Transcript Suicide

Depression
Depression Signs and Symptoms
 At Least 5 of the 9 for a two week period
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Depressed mood most of the day
Reduced interest in pleasurable activities
Weight changes
Sleep Problems
Psychomotor agitation or retardation
Lack of energy and motivation
Poor concentration
Feelings of worthlessness
Thoughts of death
Sex Differences in Depression
 Females (2-3 x more likely)
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Self-Image and Body Image (female<male)
Hormonal Changes Alter Vulnerability to MDD
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Diathesis-Stress Model (predisposition+stressor)
Females tend to focus on emotions and related
thoughts more than males
Females face more discrimination
 Males
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Expression
Depression: Risk Factors
 Unavailable or Neglectful Parents
 Having a Depressed Parent
 Family or Marital Conflict
 Poor Peer Relations
 Romantic Relationship Problems
 Transitions
 Previous Depression Predicts Future
Depression
Treatment
 Cognitive Behavioral Therapy
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Challenges
 Medication
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Does it increase risk of suicide?
Suicide
Suicide
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Ninth leading cause of death for adults in U.S.
At least 2/3 of suicide attempters are under 35
Every 20 minutes someone in the U.S. suicides
May be as many as 6 million attempts per year
Women are 3 -4 times more likely to attempt
suicide
 Men are 4-5 times more likely to succeed
 Rates of attempts are 3-4 times higher in
people who are divorced or separated
 Most attempts are related to relational discord
 Guns are the means in 60% of suicides
Adolescent Suicide
 Seventh leading cause of death in 5-14 yo.
 Third leading cause of death in 15-24 yo.
 First two are accidents and homicides)
 Suicide rate in teens tripled from 1950’s to mid 1980’s.
 Similar trends were noted in 23 out of 29 countries studied
(Lester, 1988).
 Between 7-16% of high school students report an attempt
 Between 4-8% of 11th and 12th graders an attempt
 These are the highest rates of attempts at any point in the
life span (large proportion have low lethality).
 However, 9% of males in this age range and 1-4% of
females complete within 5 years.
Risk Factors for Adolescent Suicide
 Mental Disorders (more = more risk)
 Conduct Disorder and Substance Abuse are
more common in completers.
 Mood Disorders (Depression & Anxiety) are
more common among nonfatal attempters.
 Negative Life Events (emotional pain)
 Availability of Firearms in the home.
 Stage of Life Transitions (autonomy vs control)
 Genetic Factors (twin studies )
 Hospitalized pts with Low Serotonin 10x risk
 Contagion factors 1-13% (Velting, 1997)
Sex Differences
 Females attempt more often
 Self-Image and Body Image (female<male)
 Hormonal changes alter vulnerability to MDD
 Females tend to focus on emotions and
related thoughts more than males
 Females face more discrimination
 Males
 Emotional expression and suicide are counter
male culture
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Buck-it-up dude!
Suicide: Assessment
How do I know?
Assessment of Risk I.
 Depressive Disorders and other Mental
Health problems
 Alcoholism and other Substance Abuse
 Suicide Ideation
 Prior Attempts
 Lethal Methods
 Isolation (friends and family)
 Cognitive Rigidity (Hopelessness)
Assessment of Risk II.
 Modeling (suicide in the family)
 Economic or Work Problems
 Marital Problems
 Stress and Stressful Events
 Anger, Aggression, Irritability
 Physical Illness
 Giving Away Personal Items
 Sudden Happiness
 Repetition and Combination of All Factors
Why do adolescents
suicide?
Psychache?
 In almost every case suicide is caused by pain, a certain kind of pain—psychological
pain, or “psychache”… Suicidal death, in other words, is an escape from pain… Pain is
nature’s great signal. Pain warns us; pain both mobilizes us and saps our strength;
pain, by its very nature, makes us want to stop it or escape from it… Psychache is the
hurt, anguish or ache that takes hold in the mind. It is intrinsically psychological, the
pain of excessively felt shame, guilt, fear, anxiety, loneliness, angst, and dread of
growing old or of dying badly. When psychache occurs, its introspective reality is
undeniable. Suicide happens when the psychache is deemed unbearable and death is
actively sought to stop the unceasing flow of painful consciousness. Suicide is a tragic
drama in the mind (Schneidman, 1997, pp 23, 29)
Why Suicide?
 Psychache
 Stressors exceed ones adaptive capacity
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Limited support network
Chronic history of instability
Acute life event
Cognitive limitations (problem solving, impulsivity)
 Genetic and Biological Factors
 Physiology and Chemistry
 Personality
 Neuroticism- (high negative emotionality)
 Copy Cat or Contagion Effect
Intervention
 Be Direct
 Pay Attention
 Accept the Person without Judgment
 Be Calm
 Assure
 Seek help
Prevention
 Intensive individualized attention
 Community-wide multi-agency collaborative
approaches
 Early identification and intervention
The Impact of
Suicide