Depression and Suicide in Teenagers and Children

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Depression and Suicide in Teenagers and Children

• Dr. J. Sean McKay
• Family Psychology Associates
• April 2006

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Symptoms of depression

• Depressed mood
• Sleep Disturbance
• Appetite/weight disturbance
• Concentration problems
• Loss of interest

• Withdrawal
• Feelings of hopelessness, worthlessness, guilt
• Recurrent thoughts of death/suicide

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Can depression look different in children?

• Anger / Irritability
• Behavior Problems
• Substance abuse
• Academic problems
• Preoccupation with morbid themes

• Heightened expressions of boredom
• Frequent vague, nonspecific physical complaints

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What is suicide?
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What is suicide?

• An act resulting from when a person chooses to
  end their own life to end some sort of suffering
  or pain existing in their current circumstances.

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What is suicide?

• An act resulting from when a person chooses to
  end their own life to end some sort of suffering
  or pain existing in their current circumstances.
• Contrary to what most may think, suicide is not a
  desire to die

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What is suicide?

• An act resulting from when a person chooses to
  end their own life to end some sort of suffering
  or pain existing in their current circumstances.
• Contrary to what most may think, suicide is not a
  desire to die but rather a desire to end of
  feelings of pain (and death is seen as the only
  way)

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Permanent solution to a temporary problem

• Our perception of temporary problems is that they
  seem permanent
• Use your own example of a permanent problem
• Is it still a problem?
• Is it still unmanageable and unbearable?

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Permanent solution to a temporary problem

• At times a person can become so overwhelmed they
  begin to feel there is no solution
• ENDING THE PAIN BY ANY MEANS NECESSARY begins to
  look appealing, often leading to suicidal thoughts

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A Trivia Quiz

• All suicidal teenagers are seriously mentally ill.

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A Trivia Quiz

• All suicidal teenagers are seriously mentally ill.

• False.

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A Trivia Quiz

• All suicidal teenagers are seriously mentally ill.

• False.

• Although extremely unhappy about some life
  circumstance, they are not necessarily mentally
  ill.

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A Trivia Quiz

• Suicide runs in the family.

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A Trivia Quiz

• Suicide runs in the family.

• False.

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A Trivia Quiz

• Suicide runs in the family.

• False.

• It follows an individualized, unique pattern.

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A Trivia Quiz

• Once suicidal, an adolescent will be suicidal
  forever.

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A Trivia Quiz

• Once suicidal, an adolescent will be suicidal
  forever.

• False.

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A Trivia Quiz

• Once suicidal, an adolescent will be suicidal
  forever.

• False.

• Suicidal risk is typically only for a limited
  period of time.

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A Trivia Quiz

• Teenagers always commit suicide without warning.

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A Trivia Quiz

• Teenagers always commit suicide without warning.

• False.

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A Trivia Quiz

• Teenagers always commit suicide without warning.

• False.

• Studies show that people give many clues and
  warnings before committing suicide.

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A Trivia Quiz

• Teenagers who talk about suicide dont commit
  suicide.

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A Trivia Quiz

• Teenagers who talk about suicide dont commit
  suicide.

• False.

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A Trivia Quiz

• Teenagers who talk about suicide dont commit
  suicide.

• False.

• Eight of ten suicide cases gave warnings before
  attempting or completing suicide.

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A Trivia Quiz

• Suicide strikes most often the very rich or the
  very poor teenager.

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A Trivia Quiz

• Suicide strikes most often the very rich or the
  very poor teenager.

• False.

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A Trivia Quiz

• Suicide strikes most often the very rich or the
  very poor teenager.

• False.

• Suicide is represented equally among all levels
  of society.

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A Trivia Quiz

• There is a suicide type of personality who is
  more apt to commit suicide.

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A Trivia Quiz

• There is a suicide type of personality who is
  more apt to commit suicide.

• False.

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A Trivia Quiz

• There is a suicide type of personality who is
  more apt to commit suicide.

• False.

• All appear vulnerable depending on the stresses
  they are experiencing.

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A Trivia Quiz

• When a teenager talks about suicide, change the
  topic and try to get his mind off it.

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A Trivia Quiz

• When a teenager talks about suicide, change the
  topic and try to get his mind off it.

• False.

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A Trivia Quiz

• When a teenager talks about suicide, change the
  topic and try to get his mind off it.

• False.

• Take them seriously. Give them the chance to
  express their feelings. Let them know you are
  concerned and want to help.

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A Trivia Quiz

• Suicide ranks as the third leading cause of death
  among teenagers in the U.S.

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A Trivia Quiz

• Suicide ranks as the third leading cause of death
  among teenagers in the U.S.

• True.

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A Trivia Quiz

• Suicide ranks as the third leading cause of death
  among teenagers in the U.S.

• True.

• Shocking, isnt it? Suicide lags only behind
  accidental injuries and homicides in number of
  deaths nationally.

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A Trivia Quiz

• Usually linked with a teenage suicide (or an
  attempt) is a history of failed communication.

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A Trivia Quiz

• Usually linked with a teenage suicide (or an
  attempt) is a history of failed communication.

• True.

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A Trivia Quiz

• Usually linked with a teenage suicide (or an
  attempt) is a history of failed communication.

• True.

• If a suicidal teenager feels unable or unsafe
  expressing his feelings to others, it only
  worsens feelings of isolation and helplessness.

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A Trivia Quiz

• A teenager will provide clues to those close to
  him prior to the attempting of taking his life.

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A Trivia Quiz

• A teenager will provide clues to those close to
  him prior to the attempting of taking his life.

• True.

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A Trivia Quiz

• A teenager will provide clues to those close to
  him prior to the attempting of taking his life.

• True.

• We have to be very observant, however, since
  these clues can often be indirect and subtle.

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A Trivia Quiz

• There is no reason for a person to beat around
  the bush when a teenager verbally indicates a
  desire to commit suicide.

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A Trivia Quiz

• There is no reason for a person to beat around
  the bush when a teenager verbally indicates a
  desire to commit suicide.

• True.

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A Trivia Quiz

• There is no reason for a person to beat around
  the bush when a teenager verbally indicates a
  desire to commit suicide.

• True.

• In fact, the teenager will probably welcome an
  open and honest conversation.

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Suicide by the numbers

• 2003 national data
• 31,484 deaths by suicide (all ages)

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Suicide by the numbers

• 2003 national data
• 31,484 deaths by suicide (all ages)
• 4,238 of these deaths were age 24 or younger

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Suicide by the numbers

• 2003 national data
• 31,484 deaths by suicide (all ages)
• 4,238 of these deaths were age 24 or younger
• Mortality rankings
• Sixth among 5-14 year olds

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Suicide by the numbers

• 2003 national data
• 31,484 deaths by suicide (all ages)
• 4,238 of these deaths were age 24 or younger
• Mortality rankings
• Sixth among 5-14 year olds
• Third leading cause of death for ages 15-24

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Suicide by the numbers

• 2003 national data
• 31,484 deaths by suicide (all ages)
• 4,238 of these deaths were age 24 or younger
• Mortality rankings
• Sixth among 5-14 year olds
• Third leading cause of death for ages 15-24
• Second among 25-34 year olds

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Suicide by the numbers

• In the past 6 months, about 3 of teenagers have
  attempted suicide

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Suicide by the numbers

• In the past 6 months, about 3 of teenagers have
  attempted suicide
• Within the past 6 months, up to 6 of teenagers
  have considered suicide

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Suicide by the numbers

• In the past 6 months, about 3 of teenagers have
  attempted suicide
• Within the past 6 months, up to 6 of teenagers
  have considered suicide
• By the end of high school, as many as 10 of
  students have made a suicide attempt

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Georgia Suicide Rankings

• Age 10-14
• Males 4th
• Females (not in top 10 causes)
• Combined - 5th

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Georgia Suicide Rankings

• Age 10-14
• Males 4th
• Females (not in top 10 causes)
• Combined - 5th
• Age 15-19
• Males - 3rd
• Females - 7th
• Combined - 4th

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Georgia Suicide Rankings

• Age 20-24
• Males - 3rd
• Females - 3rd
• Combined - 3rd

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Gender Differences in Teen Suicidality

• Suicidal thoughts
• 33 of females
• 20 of males
• Suicide attempts
• 14 of females
• 7 of males

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Gender Differences in Teen Suicidality

• One-half of girls who have attempted suicide have
  mothers who have also made attempts in the past
• Most completed suicides are made by boys WHY?
  the lethality of the attempt
• Girls pills
• Boys firearms

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The Impulsive Nature of Suicide

• 80 of suicides are considered to be impulsive
  acts
• Though the person may have been considering
  suicide for some time, they spend an average of
  only 25 minutes thinking about the act before
  making the attempt

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Correlates of Suicide

• 99 of attempters experience some level of
  depression severity / rates
• Mild 8
• Moderate 14
• Severe 40

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Correlates of Suicide

• 99 of attempters experience some level of
  depression severity / rates
• Mild 8
• Moderate 14
• Severe 40
• Suffering depression makes a person 27 times more
  likely to attempt suicide

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Correlates of Suicide (cont.)

• History of child abuse makes a person 30 times
  more likely to attempt suicide

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Correlates of Suicide (cont.)

• History of child abuse makes a person 30 times
  more likely to attempt suicide
• Substance abuse
• Intoxication associated with as much as 50 of
  all suicides why?
• Poor judgment
• Impulsiveness
• Aggressiveness

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More scary numbers

• 90 of suicide attempts go unrecognized by
  significant others
• 10-20 of all attempters eventually complete
  suicide
• 30-40 of those who complete suicide have made
  previous attempts that go unrecognized
• Still, nearly 50 have no previous suicide history

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Protective Factors

• Religion / spirituality
• Sobriety
• Best friends
• Pet
• Compliance with medication
• Support of significant others

• Counselor / therapist
• Duties to others
• Fear of death
• Positive self-esteem
• Good health

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What are we supposed to look for?
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Warning Signs of Suicidality

• Tendency toward isolation
• Substance abuse
• Low self-esteem
• Sense of powerlessness
• Guilt
• Emotional / psychological pain
• Withdrawal from others / activities / items
• Sexual identity crisis
• Anger / rebelliousness

• DEPRESSION
• Sudden / unusual changes in behavior
• Obsession with death
• Direct or indirect threats
• Giving away items
• Previous attempts
• Poor impulse control
• Conflict with authority
• Sudden improvement in mood sense of peace

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Classroom warning signs

• Abrupt changes in attendance
• Dwindling academic performance
• Sudden failure to complete assignments
• Lack of interest in activities and surroundings
• Changed relationships with friends and classmates
• Increased irritability, moodiness, or
  aggressiveness
• Withdrawal and displays of sadness
• Death and suicidal themes evident in reading
  selections, written essays

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Extracurricular warning signs

• Overhearing remarks indicating profound
  unhappiness or despair
• Observing prized possessions being given away
• Loss of interest in extracurricular activities
• Dropping out of sports and club activities
• Direct suicide threats or attempts
• Marked emotional instability
• Recent suicide in family (watch for anniversary
  dates)
• Heavy use of alcohol or drugs

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So what can we do?

• Know the warning signs!

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So what can we do?

• Know the warning signs!

• Find out the severity of the threat

• Death wish?
• Plan?
• Planned method?
• Environmental risk factors?
• Recent substance abuse?
• Medical illnesses?
• Psychiatric diagnoses?

• Family history of suicide?
• History of impulsivity?
• Has a will been made?
• Any talk of plans for future?
• Social support system present?
• Any recent significant losses?

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So what can we do? (cont.)

• Call suicide by its name
• Absolutely horrible
• nasty
• Hurts a lot of people
• Helps nobody
• Totally selfish
• Final theres no second chance
• (Be sure that it is the ACT of suicide referred
  to, NOT the person)

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So what can we do? (cont.)

• Educate them about suicide share the
  information you have about it

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So what can we do? (cont.)

• Educate them about suicide share the
  information you have about it
• Help the person toward professional care
• DONT keep it a secret
• DONT think it is just a threat take all
  threats seriously
• Listen to them but DONT DARE THEM

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LISTEN!

• DO
• Take seriously anyone who talks about suicide
• Trust your instincts that your friend may be
  hurting and thinking of suicide
• Listen carefully, especially to the feelings
  behind the words
• Encourage expression of feelings is a socially
  appropriate way
• DONT
• Be judgmental
• Give advice
• Try to call a bluff, daring them to do it

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BE HONEST!

• DO
• Offer to go with your friend to get help
• DONT
• Keep a suicide plan a secret
• Wait to notify the appropriate adult better
  to risk a friendship than a life
• Encourage the blaming of others inhibits
  problem solving

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SHARE YOUR FEELINGS!

• DO
• Tell your friend how you feel about their choice
• Be non-judgmental, use calm reassuring voice
• Focus on concrete actions rather than vague plans
• DONT
• Be a cheerful phony do not give the person
  false reassurances

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GET HELP!

• DO
• Get help, even if your friend is reluctant to
  accept it or tells you not to
• Try to understand a friends reluctance to accept
  adult help (shows your caring concern)
• Help them identify support systems
• Identify other resources available to them,
  including counselors and clergy
• Ask for help for yourself when you dont know
  what to do for your friend or child
• DONT
• Delay if the situation is an emergency get help
  as fast as possible