1. Self-Destructive Behaviors: Definitions & Rates Prof. Matthew K. Nock

2. Why Study Self-Injurious Behaviors? “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest– whether or not the world has three dimensions, whether the mind has nine or twelve categories– comes afterwards. These are games; one must first answer.” --Albert Camus, The Myth of Sisyphus

3. Why Study Self-Injurious Behaviors? ~1 million suicide deaths annually; 1 every 40 seconds ~30,000 deaths each year in US Twice as many suicides as HIV/AIDS deaths, >homicides 11 th leading cause of death, 3 rd among adolescents 15% of high school students “seriously consider” suicide, and 7% make a suicide attempt (YRBS, 2007) 97% of clinical psychology students see ≥ 1 suicidal patient; 25% of psychologists and 50% of psychiatrists lose patient to suicide (Kleespies & Dettmer, 2000)

4. Public Health Context

5. CountryYearMalesFemales Ukraine200052.110.0 Japan200035.213.4 Belgium199731.211.4 France199926.19.4 Bulgaria200225.68.3 Romania200223.94.7 China199913.014.8 Germany200120.47.0 Australia200120.15.3 Ireland200020.34.3 New Zealand200019.84.2 India199812.29.1 United States200017.14.0 Netherlands200012.76.2 Spain200013.14.0 Suicide Rates (per 100,000) by Country: WHO 2005

6. CountryYearMalesFemales Italy200010.93.5 Israel19999.82.3 Costa Rica19959.72.1 Brazil19956.61.8 Panama19875.61.9 Colombia19945.51.5 Mexico19955.41.0 Peru19890.60.4 Indonesia-- Nigeria-- South Africa-- Turkey-- Suicide Rates (per 100,000) by Country: WHO 2005

10. U.S. Suicide Rate by Age, Gender & Race

12. U.S. Suicide Rate by Age & Sex Over Time

13. U.S. Suicide Rate by Region

14. U.S. Suicide Rate by Age, Gender & Race

18. U.S. Suicide Rate by Method & Gender

19. Death Rates of U.S. Youth

20. Suicide Rates by Month

21. Current Context Suicide & NSSI are very difficult to predict & prevent

22. Classifying Self-Injurious Thoughts and Behaviors Common terms: “suicidality” …“deliberate self-harm”… “parasuicide”… More specific terms and definitions: –Suicide ideation: thoughts of intentionally ending one’s own life –Suicide plan: selection of method with some intent to act in the future –Suicide attempt: self-injurious behavior with intent to die –Non-suicidal self-injury (NSSI): self-injury with no intent to die Nock & Kessler (2006) J Abnormal Psychology Nock & Kazdin (2002) J Clinical Child & Adolescent Psychology

23. Epidemiology of Suicidal Outcomes What is the prevalence of suicide ideation, plans, and attempts? What are the onset, course, and risk factors?

24. Epidemiology of Suicidal Outcomes * * * * * * * * * * * * * * * * * * * * * ** * * *

25. What is the prevalence of suicide ideation, plans, and attempts? What are the onset, course, and risk factors? WHO World Mental Health Survey Initiative (Kessler et al): nationally representative survey in 28 countries (N ~ 250,000) Prevalence Estimate Range Suicide Ideation 9.2% (3.1 China - 15.9 New Zealand ) Suicide Plan3.1% (0.7 Italy - 5.6 New Zealand ) Suicide Attempt2.7% (0.9 Italy - 5.0 USA ) Nock et al. (2008). British Journal of Psychiatry N = 84,850; 17 Countries

26. Epidemiology of Suicidal Outcomes Although variability in prevalence of suicidal outcomes, there is consistency in: –Age-of-onset (AOO) of suicidal outcomes Nock et al. (2008). British Journal of Psychiatry

27. Epidemiology of Suicidal Outcomes Nock et al. (2008). British Journal of Psychiatry

28. Epidemiology of Suicidal Outcomes Although variability in prevalence of suicidal outcomes, there is consistency in: –Age-of-onset (AOO) of suicidal outcomes –Conditional probabilities of transition from ideation to plans (33.6%) and attempts (29.0%) –Speed of transition from ideation to plans and attempts Nock et al. (2008). British Journal of Psychiatry

29. Epidemiology of Suicidal Outcomes Nock et al. (2008). British Journal of Psychiatry

30. Epidemiology of Suicidal Outcomes Although variability in prevalence of suicidal outcomes, there is consistency in: –Age-of-onset (AOO) of suicidal outcomes –Conditional probabilities of transition from ideation to plans (33.6%) and attempts (29.0%) –Speed of transition from ideation to plans and attempts –Risk factors for suicide ideation, plans, and attempts Female, younger age, unmarried Presence of mental disorders Nock et al. (2008). British Journal of Psychiatry

31. Epidemiology of Suicidal Outcomes Nock et al. (2008). British Journal of Psychiatry

32. Predictors of Transition from Suicide Ideation to Attempt Nock et al. (2010). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally) Prediction of first onset of suicide ideation and attempts in the NCS-R Suicide Ideation Attempts among Ideators Depression (MDD) Anxiety (PTSD) Conduct (CD) Alcohol (Abuse/Dep) … Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here.

33. Predictors of Transition from Suicide Ideation to Attempt Prediction of first onset of suicide ideation and attempts in the NCS-R Suicide Ideation Attempts among Ideators Depression (MDD)2.3* Anxiety (PTSD)1.5* Conduct (CD)1.5* Alcohol (Abuse/Dep) … 1.8* Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here. Nock et al. (2010). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally)

34. Predictors of Transition from Suicide Ideation to Attempt Prediction of first onset of suicide ideation and attempts in the NCS-R Suicide Ideation Attempts among Ideators Depression (MDD)2.3* 1.0 Anxiety (PTSD)1.5*2.4* Conduct (CD)1.5*2.2* Alcohol (Abuse/Dep) … 1.8*2.9* Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here. Nock et al. (2010). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally)

35. Self-Injury Rate by Sex

36. Self-Injury Rate Over Time

37. Rate of NSSI among U.S. Youth (Hilt, Nock, Lloyd-Richardson & Prinstein, 2008)

38. Self-Destructive Behaviors: Definitions & Rates Prof. Matthew K. Nock