Suicidal Behavior in Adolescence. Completed Suicide: Rates/100,000 (N) by Gender & Ethnicity, Ages 15-19, 2003 CaucasianBlackAm Indian/ Alaska Native.

Suicidal Behavior in Adolescence

Completed Suicide: Rates/100,000 (N) by Gender & Ethnicity, Ages 15-19, 2003

Caucasian Black Am Indian/Alaska Native

Males 12.65(1,047)

6.55(107)

24.65(37)

Females 2.91(227)

0.88(14)

8.97(13)

U.S. Suicide Rates per 100,0001990-2003, ages 15-24

0

2

4

6

8

10

12

14

90 91 92 93 94 95 96 97 98 99 2000 '01 '02 '03

Suicide rates by age group and sexUnited States, 1997

Source: Natl. Center for Health Statistics

0

10

20

30

40

50

600-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+

Age Group in Years

Ra

te p

er 1

00

,000

po

pu

latio

n

MalesFemales

International Comparisons

Age 14 & under, US rate > 2x higher than other industrialized nations

Age 15-24, compared with 47 other nations, US rate at ~66th %ile.

Some nations, suicide rate is flat across age groups– Australia, Canada, Ireland, Costa Rica (i.e., does not increase with age).

International Rates, C’t’d Males with highest rates

in Russia 53.7/100,000, Lithuania (48.6), New Zealand (44.1)

Females with highest rates Cuba 17.9, New Zealand 12.3, Singapore 11.6,

Finland 8.4 Greatest increases in suicide rates:

Males: 154% in Ireland, 95% New Zealand, 87% Northern Ireland,

Females: N. Ireland 213%, Israel 175%, , Norway 91% Greatest Decreases:

Males: 45% Japan, 38% Czechoslovakia & Israel Females: Denmark 87%, Costa Rica 65%, Japan 40%.

Variation in US States (ages 10-19) Alaska 20.74/100,000 Wyoming, S. Dakota, Idaho, New

Mexico, Montana, ranged from 9-12/100,000

New Jersey, California, New York, Mass, 2-3/100,000

Why?? Population density/ social isolation Rural states more poor Lower access to mental health services

Can We Predict Suicide? No. Why Not?

Low base rates (e.g., ages 15-19 in US, approx. 1,700 suicides, of pop. = 20 million).

Too many ‘false positives’ and ‘false negatives’ But, we have identified risk factors which

help to place youth into ‘risk zones’ What we can do is assess risk in a

reasonable, reliable, consistent manner, and document thoroughly

Risk Factors, Predisposing Factors (Percentages)

Ethnic / racial differences: Females, 2003

Caucasian

Black Hispanic

Suicide Attempts

10.3% 9.0 15.0

Suicide Plan

18.6% 12.4 20.7

Seriously Consider Suicide

21.2% 14.7 23.4

Sad/Hopeless

33.3% 30.8 44.9

Risk Factors: Predisposing Factors

Ethnic / racial differences: Males, 2003

Caucasian

Black Hispanic

Suicide Attempts

3.7% 7.7 6.1

Suicide Plan

13.9% 8.4 14.6

Suicidal Ideation

12.0% 10.3 12.9

Sad/Hopeless

19.6% 21.7 25.9

Rates by Grade: Females, 2003

Sad/Hopeless

Ideation

Attempt

9th Grade

35.7 22.2 14.7

10th Gr 36.9 23.8 12.7

11th Gr 35.9 20.0 10.0

12th Gr 32.6 18.0 6.9

Rates by Grade: Males, 2003

Sad/Hopeless

Ideation

Attempts

9th Grade

21.0 11.9 5.8

10th Gr 22.7 13.2 5.5

11th Gr 22.1 12.9 4.6

12th Gr 22.0 13.2 5.2

Overlap of Suicide Attempts and Completed Suicide

Gender breakdown differs Methods used differ

Most common method for completers: firearms, second most common = strangulation

For attempters, most common = self-poisoning Considerable overlap for psychopathology,

family history of psychopathology, precipitating events

Roughly one-third to one-half of completed suicides have made a previous attempt

Presenting Symptoms

Psychiatric disorder present in 80-90% of youth suicides

Males Females

Mood Disorders 50% 69%

Conduct Disorder

43% 24%

Substance Abuse

38% 17%

Anxiety Disorders

19% 48%

Symptoms, continued…

Depression Depressed mood, plus other symptoms on “Student

Interview Worksheet” Irritable/grouchy mood

Hopelessness Mania (Unusually happy/excited, energetic, sure of self for

week or more) Panic Attacks Anger / agitation / impulsivity

Self report: of urgent emotion and need for relief; feeling out of control? If yes, how did you cope deal with that?

Objective: arguments, physical fights, risky behavior

Risk Factors: Predisposing Factors 2

Parental Psychopathology

Youth history of suicidal behavior

History of physical/sexual abuse, family violence, harsh discipline

Risk Factors: Precipitant Stress Recent significant loss

Major academic failure

Significant relationship conflict with family, friends, romantic partner

Unsolvable impasse

Interpersonal Functions of Emotions in Suicidal Behavior Poor family communication:

Avoid direct communication, including communication of emotions (Richman, Orbach, Pfeffer)

Use more indirect , avoidant actions (looks, gestures, walking out, ignoring).

Unexpressed hostility (Pfeffer 81). Suicidal act is a desperate attempt to

communicate

Interpersonal Factors, Ctd. Scapegoating: The “Expendable Child”

(Sabbath,’69). Parents perceive child as threat to their well-

being, and wish (perhaps unconsciously) to be rid of child or for him/her to die. Child thus feels rejected and expendable.

Scapegoating: Parental Rejection: (e,g, Richman, Orbach, others) One child (or other family member) must die, or

fail, to ensure the success of other(s). Parental rejection internalized by child, becomes

self hatred. Child feels burdensome, or that s/he has no right to live.