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Suicide Prevention:Suicide Prevention:Facts, and MythsFacts, and Myths

Counseling 407Counseling 407

Community CounselingCommunity Counseling

Dr. Jeff EdwardsDr. Jeff Edwards

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Suicides Peak in the Spring and Fall Suicides Peak in the Spring and Fall Suicide is a serious public health problem accounting for Suicide is a serious public health problem accounting for

between .4 and .9% of the deaths in the U.S. The CDC between .4 and .9% of the deaths in the U.S. The CDC also report that in the population at large it is the eighth also report that in the population at large it is the eighth leading cause of death; but among adolescents, the third leading cause of death; but among adolescents, the third leading cause. In l998, 30,551 Americans took their own leading cause. In l998, 30,551 Americans took their own lives, while in 2002, 31,655 Americans took their own lives. lives, while in 2002, 31,655 Americans took their own lives.

In the most recent year for which detailed national data are In the most recent year for which detailed national data are available (1996), November and December rank the lowest available (1996), November and December rank the lowest in the number of daily suicides. Spring and Fall are by the in the number of daily suicides. Spring and Fall are by the far the riskiest seasons for suicides in the US. Although far the riskiest seasons for suicides in the US. Although research indicates that suicides may increase for a brief research indicates that suicides may increase for a brief period after New Years day, January still remains one of period after New Years day, January still remains one of lowest months for suicide risk in the US. lowest months for suicide risk in the US.

*Centers for Disease Control and Pre*Centers for Disease Control and Preventionvention

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CDC Suicide: Fact Sheet*CDC Suicide: Fact Sheet* OccurrenceOccurrence Most popular press articles suggest a link between the Most popular press articles suggest a link between the

winter holidays and suicides (Annenberg Public Policy winter holidays and suicides (Annenberg Public Policy Center of the University of Pennsylvania 2003). However, Center of the University of Pennsylvania 2003). However, this claim is just a myth. In fact, suicide rates in the United this claim is just a myth. In fact, suicide rates in the United States are lowest in the winter and highest in the spring States are lowest in the winter and highest in the spring (CDC 1985, McCleary et al. 1991, Warren et al. 1983). (CDC 1985, McCleary et al. 1991, Warren et al. 1983).

Suicide took the lives of 30,622 people in 2001 (CDC Suicide took the lives of 30,622 people in 2001 (CDC 2004). 2004).

Suicide rates are generally higher than the national Suicide rates are generally higher than the national average in the western states and lower in the eastern and average in the western states and lower in the eastern and midwestern states (CDC 1997). midwestern states (CDC 1997).

In 2002, 132,353 individuals were hospitalized following In 2002, 132,353 individuals were hospitalized following suicide attempts; 116,639 were treated in emergency suicide attempts; 116,639 were treated in emergency departments and released (CDC 2004). departments and released (CDC 2004).

In 2001, 55% of suicides were committed with a firearm In 2001, 55% of suicides were committed with a firearm (Anderson and Smith 2003).(Anderson and Smith 2003).   

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Groups At RiskGroups At Risk MalesMales Suicide is the eighth leading cause of death for all U.S. Suicide is the eighth leading cause of death for all U.S.

men (Anderson and Smith 2003). men (Anderson and Smith 2003). Males are four times more likely to die from suicide than Males are four times more likely to die from suicide than

females (CDC 2004). females (CDC 2004). Suicide rates are highest among Whites and second Suicide rates are highest among Whites and second

highest among American Indian and Native Alaskan men highest among American Indian and Native Alaskan men (CDC 2004). (CDC 2004).

Of the 24,672 suicide deaths reported among men in 2001, Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm (Anderson and Smith 60% involved the use of a firearm (Anderson and Smith 2003). 2003).

FemalesFemales Women report attempting suicide during their lifetime about Women report attempting suicide during their lifetime about

three times as often as men (Krug et al. 2002). three times as often as men (Krug et al. 2002).

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YouthYouthThe overall rate of suicide among youth has declined slowly The overall rate of suicide among youth has declined slowly since 1992 (Lubell, Swahn, Crosby, and Kegler 2004). since 1992 (Lubell, Swahn, Crosby, and Kegler 2004). However, rates remain unacceptably high. Adolescents and However, rates remain unacceptably high. Adolescents and young adults often experience stress, confusion, and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, depression from situations occurring in their families, schools, and communities. Such feelings can overwhelm young people and communities. Such feelings can overwhelm young people and lead them to consider suicide as a “solution.” Few schools and lead them to consider suicide as a “solution.” Few schools and communities have suicide prevention plans that include and communities have suicide prevention plans that include screening, referral, and crisis intervention programs for youth.screening, referral, and crisis intervention programs for youth.

Suicide is the third leading cause of death among young Suicide is the third leading cause of death among young people ages 15 to 24. In 2001, 3,971 suicides were reported in people ages 15 to 24. In 2001, 3,971 suicides were reported in this group (Anderson and Smith 2003). this group (Anderson and Smith 2003).

Of the total number of suicides among ages 15 to 24 in 2001, Of the total number of suicides among ages 15 to 24 in 2001, 86% (n=3,409) were male and 14% (n=562) were female 86% (n=3,409) were male and 14% (n=562) were female (Anderson and Smith 2003). (Anderson and Smith 2003).

American Indian and Alaskan Natives have the highest rate of American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group (CDC 2004). suicide in the 15 to 24 age group (CDC 2004).

In 2001, firearms were used in 54% of youth suicides In 2001, firearms were used in 54% of youth suicides (Anderson and Smith 2003). (Anderson and Smith 2003).

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The ElderlyThe ElderlySuicide rates increase with age and are very high among Suicide rates increase with age and are very high among those 65 years and older. Most elderly suicide victims are those 65 years and older. Most elderly suicide victims are seen by their primary care provider a few weeks prior to seen by their primary care provider a few weeks prior to their suicide attempt and diagnosed with their first episode their suicide attempt and diagnosed with their first episode of mild to moderate depression (DHHS 1999). Older adults of mild to moderate depression (DHHS 1999). Older adults who are suicidal are also more likely to be suffering from who are suicidal are also more likely to be suffering from physical illnesses and be divorced or widowed (DHHS physical illnesses and be divorced or widowed (DHHS 1999; Carney et al. 1994; Dorpat et al. 1968).1999; Carney et al. 1994; Dorpat et al. 1968).

In 2001, 5,393 Americans over age 65 committed suicide. In 2001, 5,393 Americans over age 65 committed suicide. Of those, 85% (n=4,589) were men and 15% (n=804) were Of those, 85% (n=4,589) were men and 15% (n=804) were women (CDC 2004). women (CDC 2004).

Firearms were used in 73% of suicides committed by Firearms were used in 73% of suicides committed by adults over the age of 65 in 2001 (CDC 2004). adults over the age of 65 in 2001 (CDC 2004).

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  Risk FactorsRisk Factors

The first step in preventing suicide is to identify and The first step in preventing suicide is to identify and understand the risk factors. A risk factor is anything that understand the risk factors. A risk factor is anything that increases the likelihood that persons will harm themselves. increases the likelihood that persons will harm themselves. However, risk factors are not necessarily causes. Research However, risk factors are not necessarily causes. Research has identified the following risk factors for suicide (DHHS has identified the following risk factors for suicide (DHHS 1999):1999):

Previous suicide attempt(s) Previous suicide attempt(s) History of mental disorders, particularly depression History of mental disorders, particularly depression History of alcohol and substance abuse History of alcohol and substance abuse Family history of suicide Family history of suicide Family history of child maltreatment Family history of child maltreatment Feelings of hopelessness Feelings of hopelessness Impulsive or aggressive tendencies Impulsive or aggressive tendencies

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Barriers to accessing mental health treatment Barriers to accessing mental health treatment Loss (relational, social, work, or financial) Loss (relational, social, work, or financial) Physical illness Physical illness Easy access to lethal methods Easy access to lethal methods Unwillingness to seek help because of the stigma Unwillingness to seek help because of the stigma

attached to mental health and substance abuse attached to mental health and substance abuse disorders or suicidal thoughts disorders or suicidal thoughts

Cultural and religious beliefs—for instance, the Cultural and religious beliefs—for instance, the belief that suicide is a noble resolution of a belief that suicide is a noble resolution of a personal dilemma personal dilemma

Local epidemics of suicide Local epidemics of suicide Isolation, a feeling of being cut off from other Isolation, a feeling of being cut off from other

peoplepeople   

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Protective FactorsProtective Factors Protective factors buffer people from the risks Protective factors buffer people from the risks

associated with suicide. A number of protective associated with suicide. A number of protective factors have been identified (DHHS 1999):factors have been identified (DHHS 1999):

Effective clinical care for mental, physical, and Effective clinical care for mental, physical, and substance abuse disorders substance abuse disorders

Easy access to a variety of clinical interventions Easy access to a variety of clinical interventions and support for help seeking and support for help seeking

Family and community support Family and community support Support from ongoing medical and mental health Support from ongoing medical and mental health

care relationships care relationships Skills in problem solving, conflict resolution, and Skills in problem solving, conflict resolution, and

nonviolent handling of disputes nonviolent handling of disputes Cultural and religious beliefs that discourage Cultural and religious beliefs that discourage

suicide and support self-preservation instincts suicide and support self-preservation instincts

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The following information is from David Capuzzi’s book on The following information is from David Capuzzi’s book on Suicide Prevention in the Schools. He suggests that you can Suicide Prevention in the Schools. He suggests that you can make handouts or over heads from this information to use in make handouts or over heads from this information to use in

teaching others about suicide.teaching others about suicide.

Suicide Prevention:Suicide Prevention: UNDERSTANDING THE MYTHSUNDERSTANDING THE MYTHS Adolescents who talk about suicide never Adolescents who talk about suicide never

attempt suicide.attempt suicide. Suicide happens with no warning.Suicide happens with no warning. Adolescents from affluent families attempt Adolescents from affluent families attempt

or complete suicide more often than or complete suicide more often than adolescents from poor families.adolescents from poor families.

Once an adolescent is suicidal, he or she is Once an adolescent is suicidal, he or she is suicidal forever.suicidal forever.

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• • If an adolescent attempts suicide and If an adolescent attempts suicide and survives, he or she will never make an survives, he or she will never make an additional attempt.additional attempt.

• • Adolescents who attempt or complete Adolescents who attempt or complete suicide always leave notes.suicide always leave notes.

Most adolescent suicides happen late at Most adolescent suicides happen late at night or during the predawn hours.night or during the predawn hours.

Never use the word suicide when talking to Never use the word suicide when talking to adolescents, because using the word gives adolescents, because using the word gives some adolescents the idea.some adolescents the idea.

Every adolescent who attempts suicide is Every adolescent who attempts suicide is depressed.depressed.

Suicide is hereditary.Suicide is hereditary.

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RECOGNIZING THE PROFILERECOGNIZING THE PROFILE

(BEHAVIORS)(BEHAVIORS) Lack of concern about personal Lack of concern about personal

welfare.welfare. Changes in social patterns.Changes in social patterns. A decline in school achievement.A decline in school achievement. Difficulty in concentrating.Difficulty in concentrating. Altered sleeping and eating patterns.Altered sleeping and eating patterns.

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Suicide Prevention in the Schools: Guidelines for Suicide Prevention in the Schools: Guidelines for Middle and High School SettingsMiddle and High School Settings

RECOGNIZING THE PROFILERECOGNIZING THE PROFILE (BEHAVIORS)(BEHAVIORS) Attempts to put personal affairs in order or to Attempts to put personal affairs in order or to

make amends.make amends. Use or abuse of alcohol or drugs.Use or abuse of alcohol or drugs. Unusual interest in how others are feeling.Unusual interest in how others are feeling. Preoccupation with death and violence themes.Preoccupation with death and violence themes. Sudden improvement after a period of depression.Sudden improvement after a period of depression. Sudden or increased promiscuity.Sudden or increased promiscuity.

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RECOGNIZING THE PROFILERECOGNIZING THE PROFILE(VERBAL CUES)(VERBAL CUES)

No “universal” language for communicating suicidal intentions.No “universal” language for communicating suicidal intentions. Ask for clarification of what you hear: “Could you say a little Ask for clarification of what you hear: “Could you say a little

more about what you mean when you say. more about what you mean when you say. Paraphrase to communicate that you listened and to check Paraphrase to communicate that you listened and to check

accuracy: “You are really discouraged and upset about……..” accuracy: “You are really discouraged and upset about……..”

RECOGNIZING THE PROFILERECOGNIZING THE PROFILE (VERBAL CUES)(VERBAL CUES) “ “You won’t be seeing me for my appointment on Monday.”You won’t be seeing me for my appointment on Monday.” “ “I’m going home.”I’m going home.” “ “I thought about something I’m afraid to tell anyone about.”I thought about something I’m afraid to tell anyone about.” ““I’m tired.”I’m tired.” ““I wonder what death is like.”I wonder what death is like.” “ “She’ll be sorry about how she treated me.”She’ll be sorry about how she treated me.”

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RECOGNIZING THE PROFILERECOGNIZING THE PROFILE(THINKING PATTERNS AND (THINKING PATTERNS AND

MOTIVATIONS)MOTIVATIONS)

Motivations of suicidal adolescents can Motivations of suicidal adolescents can be understood more readily when be understood more readily when suicide is viewed as fulfilling one of suicide is viewed as fulfilling one of three primary functions:three primary functions:

AvoidanceAvoidance ControlControl CommunicationCommunication

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RECOGNIZING THE PROFILERECOGNIZING THE PROFILE (THINKING PATTERNS AND (THINKING PATTERNS AND

MOTIVATIONS)MOTIVATIONS) Wanting to escape an intolerable Wanting to escape an intolerable

situation.situation. Wanting to join someone who has died.Wanting to join someone who has died. Wanting to attract the attention of Wanting to attract the attention of

family or friends.family or friends. Wanting to manipulate someone else.Wanting to manipulate someone else. Wanting to avoid punishment.Wanting to avoid punishment.

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RECOGNIZING THE PROFILERECOGNIZING THE PROFILE (THINKING PATTERNS AND (THINKING PATTERNS AND

MOTIVATIONS)MOTIVATIONS) Wanting to be punished.Wanting to be punished. Wanting to control when or how Wanting to control when or how

death will occur.death will occur. Wanting to end a conflict.Wanting to end a conflict. Wanting to punish the survivors.Wanting to punish the survivors. Wanting revenge.Wanting revenge.

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RECOGNIZING THE PROFILERECOGNIZING THE PROFILE(PERSONALITY TRAITS)(PERSONALITY TRAITS)

Low self-esteemLow self-esteem Hopelessness/helplessnessHopelessness/helplessness IsolationIsolation High stressHigh stress Acting outActing out Need to achieveNeed to achieveRECOGNIZING THE PROFILE (PERSONALITY TRAITS)RECOGNIZING THE PROFILE (PERSONALITY TRAITS) Poor communication skillsPoor communication skills Other-directednessOther-directedness GuiltGuilt DepressionDepression Poor problem-solving skillsPoor problem-solving skills

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ADOLESCENT BEHAVIOR THAT MAY BEADOLESCENT BEHAVIOR THAT MAY BESYMPTOMATIC OF DEPRESSIONSYMPTOMATIC OF DEPRESSION

MASKED ADOLESCENT SYMPTOMSMASKED ADOLESCENT SYMPTOMS Reckless behaviorReckless behavior Boredom, lethargyBoredom, lethargy PromiscuityPromiscuity Running awayRunning away DefianceDefiance TruancyTruancy Antisocial behaviorAntisocial behavior Drug or alcohol abuseDrug or alcohol abuse Complaints of illnessComplaints of illness

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HOW YOU CAN HELPHOW YOU CAN HELP Assess the suicidal risk.Assess the suicidal risk. Listen and paraphrase.Listen and paraphrase. Evaluate the seriousness of the young person’s Evaluate the seriousness of the young person’s

situation.situation. Take every complaint and feeling the person Take every complaint and feeling the person

expresses seriously.expresses seriously. Begin to broaden the person’s perspective of his Begin to broaden the person’s perspective of his

or her past and present situation.or her past and present situation. Be positive in your outlook about the future.Be positive in your outlook about the future. Evaluate available resources.Evaluate available resources. Accompany the student to the counselor or crisis Accompany the student to the counselor or crisis

team member.team member.

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Form 7 Suicide ContractForm 7 Suicide Contract

Date: Date:

I, I, ____________ , (client), hereby contract with , (client), hereby contract with (therapist), that I will (therapist), that I will take the following actions if I feel suicidal.take the following actions if I feel suicidal.

1. I will not attempt suicide.1. I will not attempt suicide. 2. I will phone 2. I will phone at at .. 3. If I do not reach 3. If I do not reach , I will phone any of the following services: , I will phone any of the following services: Name/AgencyName/Agency PhonePhone

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4.4. I will further seek social supports from any of the following I will further seek social supports from any of the following people:people:

NameName PhonePhone 5.5. If none of these actions are helpful or not available, I will If none of these actions are helpful or not available, I will

check-in check-in the ER at one of the following:the ER at one of the following: HospitalHospital AddressAddress PhonePhone

6. If I am not able I will phone 911, or 0 for help.6. If I am not able I will phone 911, or 0 for help.

Client’s signature: Client’s signature: Date: Date: ////

Therapist’s signature: Therapist’s signature: Date: Date: ////

The S.L.A.P. ScaleThe S.L.A.P. Scale

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The S.L.A.P. ScaleThe S.L.A.P. Scale