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Addressing Youth
Depression &
Suicidal Ideation in
a Post-Pandemic
World
Cirecie West-Olatunji,
Ph. D.
Xavier University of
Louisiana
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Learning Objectives2
Acquire
•Acquire new knowledge about suicidality related to vulnerable youth.
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Increase
• Increase awareness about how marginalized, vulnerable, and at-risk youth are uniquely impacted by environmental influences.
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Augment
•Augment understanding of suicide prevention and intervention skills.
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Overview3
Suicide rates for Youth
Suicide and Infectious Disease
Suicide & Environmental Influences
Suicide Prevention & Intervention
Teletherapy & Telesupervision
Culture-centered Theory and Social Justice
Secondary Traumatic Stress Among Service Providers
Transforming Your Practice
Definitions4
Suicide: Death caused by self-directed injurious behavior with any intent to die.
Suicide attempt: A non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury.
Suicidal ideation: Thinking about, considering, or planning for suicide
(Centers for Disease Control [CDC], 2014)
Suicide
Rates in
the U.S.
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Data from the National Vital Statistics System, Mortality (Hedegaard, Curtin, & Warner, 2020) indicate:
• From 1999 through 2018, the suicide rate increased 35%, from 10.5 per 100,000 to 14.2.
• The rate increased on average approximately 1% per year from 1999 to 2006 and by 2% per year from 2006 through 2018.
• In 2018, the suicide rate for males was 3.7 times the rate for females (22.8 and 6.2, respectively).
• From 1999 through 2018, suicide rates among females were highest for those aged 45–64; among males, the rates were highest for those aged 75 and over.
• In 2018, suicide rates were higher in the most rural counties compared with the most urban counties for both males and females.
• Suicide is the 10th leading cause of death for all ages in the United States
Suicide
and
Disaster-
affected
Clients
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MHA Suicide Prevention Summit 2021-July
Highly traumatic, especially for children
Complicated grief issues
Responses of family and support members are often accompanied by guilt and shame
Suicide Rates for Disaster-affected Clients
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Young adults are at higher risk
to develop psychological
concerns (Riaz et al., 2015).
Technological disasters cause
significantly more intense and
enduring patterns of social,
economic, cultural and
psychological outcomes than
natural disasters.
Terrorism causes increased
levels of post traumatic stress
disorder (PTSD) than natural
disasters.
Females suffer more after a
natural disaster than their male
counter parts.
Pandemics as
Disasters8
Suicide
and
Infectious
Disease
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MHA Suicide Prevention Summit 2021-July
Hospitalization with infection has been associated with an elevated risk of suicide (Lund-Sorenses, Benros, Madsen, et al., 2016)
While activating the immune system can aid in fighting the infection, immune activation may also modify neurochemistry to cause individuals to feel suicidal (Kaltwassser, 2019, July)
Coronavirus and Suicide
Prevalence
In the U.S., suicide rates are at their highest
levels since World War II.
Factors, such as:
economic stress
social isolation
reduced access to religious services
overall national anxiety (probably due to
the toxic political climate) (Czeisler, Lane,
Petroysky et al., 2020).
Coronavirus and Suicide Prevalence
❑ Of note, there have been increases in:Health care provider suicide (ex.: New York–Presbyterian
Hospital emergency room director Lorna Breen, who died
by suicide in April)
Firearm sales
❑ Certain populations are more at risk for potential suicidal
thoughts, including: people who have contracted COVID-19,
those with preexisting conditions/immuno-compromised
individuals, and
those with histories of substances abuse (Reger, Stanley,
& Joiner, 2020)
❑ Suicide rates among young Americans and people of color were rising even before the pandemic.
❑ For Black children, in particular, there were 2.55 suicides per 100,000 children in 2007; in 2017, suicide rates for this population rose to 4.82 per 100,000.
Youth Suicide &
Environmental Influences
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Race-based Stress
Bullying (online and face-to-face)
Body Image Concerns
Human Trafficking & Sexual Abuse
Race-based Stress
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Suicide rates among young Americans and people of color were rising even before the pandemic.
For example, among Black children, there were 2.55 suicides per 100,000 children in 2007; in 2017, suicide rates for this population rose to 4.82 per 100,000.
Bullying14
Children who self-reported frequently bullying others are at
high and long-term risk for suicide-related behaviors.
Youth who self-report being frequently bullied by others are
at increased risk of suicide-related behaviors as well as
negative physical/mental health issues.
Young people who self-report both being bullied and
bullying others have the highest rates of negative mental
health outcomes such as, depression, anxiety, and suicidal
ideation.
(Centers for Disease Control [CDC], 2014)
Body
Image15
Body dissatisfaction has been linked to
risk-taking behaviors and mental health
problems.
Body dissatisfaction and a pressure to
be thin have been linked to depressive
symptoms and symptoms of anxiety
disorders, such as social anxiety or
panic disorder.
Impact of social media:
One study showed that, for youth,
Internalization of ideal body shapes, as
presented in the media, predicted
negative emotions about appearance.
(Mental Health Foundation, 2019)
Human Trafficking & Sexual Abuse16
Many victims are women and girls, though men and boys are also impacted
Victims include all races, ethnicities, sexual orientations, gender identities, citizens, non-citizens, and income levels
Victims are trapped and controlled through assault, threats, false promises, perceived sense of protection, isolation, shaming, and debt
Victims do not have to be physically transported between locations to be victimized
Mental health outcomes:
• depression,
• stress-srelated disorders,
• disorientation,
• confusion,
• phobias and panic attacks. •
• Feelings of helplessness, shame, humiliation, shock, denial or disbelief.
(Centers for Disease Control [CDC], 2021)
Social Activism & Suicide Prevalence
Two salient perceptions can impact suicidal ideation:
Thwarted belongingness
Perceived burdensomeness (Dreesman, 2020)
Climate Crises & Suicide
Prevalence
Initially, rates increase but
tend to stabilize except for
certain vulnerable
populations, such as people
with comorbidity and pre-
existing conditions.
Overall, however, suicide
rates decrease during the
active recovery period due
to a strong sense of
community and purpose.
Buffers19
Immediate supports
Social supports
Planning for the future
Engagement with helper
Core values/beliefs
Sense of purpose
Interventions20
Be Present/Engage
Acknowledge suicidal thoughts
Listen to understand
Validate the feelings, the experience
Evaluate hopelessness, burden and disconnection
Passive vs. Active Intent (methods and timing)
Evaluate Capability
Evaluate “Buffers”
Predict and Prepare
Mobilize Resources
Social Distancing & Emotional Wellbeing
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Stay mindful of your emotions (how are you feeling?, what are you feeling?, where are you feeling it?)
Have a plan (what’s your “go to”? What coping mechanisms have you identified? How to you restore comfort, emotional safety, and emotional calm?)
Alternate between alone time and social time; maintain a balance between alone time, such as reading a book, journaling, or meditating, and social time, such as connecting via telephone, FaceTime, Skype, etc. or face-to-face with co-habitants.
Avoid catastrophizing as a result of binging on news from television, radio, social media, emails, etc.
Pay attention to your body; eat well with nourishing foods, stay hydrated, and be creative about getting daily exercise.
Use of
Teletherapy22
Cognitive rehabilitation and cognitive-behavioral therapy using smartphone apps has been shown to be beneficial (Baumel A, Correll CU, Hauser M, Brunette M, Rotondi A, Ben-Zeev D, et al., 2016)
In a study conducted in the UK, teletherapy was found to be as effective in reducing PTSD symptoms as in-person interventions among veterans (Turgoose, Ashwick, & Murphy, 2017).
The results of a recent study indicated that, for clients with eating disorders (ED), the application of evidence-based teletherapy interventions by a teletherapy-trained therapist led to significant improvement of ED symptoms (Spoch & Anderson, 2019)
Online Clinical Supervision
*=Adapted from Martin, Kumar, & Lizarondo, 2017)
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Set Clear Expectations & Goals for Telesupervision
A range of options for online clinical supervision should be utilized, responding to individual learning needs,
accessibility of technological tools, etc.
Online clinical supervision should be embedded in
pedagogical principles of counselling and psychotherapy.
Telesupervision protocols should not supersede a
strong supervisory relationship
Be ready to deal with technology challenges and
have a back up plan
Availability of supervisor between clinical supervision
sessions can enhance the supervisee’s perception of
the effectiveness of supervision
Adhere to responsible use of technology (using a secure
platform, maintaining confidentiality for client and supervisee, ensuring safety)
Revisit and evaluate the supervisory process and
relationship frequently using informal and formal
mechanisms
TEN MOST COMMON ERRORS
DURING SUICIDE INTERVENTION WITH YOUTH(Adapted from Neimeyer & Pfeiffer, 1994)
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Superficial Reassurance
Avoidance of Strong Feelings
Professionalism
Inadequate Assessment of Suicidal Intent
Failure to Identify Precipitating Event
Passivity
Insufficient Directedness
Advice Giving
Stereotypic Responses
Defensiveness
Crisis Interventions for Youth25
crisis intervention techniques
cognitive-behavioral exercises
eye movement desensitization and reprocessing (EDMR)
psychopharmacological treatment
brainspotting
Disaster Mental Health Models
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Crisis Intervention Models
Psychological First Aid
Culture-centered Disaster Mental Health Counselling
Crisis Interventions27
crisis intervention techniques
cognitive-behavioral exercises
eye movement desensitization and reprocessing (EDMR)
psychopharmacological treatment
Psychological
First Aid28
Psychological First Aid is an
evidence-informed model utilized in
disaster response to assist those
impacted in the hours and early
days following emergency, disaster,
and terrorism (Uhernik, & Husson,
2009).
Psychological First Aid
Culture-
centered
Disaster
Mental
Health
Counseling
(C-DMHC)
Training
Model
(West-
Olatunji,
2010)
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STEP 7 Transformation: participants integrate the experience into their own personal and professional identities
STEP 6 Praxis: participants formulate advocacy action
STEP 5 Empowerment: participants are able to appropriately intervene with empowerment as the goal
STEP 4 Integration: participants integrate knowledge into clinical conceptualization
STEP 3 Context: participants acknowledge the sociopolitical context
STEP 2 Respect: participants recognize that community members have equally valid realities and funds of knowledge
STEP 1 Awareness: participants recognize that they bring their own biases into the environment
Culture-
centered
Theory
and
Social
Justice
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Facilitates counselors’
efforts to reach out to
culturally diverse individuals
and communities.
Enables counselors to
better conceptualize and
intervene with culturally
diverse clients.
Promotes awareness,
knowledge, and skills in
order to prevent cultural
encapsulation (Pederson,
1991; Sue & Sue, 2008).
Secondary
Traumatic
Stress
The presence of burnout, or secondary traumatic stress, may potentially affect the counselor, the work setting, and the client. (Wilkerson & Bellini, 2006)
Researchers need to be able to educate counseling professionals about the risk factors, symptoms, and effects of secondary traumatic stress.
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Secondary
Traumatic
Stress (cont.)
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Over the past decade,
scholars have examined the
concept of burnout within
specific counseling specialty
areas:–school counselors (Wilkerson, 2009; Wilkerson
& Bellini, 2006)
substance abuse counselors
(Wallace, Lee, & Lee, 2010)
rehabilitation counsellors (Garske, 2007; Templeton & Satcher, 2007)
Transforming Your Practice33
Include suicide risk assessment and intervention strategies as core elements of training and practice (Moutier, 2014).
Include
Restrict lethal means. Restrict
Provide increased and enhanced quality of support in the aftermath of suicide.
Provide
Reach out to the family, friends, and colleagues of suicidal individuals as, in some cases, it can trigger more attempts in the aftermath of suicide.
Reach out
Take social action to speak out and encourage others to do so.
Take
Selected References
Be Real. Somebody Like Me: A report investigating the impact of body image anxiety
on young people in the UK. [Internet]. 2017. Available
from: https://www.berealcampaign.co.uk/research/somebody-like-me
Credos. Picture of Health? [Internet]. 2016. Available
from: http://www.adassoc.org.uk/wp-content/uploads/2016/08/Picture-of-
health_FINAL.pdf
Moutier, C. (2014). Tactics of the War on Suicide. Depression & Anxiety (1091-4269),
31(12), 961–963. https://doi.org/10.1002/da.22345
Riaz, M. N., Malik, S., Nawaz, S., Riaz, M. A., Batool, N., & Shujaat, J. M. (2015).
Well-Being and Post-Traumatic Stress Disorder due to Natural and Man-Made
Disasters on Adults. Pakistan Journal of Medical Research, 54(1), 25–28. Retrieved
from
http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=102056010&site=eho
st-live&scope=site
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CULTURE-CENTERED DISASTER MENTAL HEALTH COUNSELING CREDENTIALING PROGRAM
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