1. Life Crisis vs Daily Stress
life crisis creates an extremely high level of stress
Often, life crises are not in your control

2. People work through a crisis in the same way…although not always at the same pace
Denial
Anger
Bargaining
Depression
Acceptance

3. Well-adjusted people deal with disappointments and trauma BUT…adjust and move on.
This doesn’t mean they LIKE what happened…only that they will not allow the event to continue to affect them negatively.

4. Successfully working through difficult times help you become more emotionally mature.
Emotional maturity helps you deal with future disappointments in a positive way.

5. DEPRESSION
Is a NORMAL response to any disappointment, crisis, personal loss
Depression that lasts two weeks or longer is NOT normal

6. Teen Depression
Teenagers may exhibit several symptoms of depression and yet be unaware that they are suffering from depression.
Depression is not just sadness. It is a diagnosable illness with specific symptoms. In order to be diagnosed with depression, the individual must have symptoms for at least two weeks.
Children and adolescents sometimes don’t have the language to label their own emotions. They may have been depressed for so long, they don’t realize that what they are experiencing is depression. They don’t understand that it’s possible to feel differently.
About 4% of teenagers have a Major Depressive Disorder (MDD) at any one time.
Among teens, girls are more often affected than boys.
MDD frequently interferes with home, school and family life, including causing a lot of family stress.
Suicide is the third leading cause of death among teenagers, with about half of these associated with depression
National Institute of Mental Health, Treatment of Adolescent Depression Study (TADS) 6

7. Teen Depression Extreme sensitivity to rejection or failure
Low self-esteem and feelings of guilt
Frequent complaints of physical illnesses such as headaches and stomachaches
Frequent absences from school or poor performance in school
Threats or attempts to run away from home
Major changes in eating or sleeping patterns
Go over each point. Add:
Teens who are depressed often have a negative view of themselves, the world and their future. As such, they may appear to be on the lookout for signs of rejection or criticism. They may appear to overreact to situations that aren’t necessarily negative.
Since they are very connected to their peer groups, depressed teens may feel responsible, or guilty about things that happen with their friends. They see themselves as having little control and their feelings to hinge on things that are happening around them. 7

8. Teen Depression
Sad, blue, irritable and/or complains that nothing is fun anymore
Trouble sleeping, low energy, poor appetite and trouble concentrating
Socially withdrawn or performs more poorly in school
Can be suicidal
Go over key points on slide. Emphasize:
While many people think of depression as a pervasive feeling of sadness, in teens it often shows up as increased irritability.
“Most children experience fluctuations in mood and behavior as a result of normal developmental transitions. Healthy children can exhibit on occasion, any of the symptoms of more serious behavioral and emotional disorders without needing much concern. However, when these symptoms appear over an extended period of time, it is wise to have the child checked by a doctor.” (Red Flags in Children’s Behavior)
Teens also show depression by dropping out of activities that they once found enjoyable, and by reporting that things that they are doing isn’t fun anymore. Depressed teens may continue to try to do things with friends, and may have the expectation that the activity is going to be fun, but then finds that it isn’t fun when they try to do it.
They may stop calling their friends, and may stop taking friend’s phone calls. However, some teens report their most serious symptoms either at home or at school, and may say they feel fine when they are with their friends. This generally has to do with the lower expectations that are placed on them by friends as opposed to home or school.
Younger teens may not actively threaten to kill themselves, but instead might make statements saying they wished they were dead, or had never been born. 8

9. LIFE’S GRAND ESSENTIALS
SOMEONE TO LOVE
SOMETHING TO HOPE FOR
SOMETHING TO DO
Suicidal people are often missing one or more of these elements for happiness

10. Suicide: a PERMANENT solution to a TEMPORARY problem

11. Myths Versus Facts About Suicide
Most of these facts are taken from psychological autopsy reports. 11 11

12. Myths versus facts…
People who talk about suicide don’t complete suicide.
FACT:
Many people attempt/talk about suicide are just trying to “reach out” to someone and hope they understand their pain. It is called “parasuicidal intent”…they want to be heard.
Robins, E 1981: 50% to spouses, 40% to coworkers
Reuneson, B, Suicide Life Threat Beh 1992 12 12

13. Suicide happens without warning. MYTH:
Myths versus facts…
Suicide happens without warning.
MYTH:
Most suicidal people give many clues and warning signs regarding their suicidal intention. 13 13

14. Myths versus facts… Suicidal people are fully intent on dying. MYTH
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. 14 14

15. Males are more likely to feel suicidal. MYTH
Myths versus facts…
Males are more likely to feel suicidal.
MYTH
Men COMPLETE suicide more often than women. However, women attempt suicide three times more often than men.
It is estimated that there are 25 attempted suicides for each death by suicide.
(Ratio implies 730,000 suicide attempts annually in USA). 15 15

16. Myths versus facts…
Asking a depressed person about suicide will push him/her to complete suicide.
MYTH
Studies have shown that patients with depression have these ideas and talking about them does not increase the risk of them taking their own life.
In a study investigating the potential risk of screening for mental health problems, high school students were randomly assigned to 2 groups, one who received a survey with suicide questions (experimental group) and one who did not (control group). Distress levels after the survey were no different between the two groups. Two days later both groups were measured again with the same survey that included the suicidal questions. There were no differences in the report of suicidal ideation in the exposed or unexposed groups. “High- risk students” (defined as those with depression symptoms, substance use problems, or any previous suicide attempts) in the experimental group were neither more suicidal or distressed than “high-risk youth” in the control group: on the contrary, depressed students and previous suicide attempters in the experimental group appeared less distressed and suicidal than high-risk youths in the control group. Gould et al, JAMA (2006). 16 16

17. Myths versus facts…
Improvement following a suicide attempt or crisis means that the risk is over.
MYTH
Most suicides occur within days or weeks of “improvement” when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts.
After psychiatric hospitalization for depression, the days immediately following discharge are the highest risk for suicide and it diminishes gradually over the year.
Fawcett et al, Am J Psychiatry, 1990
Hoyer et al, J Affect Disord, 2004
Qin and Nordentoft, Arch Gen Psychiatry, 2005 17 17

18. Myths versus facts…
Once a person attempts suicide the pain and shame will keep them from trying again.
MYTH
The most common psychiatric illness that ends in suicide is Major Depression, a recurring illness. Every time a patient gets depressed, the risk of suicide returns.
Although it is true that suicide as an outcome is highest in the first years of an illness like Major Depression (Isometsa et al, 1994, Angst, 2004 and 2005), it still can occur every time the patient has a recurring depression. Those who are the most suicidal and complete suicide while depressed are removed from the pool of potential suicides, so the frequency of the event goes down. Still, it happens. 18 18

19. Sometimes a bad event can push a person to complete suicide.
Myths versus facts. . .
Sometimes a bad event can push a person to complete suicide.
MYTH
Suicide results from serious psychiatric disorders not just a single event. Major disappointments
just add “fuel to the fire”
From studies, although there can be triggering events before a suicide in a person with depression, the most important issue is to identify the depressive disorder and get adequate and aggressive treatment.
In patients with a diagnosis of chronic alcoholism who commit suicide (usually later in their illnesses) acute interpersonal losses play a more important role. Murphy G, Suicide in Alcoholism, Oxford Press, 1992.
Use of alcohol (or drugs) can play a role in suicide, because of the disinhibition it causes. 19 19

20. Myths versus facts. . .
Suicide occurs in great numbers around holidays in November and December.
MYTH
Highest rates of suicide are in April while the lowest rates are in December.
(18 years)
Month Average Percent
January
February
March
April
May
June
July
August
September
October
November
December
Accurate to the decimal places shown. 20 20

21. 3rd leading cause of death for youth in the United States
Youth Suicide
3rd leading cause of death for youth in the United States

22. ONE MILLION youth attempted suicide last year
That averages to 112 attempts each minute!

23. Objectives Certain risk factors increase thoughts of suicide
Recognizing signs may prevent a suicide
Community resources exist to help anyone with suicidal thoughts

24. WHY…would someone want to end their life?
Divorce, isolation, frequent moves, dysfunctional families, drug use, the fast pace of life, change in finances, pressure to succeed, “throw-away” society, violence in the media, easy acquisition of firearms, and a lack of parental involvement (90% said that their parents “don’t understand me”)

25. Four out of Five young people who attempt suicide have given clear warnings.

26. Suicidal Threats “There’s no point in going on”
“I can’t take it anymore”
“I have nothing left to live for”
“I can’t stop the pain”
“I can’t live without _______”
“My life keeps getting worse and worse”
“I might as well kill myself”
Hopelessness is a component of depression and a risk factor for suicide. People experience hopelessness when they believe that there is no chance of improvement in the future. They may have reasons why their problems cannot get better in the future or that life will continue to be unbearably painful or even worsen. Children and teens may especially have poor coping or problem-solving skills which add to their feelings of hopelessness.
People who are suicidal often talk about feelings – for example they may say things like those listed on the slide. Usually there is a theme of intense psychological pain and a lack of hope about the future in these statements. 26

27. Previous suicide attempts
Four out of Five completed suicides are NOT the first attempt

28. Sudden Changes In Behavior
Examples: A quiet person becomes very loud & obvious; a loud person becomes aggressive and angers easily; an out-going person suddenly becomes withdrawn; Withdrawal from activities previously enjoyed; Changes in relationships with friends; A despairing attitude about things that were once important. A SUDDEN LILFT IN SPIRITS!

29. Examples: Giving away prized possessions, asking friends to take care of something if no longer around, writing a “will”
Making final arrangements ex. Giving away possessions, “making peace” with others, gathering means for suicidal action

30. Preoccupation with death and morbidity

31. Others….. Intolerance for praise or reward poor performance in school
increase in substance use
bored, indifferent
withdrawn or isolated from friends

32. Factors that raise the risk of suicidal thought
You can just go through each of the next slides pretty quickly, as they are pretty self-explanatory.

33. Low Self –esteem

34. Depression

35. Being a victim of abuse, molestation, or neglect

36. Abuse of drugs and alcohol

37. Alcohol and Suicide
Alcoholics have a suicide rate 50 times higher than the general population
Alcohol dependent persons make up 25% of all suicides
18% of alcoholics eventually complete suicide
A study by Gould, et al (1998) reported finding that substance use may be a factor in escalating suicidal ideation into suicide attempts. 37

38. Perfectionists

39. Changes in school or social status

40. Loners

41.                                                       
How Do I Help?
At this point people may be feeling overwhelmed by the situation, so you may want to say something like: “So you may be wondering what can I do? How can I possibly help? Well here is an easy way to remember what to do if you have a friend who is having thoughts about hurting him or herself…”

42. You can help. . .
Know warning signs
Intervention 42 42

43. You can help. . .
Most suicidal people don’t really want to die – they just want their pain to end.
About 80% of the time people who kill themselves have given definite signals or talked about suicide. 43 43

44. How to Intervene You can help. . . Three Basic Steps Show you care
Ask about suicide
Get help 44 44

45. You can help… Show you care Take ALL talk of suicide seriously
If you are concerned that someone may take their life, trust your judgment!
Listen carefully
Reflect what you hear
Use language appropriate for age of person involved
Do not worry about doing or saying exactly the “right” thing. Your genuine interest is what is most important. 45 45

46. You can help. . .
Be Genuine
Let the person know you really care. Talk about your feelings and ask about his or hers.
“I’m concerned about you…about how you feel.”
“Tell me about your pain.”
“You mean a lot to me and I want to help.”
“I care about you, about how you’re holding up.”
“I don’t want you to kill yourself.”
“I’m on your side…we’ll get through this.” 46 46

47. Intervention Step Two:
You can help. . .
Intervention Step Two:
Ask About Suicide
Be direct but non-confrontational
Don’t hesitate to raise the subject.
Talking with people about suicide won’t put the idea in their heads. Chances are, if you’ve observed any of the warning signs, they’re already thinking about it. Be direct in a caring, non-confrontational way. Get the conversation started. 47 47

48. What NOT to Say… “It’s just a phase” “You’ll snap out of it”
“Stop being so selfish”
“You’re just trying to get attention”
“Get over it”
Review these items with the idea that they are often said by well meaning people. Explain that they are not helpful to someone who is feeling intense pain and may be suffering from depression. 48

49. When should you NOT stay with a suicidal person?
When there is a danger to YOU!
In times of crisis, we tend to panic. All of us respond best in a crisis when we have rehearsed the behavior we will need to perform. We’ve all heard stories of people who successfully performed CPR even though they had taken the class years before. This is because of the repetitive practice one must do to pass a CPR class.
When you first discover that a student is suicidal, this is also a time of crisis. Sometimes we panic and are at a loss for what to say. If you practice some of these phrases, they will hopefully come to mind when you need them.
Ask the audience if they can think of anything else that would be helpful to say initially. 49

50. Steps teens can take Take your friend’s actions seriously
Encourage your friend to seek professional help, accompany if necessary
Talk to an adult you trust. Don’t be alone in helping your friend.
4. Don’t keep the secret.
Optional Slide (if the audience is wondering what to tell teens to do):
It is important to emphasize to teens that they cannot be sworn to secrecy if a friend is threatening suicide. This is not a secret to keep.
Then go over the points in the slide. 50

51. Things to avoid: Do not ignore the warning signs
Do not refuse to talk about suicide with your friend
Do not react with disapproval or repulsion
Do not offer false reassurances like “Everything will be all right” or comments like “you have a great life and you should be thankful for…”
Do not abandon your friend after you get them help.

52. Where do I go for HELP? Call 911 1-800-suicide
Blue pages of phone directory
Trusted adults

53. Resiliency is a “protective factor” against life crises
Involvement in school and community activities
Ask for support when you need it
Avoid harmful coping behaviors
Deal with difficult issues as they arise

54. Surround yourself with supportive friends
Have a close relationship with a “mentor”
Have a close relationship with your family
Remember…you are NEVER alone!

55. No matter the problem,
there IS a solution!