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1 THE CARTER JENKINS CENTER PRESENTS. 2 Suicide in Children and Adolescents by Humberto Nagera M.D. Professor of Psychiatry, University of South Florida.

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Presentation on theme: "1 THE CARTER JENKINS CENTER PRESENTS. 2 Suicide in Children and Adolescents by Humberto Nagera M.D. Professor of Psychiatry, University of South Florida."— Presentation transcript:

1 1 THE CARTER JENKINS CENTER PRESENTS

2 2 Suicide in Children and Adolescents by Humberto Nagera M.D. Professor of Psychiatry, University of South Florida. Professor of Psychiatry, University of South Florida. Professor Emeritus, University of Michigan. Training and Supervising Psychoanalyst, Tampa Bay Psychoanalytic Institute. Director, The Carter-Jenkins Center.

3 3 Suicide in Children and Adolescents A) General Statistics of Suicides in Children: 1) Suicide is relatively rare in pre-pubertal kids 1) Suicide is relatively rare in pre-pubertal kids 2) But there are each year an estimated one 2) But there are each year an estimated one million accidental ingestions of toxic million accidental ingestions of toxic substances by under fives substances by under fives 3) In the 5 to 14 age group there are 100,000 self- 3) In the 5 to 14 age group there are 100,000 self- poisonings each year poisonings each year

4 4 Suicide in Children and Adolescents 4) In 1985, 232 children aged 5 to 14 years old 4) In 1985, 232 children aged 5 to 14 years old committed suicide (for a rate 0.7/100,000) committed suicide (for a rate 0.7/100,000) 5) In the 10 to 14 years old the rate is 1.6/100,000 5) In the 10 to 14 years old the rate is 1.6/100,000 with 317 deaths in 1998 with 317 deaths in ) But that rate increased to 10.9/100,00 in the 15 6) But that rate increased to 10.9/100,00 in the 15 to 19 group in 1998 with about 2160 deaths to 19 group in 1998 with about 2160 deaths

5 5 Suicide in Children and Adolescents 7) From 1980 to 1998 the suicide rates in children (10 to 14 years old) increased over 120% (10 to 14 years old) increased over 120% 8) The low incidence of fatalities (1:11,000 events in ages 5-14) suggests that the lethality of intent is ages 5-14) suggests that the lethality of intent is minimal when compared to ages 15-24, where minimal when compared to ages 15-24, where fatalities are 1:168 events fatalities are 1:168 events

6 6 Suicide in Children and Adolescents

7 7 B) Statistics of Suicide in Adolescence: B) Statistics of Suicide in Adolescence: 1) Among adolescents aged 15 to 19 the suicide 1) Among adolescents aged 15 to 19 the suicide rate was 8.9/100,000 with 1,737 deaths in 1998 rate was 8.9/100,000 with 1,737 deaths in ) The 1998 gender ratio for 15 to 19 years old was 2) The 1998 gender ratio for 15 to 19 years old was 5:1 (males:females) 5:1 (males:females) 3) Suicide is the third leading cause of death in the 3) Suicide is the third leading cause of death in the age group (follows unintentional injuries age group (follows unintentional injuries and homicide) and homicide)

8 8 Suicide in Children and Adolescents 4) In this same group (15-24) there were 4,135 4) In this same group (15-24) there were 4,135 suicides, for a rate of 11.1 per 100,000 suicides, for a rate of 11.1 per 100,000 5) Adolescents ratio of suicide attempts or 5) Adolescents ratio of suicide attempts or gestures to completed ones is estimated at gestures to completed ones is estimated at 200:1 200:1 6) This suggests that over one million attempts 6) This suggests that over one million attempts or gestures are made annually by US or gestures are made annually by US adolescents adolescents

9 9 Suicide in Children and Adolescents

10 10 Suicide in Children and Adolescents Government report released on July 13/2002 stated: Government report released on July 13/2002 stated: -Three millions American teenagers thought -Three millions American teenagers thought seriously about suicide and about one million seriously about suicide and about one million attempted it! attempted it! - Thus 13% of teenagers (14-17) considered - Thus 13% of teenagers (14-17) considered suicide in 2000 suicide in only 36% has received treatment or counseling - only 36% has received treatment or counseling - girls twice as likely as boys to say they thought - girls twice as likely as boys to say they thought about suicide about suicide

11 11 Suicide in Children and Adolescents 7) Clusters of teenagers suicides are occurring 7) Clusters of teenagers suicides are occurring more frequently i e, one suicide triggers many more frequently i e, one suicide triggers many others. others. (The copy cat phenomena) (The copy cat phenomena) 8) Most suicide attempters’ motivation (all ages) is 8) Most suicide attempters’ motivation (all ages) is not necessarily a wish to die but: not necessarily a wish to die but: a) a desire to influence another person a) a desire to influence another person b) to make someone feel guilty b) to make someone feel guilty c) to express anger or gain attention c) to express anger or gain attention d) to escape a difficult situation d) to escape a difficult situation

12 12 Suicide in Children and Adolescents 9) Kessel in the Edinburgh study concluded that 9) Kessel in the Edinburgh study concluded that at least 80% of self poisonings were done at least 80% of self poisonings were done believing that death will not occur believing that death will not occur 10) Many adolescents suicide deaths are probably unintentional 10) Many adolescents suicide deaths are probably unintentional 11) The adolescents were not victims of suicide 11) The adolescents were not victims of suicide but of pharmacological roulette but of pharmacological roulette

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14 14 Suicide in Children and Adolescents 12) The best single correlate of lethality 12) The best single correlate of lethality is the probability of rescue that existed is the probability of rescue that existed 13) Many self-poisoning adolescents ensure that 13) Many self-poisoning adolescents ensure that they will be found soon after ingestions they will be found soon after ingestions 14) Alternatively they themselves notify 14) Alternatively they themselves notify somebody somebody

15 15 Suicide in Children and Adolescents 15) Imitation through exposure (friends or media 15) Imitation through exposure (friends or media publicity) makes adolescents more vulnerable publicity) makes adolescents more vulnerable to suicide (The copy cat phenomena) to suicide (The copy cat phenomena) 16) Exposure to suicide or suicidal behavior in 16) Exposure to suicide or suicidal behavior in the family, significant influences vulnerable the family, significant influences vulnerable adolescents adolescents

16 16 Suicide in Children and Adolescents 17) Potentially suicidal adolescents may show: 17) Potentially suicidal adolescents may show: a) a dysphoric mood a) a dysphoric mood b) aggressiveness or hostility b) aggressiveness or hostility c) frequent problems with peers c) frequent problems with peers d) reaction to a crisis situation d) reaction to a crisis situation e) inhibited personalities e) inhibited personalities f) marked loneliness and extreme quietness f) marked loneliness and extreme quietness g) extreme sensibility, lack of friends g) extreme sensibility, lack of friends

17 17 Suicide in Children and Adolescents 18) Suicidal youngsters have more psychiatric 18) Suicidal youngsters have more psychiatric symptoms than the non-suicidal controls symptoms than the non-suicidal controls 19) Symptoms of depression appeared in 76% of 19) Symptoms of depression appeared in 76% of the suicide victims compared to 24% in the the suicide victims compared to 24% in the controls controls 20) Many male suicidal adolescents do not meet 20) Many male suicidal adolescents do not meet DSM criteria for depression but are dysphoric DSM criteria for depression but are dysphoric

18 18 Suicide in Children and Adolescents 21) Antisocial symptoms, previous history of 21) Antisocial symptoms, previous history of suicidal tendencies, drug abuse are suicidal tendencies, drug abuse are prominent among suicide victims prominent among suicide victims 22) If high suicidal intent is present hospitalize 22) If high suicidal intent is present hospitalize the adolescent immediately the adolescent immediately

19 19 Suicide in Children and Adolescents 23) Unsuccessful attempts go from nearly 23) Unsuccessful attempts go from nearly lethal to desperate low lethality cries for lethal to desperate low lethality cries for help, to minor gestures clearly help, to minor gestures clearly manipulative in intent manipulative in intent 24) Suicide behavior occasionally is impulsive 24) Suicide behavior occasionally is impulsive handling of stress in at times a neglectful and handling of stress in at times a neglectful and unsupportive environment unsupportive environment

20 20 Suicide in Children and Adolescents 25) Death occasionally can be seen as retaliatory 25) Death occasionally can be seen as retaliatory abandonment, reunion, rebirth, self- abandonment, reunion, rebirth, self- punishment, or confirmation of feeling already punishment, or confirmation of feeling already dead dead 26) Suicidal adolescents may feel they want to 26) Suicidal adolescents may feel they want to cause pain in the life of a family member or cause pain in the life of a family member or friends that cause him real or imagined hurts friends that cause him real or imagined hurts

21 21 Suicide in Children and Adolescents 27) Adolescents may have funeral fantasies in 27) Adolescents may have funeral fantasies in which others sit around in pain saying, “Why which others sit around in pain saying, “Why did not I treat him better”,or “Why did I not did not I treat him better”,or “Why did I not tell him/her that he/she was a good tell him/her that he/she was a good son/daughter”, etc. son/daughter”, etc. 28) Some suggest to have them read the part on 28) Some suggest to have them read the part on “From here to Eternity”, where corporal Bloom suicides. They can thus see the reality of their “From here to Eternity”, where corporal Bloom suicides. They can thus see the reality of their peers reactions peers reactions

22 22 Suicide in Children and Adolescents 29) Some adolescents take their lives suddenly and without prior warning, at times when they seem to be doing well (about to graduate, etc) 29) Some adolescents take their lives suddenly and without prior warning, at times when they seem to be doing well (about to graduate, etc) 30) Any suicide attempt needs a thorough 30) Any suicide attempt needs a thorough evaluation for depressive or psychotic evaluation for depressive or psychotic features features

23 23 Suicide in Children and Adolescents METHODS OF SUICIDE: METHODS OF SUICIDE: 1) Firearms, poisoning and hanging are the most 1) Firearms, poisoning and hanging are the most common methods in the groups 5-14 and common methods in the groups 5-14 and ) Suicide by firearms is unfortunately the method 2) Suicide by firearms is unfortunately the method that has increased most dramatically that has increased most dramatically

24 24 Suicide in Children and Adolescents 3) Drugs used most commonly are: a) analgesics (Tylenol, Aspirin, etc) a) analgesics (Tylenol, Aspirin, etc) b) tranquilizers b) tranquilizers c) sedatives c) sedatives d) antihistaminics d) antihistaminics e) up to recently anti-depressants (tricyclics…) e) up to recently anti-depressants (tricyclics…)

25 25 Suicide in Children and Adolescents

26 26 Suicide in Children and Adolescents PREDICTORS OF SUICIDE: PREDICTORS OF SUICIDE: 1) Previous suicidal behavior. 1) Previous suicidal behavior. 2) Affective disorders and schizophrenia 2) Affective disorders and schizophrenia 3) Family psychiatric disorders, especially 3) Family psychiatric disorders, especially affective disorders affective disorders

27 27 Suicide in Children and Adolescents 4) Exposure to parental, peers or relatives suicidal ideas: -or parental threats or attempts of suicide -or parental threats or attempts of suicide -or parental severe emotional problems -or parental severe emotional problems -or parental absence or death -or parental absence or death -or parental divorce or separations -or parental divorce or separations -or evidence of physical abuse -or evidence of physical abuse

28 28 5) Other common factors are: 5) Other common factors are: -disputes with peers, boyfriends, girlfriends -disputes with peers, boyfriends, girlfriends -arguments with a parent -arguments with a parent -humiliations -humiliations -punishment -punishment -sense of failure -sense of failure -pregnancy -pregnancy Suicide in Children and Adolescents

29 29 Suicide in Children and Adolescents -loss of communication with one or both -loss of communication with one or both parents parents -lack of religious ties -lack of religious ties -anger -anger -wish to go back to ward where staff is seen -wish to go back to ward where staff is seen as more loving and reliable than those at as more loving and reliable than those at home home -significant changes in eating or sleeping -significant changes in eating or sleeping habits habits

30 30 Suicide in Children and Adolescents -writing notes or poems about death -writing notes or poems about death -giving away precious possessions -giving away precious possessions -drug or alcohol abuse -drug or alcohol abuse -dramatic personality changes -dramatic personality changes -loss of interest in previously valued activities -loss of interest in previously valued activities -school work deterioration, etc -school work deterioration, etc

31 31 Suicide in Children and Adolescents Conclusions and Treatment Suggestions: Conclusions and Treatment Suggestions: 1) Suicide, the third leading cause of death in 1) Suicide, the third leading cause of death in this group is preventable this group is preventable 2) Important to confront the adolescent with 2) Important to confront the adolescent with their phantasies that their suicide will their phantasies that their suicide will provoke remorse and guilt, or be a provoke remorse and guilt, or be a punishment for those left behind punishment for those left behind

32 32 Suicide in Children and Adolescents 3) They need to understand what really will 3) They need to understand what really will happen and how after a while people will go happen and how after a while people will go on with their lives on with their lives 4) Describe comments that will be made such 4) Describe comments that will be made such as “ He was a little crazy”, “The Lord knows as “ He was a little crazy”, “The Lord knows we tried”, etc we tried”, etc

33 33 Suicide in Children and Adolescents 5) Decrease access to firearms, drugs, etc 5) Decrease access to firearms, drugs, etc 6) Do not let them paint themselves into a 6) Do not let them paint themselves into a corner since to save face they may do corner since to save face they may do something dangerous something dangerous 7) Interventions need to be life saving while 7) Interventions need to be life saving while avoiding secondary gains avoiding secondary gains

34 34 Suicide in Children and Adolescents 8) May be useful to describe with examples 8) May be useful to describe with examples the loss of function due to decrease the loss of function due to decrease oxygenation, cutting through nerves, etc oxygenation, cutting through nerves, etc 9) Adolescents believe that adults will make 9) Adolescents believe that adults will make things o.k, with no resulting damage things o.k, with no resulting damage

35 35 THE END This has been a Carter Jenkins Center service for the community QUESTIONS? Donations are gratefully accepted and are tax deductible

36 36 For any further information about: 1) The Carter Jenkins Center 1) The Carter Jenkins Center 2) The monthly programs for the community 2) The monthly programs for the community 3) The monthly programs for the professionals 4) Psychoanalytic Training in Tampa 5) The International (Virtual) Psychoanalytic Institute 6) The International (Virtual) Psychoanalytic Society, VISIT OUR WEB SITE AT:


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