1 Suicide Prevention: Facts, and Myths Counseling 407 Community Counseling Dr. Jeff Edwards

2  Suicides Peak in the Spring and Fall  Suicide is a serious public health problem accounting for between.4 and.9% of the deaths in the U.S. The CDC also report that in the population at large it is the eighth leading cause of death; but among adolescents, the third leading cause. In l998, 30,551 Americans took their own lives, while in 2002, 31,655 Americans took their own lives.  In the most recent year for which detailed national data are available (1996), November and December rank the lowest in the number of daily suicides. Spring and Fall are by the far the riskiest seasons for suicides in the US. Although research indicates that suicides may increase for a brief period after New Years day, January still remains one of lowest months for suicide risk in the US. 

*Centers for Disease Control and Prevention3 CDC Suicide: Fact Sheet*  Occurrence  Most popular press articles suggest a link between the winter holidays and suicides (Annenberg Public Policy Center of the University of Pennsylvania 2003). However, this claim is just a myth. In fact, suicide rates in the United States are lowest in the winter and highest in the spring (CDC 1985, McCleary et al. 1991, Warren et al. 1983).  Suicide took the lives of 30,622 people in 2001 (CDC 2004).  Suicide rates are generally higher than the national average in the western states and lower in the eastern and midwestern states (CDC 1997).  In 2002, 132,353 individuals were hospitalized following suicide attempts; 116,639 were treated in emergency departments and released (CDC 2004).  In 2001, 55% of suicides were committed with a firearm (Anderson and Smith 2003).  In 2001, 55% of suicides were committed with a firearm (Anderson and Smith 2003).

4  Groups At Risk  Males  Suicide is the eighth leading cause of death for all U.S. men (Anderson and Smith 2003).  Males are four times more likely to die from suicide than females (CDC 2004).  Suicide rates are highest among Whites and second highest among American Indian and Native Alaskan men (CDC 2004).  Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm (Anderson and Smith 2003).  Females  Women report attempting suicide during their lifetime about three times as often as men (Krug et al. 2002).

5  Youth The overall rate of suicide among youth has declined slowly since 1992 (Lubell, Swahn, Crosby, and Kegler 2004). However, rates remain unacceptably high. Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities. Such feelings can overwhelm young people and lead them to consider suicide as a “solution.” Few schools and communities have suicide prevention plans that include screening, referral, and crisis intervention programs for youth.  Suicide is the third leading cause of death among young people ages 15 to 24. In 2001, 3,971 suicides were reported in this group (Anderson and Smith 2003).  Of the total number of suicides among ages 15 to 24 in 2001, 86% (n=3,409) were male and 14% (n=562) were female (Anderson and Smith 2003).  American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group (CDC 2004).  In 2001, firearms were used in 54% of youth suicides (Anderson and Smith 2003).

6  The Elderly Suicide rates increase with age and are very high among those 65 years and older. Most elderly suicide victims are seen by their primary care provider a few weeks prior to their suicide attempt and diagnosed with their first episode of mild to moderate depression (DHHS 1999). Older adults who are suicidal are also more likely to be suffering from physical illnesses and be divorced or widowed (DHHS 1999; Carney et al. 1994; Dorpat et al. 1968).  In 2001, 5,393 Americans over age 65 committed suicide. Of those, 85% (n=4,589) were men and 15% (n=804) were women (CDC 2004).  Firearms were used in 73% of suicides committed by adults over the age of 65 in 2001 (CDC 2004).

7  Risk Factors  The first step in preventing suicide is to identify and understand the risk factors. A risk factor is anything that increases the likelihood that persons will harm themselves. However, risk factors are not necessarily causes. Research has identified the following risk factors for suicide (DHHS 1999):  Previous suicide attempt(s)  History of mental disorders, particularly depression  History of alcohol and substance abuse  Family history of suicide  Family history of child maltreatment  Feelings of hopelessness  Impulsive or aggressive tendencies

8  Barriers to accessing mental health treatment  Loss (relational, social, work, or financial)  Physical illness  Easy access to lethal methods  Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or suicidal thoughts  Cultural and religious beliefs—for instance, the belief that suicide is a noble resolution of a personal dilemma  Local epidemics of suicide  Isolation, a feeling of being cut off from other people  Isolation, a feeling of being cut off from other people

9  Protective Factors  Protective factors buffer people from the risks associated with suicide. A number of protective factors have been identified (DHHS 1999):  Effective clinical care for mental, physical, and substance abuse disorders  Easy access to a variety of clinical interventions and support for help seeking  Family and community support  Support from ongoing medical and mental health care relationships  Skills in problem solving, conflict resolution, and nonviolent handling of disputes  Cultural and religious beliefs that discourage suicide and support self-preservation instincts

10 The following information is from David Capuzzi’s book on Suicide Prevention in the Schools. He suggests that you can make handouts or over heads from this information to use in teaching others about suicide.  Suicide Prevention:  UNDERSTANDING THE MYTHS  Adolescents who talk about suicide never attempt suicide.  Suicide happens with no warning.  Adolescents from affluent families attempt or complete suicide more often than adolescents from poor families.  Once an adolescent is suicidal, he or she is suicidal forever.

11  If an adolescent attempts suicide and survives, he or she will never make an additional attempt.  Adolescents who attempt or complete suicide always leave notes.  Most adolescent suicides happen late at night or during the predawn hours.  Never use the word suicide when talking to adolescents, because using the word gives some adolescents the idea.  Every adolescent who attempts suicide is depressed.  Suicide is hereditary.

12 RECOGNIZING THE PROFILE  (BEHAVIORS)  Lack of concern about personal welfare.  Changes in social patterns.  A decline in school achievement.  Difficulty in concentrating.  Altered sleeping and eating patterns.

13 Suicide Prevention in the Schools: Guidelines for Middle and High School Settings  RECOGNIZING THE PROFILE  (BEHAVIORS)  Attempts to put personal affairs in order or to make amends.  Use or abuse of alcohol or drugs.  Unusual interest in how others are feeling.  Preoccupation with death and violence themes.  Sudden improvement after a period of depression.  Sudden or increased promiscuity.

14 RECOGNIZING THE PROFILE (VERBAL CUES)  No “universal” language for communicating suicidal intentions.  Ask for clarification of what you hear: “Could you say a little more about what you mean when you say.  Paraphrase to communicate that you listened and to check accuracy: “You are really discouraged and upset about……..”  RECOGNIZING THE PROFILE  (VERBAL CUES)  “You won’t be seeing me for my appointment on Monday.”  “I’m going home.”  “I thought about something I’m afraid to tell anyone about.”  “I’m tired.”  “I wonder what death is like.”  “She’ll be sorry about how she treated me.”

15 RECOGNIZING THE PROFILE (THINKING PATTERNS AND MOTIVATIONS)  Motivations of suicidal adolescents can be understood more readily when suicide is viewed as fulfilling one of three primary functions:  Avoidance  Control  Communication

16  RECOGNIZING THE PROFILE  (THINKING PATTERNS AND MOTIVATIONS)  Wanting to escape an intolerable situation.  Wanting to join someone who has died.  Wanting to attract the attention of family or friends.  Wanting to manipulate someone else.  Wanting to avoid punishment.

17  RECOGNIZING THE PROFILE  (THINKING PATTERNS AND MOTIVATIONS)  Wanting to be punished.  Wanting to control when or how death will occur.  Wanting to end a conflict.  Wanting to punish the survivors.  Wanting revenge.

18 RECOGNIZING THE PROFILE (PERSONALITY TRAITS)  Low self-esteem  Hopelessness/helplessness  Isolation  High stress  Acting out  Need to achieve RECOGNIZING THE PROFILE (PERSONALITY TRAITS)  Poor communication skills  Other-directedness  Guilt  Depression  Poor problem-solving skills

19 ADOLESCENT BEHAVIOR THAT MAY BE SYMPTOMATIC OF DEPRESSION  MASKED ADOLESCENT SYMPTOMS  Reckless behavior  Boredom, lethargy  Promiscuity  Running away  Defiance  Truancy  Antisocial behavior  Drug or alcohol abuse  Complaints of illness

20 HOW YOU CAN HELP  Assess the suicidal risk.  Listen and paraphrase.  Evaluate the seriousness of the young person’s situation.  Take every complaint and feeling the person expresses seriously.  Begin to broaden the person’s perspective of his or her past and present situation.  Be positive in your outlook about the future.  Evaluate available resources.  Accompany the student to the counselor or crisis team member.

21 Form 7 Suicide Contract  Date:  I, ______, (client), hereby contract with (therapist), that I will take the following actions if I feel suicidal.  1. I will not attempt suicide.  2. I will phone at.  3. If I do not reach, I will phone any of the following services:  Name/AgencyPhone 

22  4.I will further seek social supports from any of the following people:  NamePhone   5.If none of these actions are helpful or not available, I will check-in the ER at one of the following:  HospitalAddressPhone   6. If I am not able I will phone 911, or 0 for help.  Client’s signature: Date: //  Therapist’s signature: Date: / /  The S.L.A.P. Scale

23 The S.L.A.P. Scale