Teen Depression & Suicide Prevention Kern County Mental Health Meghan Boaz Alvarez, M.S., MFT Suicide Prevention Week 2013

Teen Depression Facts About 20% of teens will experience depression before reaching adulthood About 10% of teens have some symptoms of depression at any given time 5% of those will be major depression Only about 30% get any kind of treatment

Risk Factors for Teen Depression Hormonal changes Emotional changes Situational stressors Social pressure Academic pressure Family history Abuse Illness Alcohol use

Things to look for… Withdrawn Lack of interest is previously enjoyed activities Angry outbursts Sleep problems Changes in school performance Moodiness http://www.youtube.com/watch?v=uiOjmfaxhdE

Key factor~ Do these changes or signs persist for weeks on end without any periods of relief? If the answer to the above is yes, it’s time for professional help

Without treatment 30% will develop a substance abuse problem More likely to struggle with friends, school, and later on employment Higher rate of Physical illness Sexually risky behavior Teen pregnancy STDs

Higher Suicide Rate Untreated depression is the main contributing factor to death by suicide, making a teen as much as 12 times more likely to attempt suicide Suicide is the third highest cause of death for young people (15-19) As a nation, we lose 12 young people a day to suicide

Facing the Facts An Overview of Suicide

Facing the Facts In 2008, 36,035 people in the United States died by suicide. About every 15 minutes someone in this country intentionally ends his/her life. Over half of these suicides were by firearm We believe suicide is underreported by 5-25% 40 to 100 times more non-fatal suicidal behavior incidents (attempts) We have seen a slight increase in the last two years in Kern County. Economic issues may play a role From the studies of committed suicide, about 50% of men who died were not in treatment and 75% of the men who died had no medications in their systems at the time of their deaths, so even if they were in treatment, they were not taking the medications. The data on whether treatments will help decrease suicide rates are also controversial. There is only one study (Angst et al, JAD (2002), Angst et al, Arch.Suic.Res. (2005) that indicates, in a naturalistic study (e.g. the patients were sent to their local physicians for treatment after they were discharged from the psychiatric hospital) from Switzerland, if patients with either major depression or bipolar illness were treated with antidepressants, neuroleptics and lithium their suicide rates and deaths from other causes were markedly decreased. There are also three studies that showed that treatment with Lithium, usually in patients with bipolar disease, also helps decrease the suicide and overall death rate significantly. However, many studies have shown, even patients in treatment or patients who have been hospitalized after a suicide attempt, that the treatment is not adequate. The conclusion is that there are many factors that contribute to the suicide rates, and we must work to change all of them to have an impact. In 2006, there were 33,300 suicides, the rate is 11.2 per 100,000.

County of Kern Suicide Data 2000   74 2001   62 2002   72 2003   68 2004   76 2005   71 2006   71 2007   90 2008   78 2009   100 2010   92 2011 95  Year    count

Facing the Facts Suicide is the second leading cause of death among college students. Suicide is the second leading cause of death for people aged 24-34. Suicide is the third leading cause of death for people aged 10-24. Suicide is the fourth leading cause of death for adults between the ages of 18 and 65. Suicide is highest in white males over 85. (45.4/100,000, 2007) The first and second leading causes of deaths in young adults (18-24) are accidents and homicides. Since the CDC does not collect data on men and women who are specifically in college, we assume, since homicide is low in this group, it may be the second leading cause of death. Although suicide rates in the US are highest in the very elderly, because there are so many other reasons why men die at this age, it is not a "leading" cause of death. Data on this can best be obtained through the CDC website www.cdc.gov or NIMH website www.nimh.nih.gov.

Annual Deaths, by Cause

Facing the Facts Suicide Is Not Predictable in Individuals Individuals of all races, creeds, incomes and educational levels die by suicide. There is no typical suicide victim. A prospective research study attempted to identify persons who would subsequently commit or attempt suicide. The sample consisted of 4,800 patients who were consecutively admitted to the inpatient psychiatric service of a Veterans Administration hospital. They were examined and rated on a wide range of instruments and measures, including most of those previously reported as predictive of suicide. Many items were found to have positive and substantial correlations with subsequent suicides and/or suicide attempts. However, all attempts to identify specific subjects were unsuccessful, including use of individual items, factor scores, and a series of discriminant functions. Each trial missed many cases and identified far too many false positive cases to be workable. Identification of particular persons who will commit suicide is not currently feasible, because of the low sensitivity and specificity of available identification procedures and the low base rate of this behavior. Pokorny AD. Arch Gen Psychiatry. 1983. Data from a 1983 prospective study of suicide in a cohort of 4800 psychiatric inpatients were reanalyzed using logistic regression, which is more appropriate for a binary outcome. The results were the same as in the previous study: too few of the subsequent suicides were identified and there were too many false positives to make this procedure useful. Several additional "artificial" logistic regression analyses were done: one series randomly removed increasing numbers of nonsuicide cases to increase the base rates; another series added an increasingly powerful hypothetical "test." Both of these maneuvers helped, but fell well short of perfection. Pokorny AD. Suicide Life Threat Behav. 1993 Five year follow-up of 4154 patients presenting with deliberate self harm showed that the predictive powers of Beck's Suicidal Intent Scale (SIS) was low (meaning they couldn't predict suicide). Harriss and Hawton, JAD 2005

Facing the Facts Research shows that during our lifetime: 20% of us will have a suicide within our immediate family. 60% of us will personally know someone who dies by suicide. This is from a Canadian study. It involves life time exposure, so the suicide could be a relative who had died before the living person knew him or her. Ramsay, R and Bagley, C. Suic and Life Threat Beh (1985). A more recent study showed that in the last year, 7% of the population knew a person, mainly a friend or acquaintance who killed himself and 1.1% of the population had a family member or relative who killed himself (or herself) Crosby and Sacks, Exposure to Suicide, Suic and Life Threat Beh (2002).

Myths Versus Facts About Suicide Most of these facts are taken from psychological autopsy reports.

Myths versus Facts MYTH: People who talk about suicide don't complete suicide. FACT: Many people who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously. Robins, E 1981: 50% to spouses, 40% to coworkers Reuneson, B, Suicide Life Threat Beh 1992

Myths versus Facts MYTH: Suicide happens without warning. FACT: Most suicidal people give clues and signs regarding their suicidal intentions.

Myths versus Facts MYTH: Suicidal people are fully intent on dying. Most suicidal people are undecided about living or dying, which is called “suicidal ambivalence.” A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to "gamble with death," leaving it up to others to save them. This is “Suicidal Ambivalence”.

Myths versus Facts MYTH: Men are more likely to be suicidal. FACT: Men are four times more likely to kill themselves than women. Women attempt suicide three times more often than men do. It is estimated that there are 25 attempted suicides for each death by suicide. (Ratio implies 730,000 suicide attempts annually in USA).

Myths versus Facts MYTH: Suicide occurs in great numbers around holidays in November and December. FACT: Highest rates of suicide are in May or June, while the lowest rates are in December. 1972-1990 (18 years) Month Average Percent January 75.27 97.4 February 76.66 99.3 March 79.83 103.3 April 80.12 103.7 May 79.45 102.9 June 78.49 101.6 July 78.52 101.6 August 78.30 101.4 September 77.50 100.3 October 76.03 98.4 November 75.00 97.1 December 71.63 92.8 Accurate to the decimal places shown.

Intervention Prevention may be a matter of a caring person with the right knowledge being available in the right place at the right time. www.suicideispreventable.org/

Link person Formal Resources Informal Mental Health MET Team Crisis Line Informal Family Friends

Information on community services KCMH Hotline 1-800-991-5272 MH Services for Adults & Children 24 Availability of Crisis Services National Suicide Prevention Lifeline Suicide Survivors Support Group Suicide Attempters Support Group

Meghan Boaz Alvarez, M.S., MFT Kern County Mental Health Crisis Hotline/Access Center 868-8007 Mboaz@co.kern.ca.us