1. Depression

2. Depression Signs and Symptoms At Least 5 of the 9 for a two week period Depressed mood most of the day Reduced interest in pleasurable activities Weight changes Sleep Problems Psychomotor agitation or retardation Lack of energy and motivation Poor concentration Feelings of worthlessness Thoughts of death

3. Sex Differences in Depression Females (2-3 x more likely) Self-Image and Body Image (female<male) Hormonal Changes Alter Vulnerability to MDD Diathesis-Stress Model (predisposition+stressor) Females tend to focus on emotions and related thoughts more than males Females face more discrimination Males Expression

4. Depression: Risk Factors Unavailable or Neglectful Parents Having a Depressed Parent Family or Marital Conflict Poor Peer Relations Romantic Relationship Problems Transitions Previous Depression Predicts Future Depression

5. Treatment Cognitive Behavioral Therapy Challenges Medication Does it increase risk of suicide?

6. Suicide

7. Ninth leading cause of death for adults in U.S. At least 2/3 of suicide attempters are under 35 Every 20 minutes someone in the U.S. suicides May be as many as 6 million attempts per year Women are 3 -4 times more likely to attempt suicide Men are 4-5 times more likely to succeed Rates of attempts are 3-4 times higher in people who are divorced or separated Most attempts are related to relational discord Guns are the means in 60% of suicides

8. Adolescent Suicide Seventh leading cause of death in 5-14 yo. Third leading cause of death in 15-24 yo. First two are accidents and homicides) Suicide rate in teens tripled from 1950’s to mid 1980’s. Similar trends were noted in 23 out of 29 countries studied (Lester, 1988). Between 7-16% of high school students report an attempt Between 4-8% of 11 th and 12 th graders an attempt These are the highest rates of attempts at any point in the life span (large proportion have low lethality). However, 9% of males in this age range and 1-4% of females complete within 5 years.

9. Risk Factors for Adolescent Suicide Mental Disorders (more = more risk) Conduct Disorder and Substance Abuse are more common in completers. Mood Disorders (Depression & Anxiety) are more common among nonfatal attempters. Negative Life Events (emotional pain) Availability of Firearms in the home. Stage of Life Transitions (autonomy vs control) Genetic Factors (twin studies ) Hospitalized pts with Low Serotonin 10x risk Contagion factors 1-13% (Velting, 1997)

10. Sex Differences Females attempt more often Self-Image and Body Image (female<male) Hormonal changes alter vulnerability to MDD Females tend to focus on emotions and related thoughts more than males Females face more discrimination Males Emotional expression and suicide are counter male culture Buck-it-up dude!

11. Suicide: Assessment How do I know?

12. Assessment of Risk I. Depressive Disorders and other Mental Health problems Alcoholism and other Substance Abuse Suicide Ideation Prior Attempts Lethal Methods Isolation (friends and family) Cognitive Rigidity (Hopelessness)

13. Modeling (suicide in the family) Economic or Work Problems Marital Problems Stress and Stressful Events Anger, Aggression, Irritability Physical Illness Giving Away Personal Items Sudden Happiness Repetition and Combination of All Factors Assessment of Risk II.

14. Why do adolescents suicide? Psychache?

15. In almost every case suicide is caused by pain, a certain kind of pain—psychological pain, or “psychache”… Suicidal death, in other words, is an escape from pain… Pain is nature’s great signal. Pain warns us; pain both mobilizes us and saps our strength; pain, by its very nature, makes us want to stop it or escape from it… Psychache is the hurt, anguish or ache that takes hold in the mind. It is intrinsically psychological, the pain of excessively felt shame, guilt, fear, anxiety, loneliness, angst, and dread of growing old or of dying badly. When psychache occurs, its introspective reality is undeniable. Suicide happens when the psychache is deemed unbearable and death is actively sought to stop the unceasing flow of painful consciousness. Suicide is a tragic drama in the mind (Schneidman, 1997, pp 23, 29)

16. Why Suicide? Psychache Stressors exceed ones adaptive capacity Limited support network Chronic history of instability Acute life event Cognitive limitations (problem solving, impulsivity) Genetic and Biological Factors Physiology and Chemistry Personality Neuroticism- (high negative emotionality) Copy Cat or Contagion Effect

17. Intervention Be Direct Pay Attention Accept the Person without Judgment Be Calm Assure Seek help

18. Prevention Intensive individualized attention Community-wide multi-agency collaborative approaches Early identification and intervention

19. The Impact of Suicide