2. Suicide 101

3. 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.

4. 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.

5. 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.

6. 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.

7. Epidemiology of Suicide by Age

8. Epidemiology of Youth Suicide

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

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

13. Epidemiology of U.S. Suicide All Ages

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

15. Risk Associated with Sexual Identity
Source:
CDC web-site

16. Risk Factors for Suicide
Source: CDC web-site

17. Risk Associated with Season
Source:
CDC web-site

18. Risk Associated with Season for Youth

19. Risk Factors for Suicide
Source: CDC web-site

20. 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

22. Youth Risk Behavior Survey (YRBS) 2017

23. YRBS 2017 ND Suicide Attempts

24. Risk Associated with Sexual Identity

25. 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%

26. 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)

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

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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. Protective Factors from Suicide
Source: CDC web-site

37. 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.