould and Lake, The contagion of Suicidal Behavior, 2013, NIH web-site

Suicide Clusters Completers were more likely to have preexisting vulnerabilities (e.g., emotional illness, substance abuse problems, frequent changes of residence, recent or anticipated relationship break-up) that may have increased their susceptibility to suicide contagion. Gould and Lake, The contagion of Suicidal Behavior, 2013, NIH web-site

Impact on Adolescents of Exposure to a Suicidal Peer A significant association between exposure to the suicidal behavior of an adolescent peer and a subsequent adolescent suicide attempt. Odds ratios ranged from 2.8 to 11.0 for attempted suicide. Teens who know friends or family members who have attempted suicide are about three times more likely to attempt suicide than are teens who do not know someone who attempted Gould and Lake, The contagion of Suicidal Behavior, 2013, NIH web-site

Impact on Adolescents of Exposure to a Suicidal Peer Girls are more likely to attempt suicide if they knew someone who had survived a suicide attempt Boys are more likely to attempt suicide if they knew someone who had died by suicide. Teens who do not make a suicide attempt in wave 1 are more likely to have attempted suicide in wave 2 if they knew someone who had attempted suicide in the interim Gould and Lake, The contagion of Suicidal Behavior, 2013, NIH web-site

Protective Factors from Suicide Source: CDC web-site

The case of J.S. What about now? Still in same guardian's home and unsure about what will do when reaches legal age to leave. Appears depression is controlled. Denies substance use. ADHD effectively treated without a controlled substance. Less engaged in fantasy of rescuing biological family.