Suicide Assessment/Self Harm in Youth

Suicide Assessment/Self Harm in Youth

Depression, Self Harm & Suicide in Adolescence ALA Great Stories Club ~ March 10, 2017 Nosheen Hydari, MS, LMFT Licensed Marriage & Family Therapist Objectives Gain an understanding of the rates, myths, risk factors and responses to depression and suicidality in adolescence Increase awareness and provide information about the prevalence of depression, self harm, psychosis and conflicts of attachment as contributors of suicidal ideation Empower program facilitators to engage comfortably with a teen who is expressing issues with his/her mental health, and address teens mental health needs if/as they arise

Decrease future negative behaviors and risk of youth participating in GSC programs Depression in Todays Teens Approximately 20% of teens will experience depression before they reach adulthood Between 10 to 15 percent of teenagers have some symptoms of depression at any one time Depression increases a teens risk for attempting suicide by 12 times 30% of teens with depression also develop a substance abuse problem Depressed teens are more likely to have trouble at school and in jobs, and to struggle with friendships and relationships Depressed teens present more irritable/angry vs. sad/low Physical symptoms (psychosomatic vs. self-harm) Depressed teens are specifically vulnerable to criticism, due to feelings of low self worth, rejection and failure Teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd. Taken from I Need a Lighthouse (Teen Depression, n.d.) Depression When Untreated

Problems at school Running away School Refusal Substance abuse Low self-esteem Eating disorders

Internet addiction Self-injury Reckless behavior Aggression Violence Suicide Self-Harm: What You Need to Know While self-harm is found in 4060% of suicides, its more often used as a coping tool on its own rather than a means to initiate suicide Cutting: allows youth to feel after a state of numbing (likely caused by increased emotional overwhelment); releases endorphins resulting in feeling pleasure and relief Self-harm like cutting and scratching, is most prevalent in adolescents identifying as female, and is on a wide spectrum (superficial cuts -> attention-seeking; deeper and/or hidden cuts -> more risk of harm and potential threat of suicidality)

Head banging and punching ones body is typically done in a less private manner, and tends to be seen in adolescents identifying as male as a means to release their frustration Suicidality Overview Definition: the intent to cause self-injury or death, regardless of the cognitive ability to understand finality, lethality, or outcomes thoughts and/or actions that if fully carried out may lead to serious self-injury or death. (Pfeffer, 1997) Differentiating between problem behavior and acute symptomology Adolescents are divided into three groups based on the lethality of their attempts (e.g., low, medium, high). Treatment recommendations: Targeted toward the level of lethality Can potentially include discharge with a plan of outpatient follow-up (with low-risk patients)

Attempts by youth are likely indicative of a serious disturbance in social, emotional, cognitive, or family functioning. In this case, referring to an inpatient psychiatric setting is indicated. Statistics Suicide is the now the second leading cause of death for 15 - 24 year olds. Every minute, a child attempts suicide; and, every 12.3 minutes, a child is successful Over 20% of youth between the ages of 13 and 18 suffer from a mental health condition. In the past decade, the number of teens prescribed psychotropic drugs has increased sevenfold Firearms are the most commonly used method of suicide by males 75% of all suicides show a warning sign Prepubertal children who have attempted suicide previously may be up to six times more likely to attempt suicide in adolescence, as such behavior may begin with relatively low intent and lethality and increase Findings suggested that the offspring of suicide attempters had a 6-fold increased risk of suicide attempts relative to offspring of non-attempters.

Considerations Problems with a romantic relationship, conflicts with parents and disciplinary crises are potential suicide precipitants for adolescents Tweens are emotionally linked to their peers with a strong emphasis on "group think" - to be accepted implies being like your peers Teenage years are developmentally the testing of boundaries, the passion to explore what is unknown and exciting (from Dan Siegels Brainstorm) Feelings of hopelessness and anger, as well as psychotic symptoms such as hearing voices directing the children to kill themselves, were also associated with suicidality Myths About Suicide Acknowledging and validating suicidal thoughts will validate suicidal acts Suicidality is impulsive (hormone-induced)

Suicide is not preventable (esp. as it relates to family history) (taken from NPRs Middle School Suicides Reach An All-Time High 2016) Hallucinations: Hearing Voices and Seeing Things HALLUCINATION: an experience involving the apparent PERCEPTION of something not present EGO: a persons sense of self-esteem or self-importance EGOSYNTONIC: thoughts/behaviors/values/feelings that are in harmony or acceptable to the needs and goals of the ego or consistent with ones ideal self-image EGODYSTONIC: thoughts/behaviors/values/feelings that are in conflict with the needs and goals of the ego leading to a conflict with a persons IDEAL self-image Hallucinations:

Hearing Voices and Seeing Things Intrusive negative thoughts can take hold as hallucinations, often in absence of a secure attachment relationship in the youths life; internal voices are reflective of ego Auditory hallucinations typically reinforce criticisms (youth who experience AHs are more likely to experience suicidal ideation) Auditory hallucinations present as a different voice than ones own, or a scarier version of ones own voice (dominantly negative) Visual hallucinations can present as shadows or people Hallucinations are symptomatic of decreased connection and increased isolation Suicidality: Risk Factors

Maltreatment/Abuse (physical/sexual/emotional) Poverty, poor family cohesion, divorce, experiencing multiple Social Isolation (Vulnerability to critical thoughts) transitions in the living situation, loss (death, separation, termination of a relationship w/a loved one) Access to a weapon Exposure to trauma/violence IQ (controversial) School Problems Previous Suicide Attempts Presence of psychiatric diagnosis (affective disorders, disruptive/conduct disorders, and

schizophrenia, ADHD, Conduct D/O, ODD) Bullying Family history of psychopathology and suicide Parental incarceration Preoccupation with death Sexual Orientation Feelings of Hopelessness Anger/aggression Race (Native American and White youth have highest rates; Latino youth have lowest rates) Insomnia

Substance Abuse Referrals to Child Welfare/DCFS-involved youth Self-harm (and longer length of time in child welfare system) How to Talk About Suicidality: Questions to Ask A best practice for the GSC groups may be to introduce the literature and subject matter, with a discussion of the possible mental health issues that group members are currently experiencing/may experience; note that facilitators will be available if personal mental health concerns are present (clarify degree of availability, access to a mental health staff or co-facilitator in cases that there is one provided, etc.) One-on-one conversation w/teen (important to establish safety and trust); tracking using a scale Research suggests child is the most important informant, because parents tend to underestimate the presence and frequency of childrens suicidality. (One study found that parents of approximately 75% of participants reporting suicidal ideation were unaware of this problem.)

Do you ever think about hurting yourself? Do you ever feel sad enough that it makes you want to not be around? Do you feel like crying a lot? Did you think that you would die from taking those pills, or cutting your arms with that knife, etc.? Do you want to die? Assess depressive symptoms: sleep, appetite, concentration, energy level, fatigue, feelings of worthlessness, selfesteem, guilt, anger irritability, agitation, general mood, coping skills, etc. How to Talk About Suicidality (cont.) If risk is expressed -> Involve Guardian in conversation Link to a mental health entity (Hospital, Clinic, outpatient mental health facility) In Illinois, SASS Program assesses youth in crisis under

Public Aid (call CARES line to report current crisis leading to a crisis assessment; similar programs across the U.S.) Assessment Low Risk of Suicide Attempt (Outpatient Services) High Risk of Suicide Attempt (Hospitalization) Ideation with a Plan (degree of Ideation without a Plan (passive ideation) Low method of lethality Home environment is positive Supportive caregiver to monitor and help engage in psych treatment

Child and caregiver able to create a safety plan Reasons to live (plans for future) V S planning) High method of lethality Ability to carry out plan The home environment is detrimental Caregiver is unsupportive Child and caregiver are unable to engage in safety planning No identified reasons to live/future

plans ED Medical Assessment Model Solutions Strengths-based conversations Check-ins (tracking) Mindfulness apps: Buddhify, Headspace, Smiling Mind, Omvana (start and end your group with a mindfulness exercise) Brain breaks Smartphone usage: social media for good Practicing safe coping skills

Safety planning; identifying supports Illicit laughter Resources for Further Information I Need a Lighthouse 1-800-SUICIDE (1.800.784.2433) National Suicide Prevention Lifeline 1-800-273-TALK (8255) In Illinois: CARES Crisis Assessment Line 1-800-345-9049 American Foundation for Suicide Prevention References

Doshi A, Boudreaux ED, Wang N, Pelletier AJ, Camargo CA Jr. National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001. Ann Emerg Med. 2005; 46:36975. Hawton K., Zahl D. and Weatherall, R. (2003), "Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital", British Journal of Psychiatry, 182: 537 542, doi:10.1192/bjp.182.6.537 Nadworny, Elissa. (2016), Middle School Suicides Reach An All-Time High, NPR.

Pfeffer CR. Childhood suicidal behavior: a developmental perspective. Psychiatric Clinic North Am. 1997; 20:55162. "Suicide Prevention: Youth Suicide". 30 March 2006. Retrieved 2 February 2017. Teen Depression. (n.d.) Tishler, C. L., Reiss, N. S. and Rhodes, A. R. (2007), Suicidal Behavior in Children Younger than Twelve: A Diagnostic Challenge for Emergency Department Personnel.

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