Suicide rates by age group and sex United States, 1997 Source: Natl. Center for Health Statistics
International Comparisons Age 14 & under, US rate > 2x higher than other industrialized nations Age 15-24, compared with 47 other nations, US rate at ~66 th %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
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 MalesFemales Mood Disorders50%69% Conduct Disorder43%24% Substance Abuse38%17% Anxiety Disorders19%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.