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  2. Setting the Stage  What are the commonmythsabout suicidein children and adolescents?  If I suspectmychild isfeeling suicidal, what shouldIdo?  Howcanschoolsand communities work together to prevent suicide?
  3. Continuumof SuicidalBehavior  Suicide - Death caused by self-directed injurious behavior with any intent to die as a result of the behavior Note: T erms“committed” suicide,“completedsuicide”and “successfulsuicide”are not consideredunacceptable; preferred termsare “death bysuicide”or "died by suicide"  Suicideattempt:Anon-fatal self-directed potentially injurious behavior (mayor maynot result in injury) with any intent to die asresult of the behavior  Suicidalideation: Thoughtsof suicidethat canrange in severity from a vague wishto be dead to active suicidal ideation with a specific plan and intent
  4. Suicideisa SeriousProblem  Myth – Suicidein youthisnot a problem  Truth- Suicidein youngpeople isa seriousand prevalent problem: 3rd leading causeof death for youngpeople ages 10-24 and accountsfor 20% of all deaths annually T opmethodsused- firearms, suffocation, poisoning
  5. Suicidal Behavior: A Serious Problem  Boysare morelikely than girls to die from suicide  Of the reported suicidesin the 10-24 age group, 81% were males  Girls attempt suicidemorethan boys,a particular problem for girls from Latina backgrounds
  6. Suicidal Behavior: A Serious Problem  Ratesof other suicidal behavior are high according to a nationally-representative sampleof high school students 15.8% seriously considered attempting suicide 12.8% made a plan about how they would attempt suicide 7.8% attempted suicide oneor more times 2.4% made a suicide attempt that resulted in an injury, poisoning, or an overdose that required medical attention
  7. Riskand Protective Factors  Riskfactors – Increaselikelihood that a youngperson will engage in suicidal behavior Intrapersonal, Social/situational, Cultural/environmental  Protective factors – Mitigate or eliminate risk Intrapersonal, Social/situational, Cultural/environmental  Considerthe balance between the two
  8. RiskFactors:Intrapersonal  Recentor seriousloss  Mental disorders (particularly mooddisorders)  Hopelessness,helplessness,guilt,worthlessness  Previoussuicideattempt  Alcohol and other substanceuse disorders  Disciplinary problems  High risk behaviors  Sexual orientation confusion
  9. RiskFactors:Social/Situational  Recentor seriousloss(e.g., death, divorce, separation, broken relationship; self-esteem; lossof interest in friends, hobbies, or activities previously enjoyed)  Family history of suicide  Witnessingfamily violence  Child abuseor neglect  Lackof socialsupport  Senseof isolation  Victim of bullying or being a bully
  10. RiskFactors:Cultural/Environmental  Accessto lethal means(i.e. firearms, pills)  Stigma associated with asking for help  Barriers to accessing services Lackof bilingual service providers Unreliable transportation Financialcostsof services  Cultural and religious beliefs (e.g., belief that suicide isnoble resolution of a personal dilemma)
  11. Protective Factors  Skillsin problem solving,conflict resolution and handling problems in a non-violent way  Strong connectionsto family, friends, and community support  Restricted accessto highly lethal meansof suicide  Cultural and religious beliefs that discourage suicideand support self- preservation
  12. Protective Factors  Easyaccessto a variety of clinical interventions  Effective clinical care for mental, physical, and substanceusedisorders  Support through ongoing medical and mental health care relationships
  13. Warning Signs  A warning sign does not mean automatically that a person is going to attempt suicide, but it should be responded to in a serious& thoughtful manner  Donot dismissa threat asa cry forattention! Whatkindsof warning signsarecause for concern?
  14. Specific Warning Signs  TalkingAbout Dying - Anymentionof dying, disappearing, jumping, shooting oneself,or other types of self harm  Changein Personality - Sad, withdrawn, irritable, anxious,tired, indecisive,or apathetic  Changein Behavior- Difficulty concentratingon school,work, or routine tasks  Changein SleepPatterns- Insomnia,often with early waking or oversleeping, nightmares  Changein EatingHabits- Lossof appetite and weight, overeating  Fearof losingcontrol- Acting erratically, harming self or others
  15. HowToTalkWith Your Child Talkin a calm,non-accusatory manner Letthemknowyoulove and care Conveyhowimportant they are toyou Focusonconcernfor their well-being Make statementsthat conveyyouhave empathy for their stress Encourageseekingprofessional help Reassurethemthat they will not feel like thisforever by utilizing appropriate help
  16. PreventYourChild’sSuicidal Behavior  Prioritize interacting with themin positive ways  Increasetheir involvementin positiveexperiences  Monitor appropriately your child’s whereabouts and communications (i.e., texting, Facebook, Twitter) with the goal of keeping them safe
  17. PreventYourChild’sSuicidal Behavior  Get involved and be aware your child's friends  Communicateregularly with other parents in your community  Limityour child’s accessto guns,knives,alcohol, prescription pills, and illegal drugs  Communicateregularly with your child’s schoolto ensureoptimal safety and care for your child in the school setting
  18. Help YourSuicidalChild Talkwith your child about your concerns and askdirectly about suicidal thoughts Explain value of therapy and potential for medication managementof symptoms Addressyour concernswith other important adults in your child’s life Discussconcernswith your child’s doctor to get appropriate mental health referrals Talkwith people in the schoolwhocan provide support and guidance
  19. SeekProfessionalHelp  Besafe, not sorry!  T akeappropriate action when needed to protect your child Feelthat somethingisnot right Notice warning signsin your child (including worsening signs)  Recognizeif your child hasa lot of risk factors for suicideand few protective factors
  20. SeekProfessionalHelp  Finda mental health provider that hasexperience with suicidal youth  Choosea mental health provider with whomyou and your child feel comfortable  Participate actively in therapy with your child  Call 911 or take your child to a hospital in caseof an emergency Suicidal thoughtsor behaviors are a mental health emergency
  21. Intervention Programs  Psychotherapyisan important componentin the managementof suicidal ideation and behaviors  Thereare two documented effective psychotherapies for treating thosewho attempt suicide: Cognitive behavior therapy (CBT) Dialectical behavioral therapy (DBT)for youthdiagnosed with borderline personality disorder and recurrent suicidal ideation
  22. Intervention Programs  Thereare other promising interventions!  Family therapy  Medications
  23. Partner with Schools& Community  Toprevent suicide: Work with schoolsto ensurethat educational suicide prevention programs are offered Collaborate with schoolsonthe development of peer gatekeeper programs related to identifying at-risk peers and encouraging themto seekhelp Work with local sectionsof national suicide prevention organizations to haveoptimal suicide prevention programming available in your community
  24. If YourChild Hasa SuicidalFriend  Havea plan for helping your child: Tellyour teenagers that if a friend saysthat they are going to kill themselves,they shouldinform a trusted adult (i.e. parent, schoolnurse,or guidance counselor)to get professional help for their friend Assureyour child that it isnot their responsibility to decide if their friend’s threat is credible Remindthemnottokeepit a secret!
  25. Immediate Prevention Help  Available 24/7: National Suicide PreventionLifeline: 1-800-273-TALK (8255) TheTrevorProject, a national organization providing crisis intervention and suicide prevention servicesto lesbian, gay, bisexual, transgender, and questioning youth: 1-866-488-7386
  26. Online Prevention Resources  National Associationof SchoolPsychologists: aspx  AmericanAssociationof Suicidology:  AmericanFoundation for Suicide Prevention:  Society for the Preventionof T eenSuicide:  YouthSuicide PreventionProgram (YSPP)
  27. If YouLoseA Child ToSuicide  Get support! Remember in your time of sorrow and sadness, youare not alone Reachout to family, friends, and other community members Engagewith support groups, locally and nationally (including on-line communities) Honoryour loved oneand remember howthey lived Volunteer to help other survivors Participate in communityactivities to prevent suicide
  28. Take Action!  Formoreinformation onsuicidein children and adolescents, AmericanPsychologicalAssociation: AmericanAssociationof Suicidology: FrequentlyAskedQuestions(FAQ)about T eenSuicide Prevention: dePreventionFAQs.pdf
  29. Questions?
  30. References 1. Centersfor DiseaseControl and Prevention, National Center for Injury Prevention and Control. Web-based Injury StatisticsQuery and Reporting System(WISQARS)[online]. (2010). [cited 2012 Oct 19] Available from 2. Centersfor DiseaseControl and Prevention.Youth risk behavior surveillance—United States,2011. MMWR,Surveillance Summaries2012;61(no. SS-4). Available from