1. BULLYING AND SUICIDE: UNRAVELING THE LINK Christine Moutier, M.D., AFSP Chief Medical Officer Deborah Temkin, Ph.D., The Robert F. Kennedy Center Jill Harkavy Friedman, Ph.D., AFSP Vice President of Research

2. THIS SESSION WILL:  Acknowledge prominent discussion/public opinion re: bullying and suicide – and offer an alternative  Present a model for understanding youth suicide in the context of multiple risk and protective factors, and show where bullying can fit into this model  Review current research findings  Present a model bullying prevention approach  Emphasize and offer guidance on safe messaging  Provide future direction for AFSP Field Advocates and Chapters 2

3. CURRENT DIALOGUE – IS IT REALLY ACCURATE?  Media and public discussion have created a narrative of “death by bullying”  Many suicide prevention and mental health groups (including AFSP) have reacted by insisting the opposite – that suicide is NOT directly caused by bullying  Reality is probably somewhere in the middle of these 2 polarized discussions 3

4. INTERACTING VARIABLES  RISK Biological Factors Psychological Factors RISK Past History Current Life Events

5. INTERACTING VARIABLES  RISK Biological Factors Psychological Factors RISK Past History Current Life Events

6. INTERACTING VARIABLES  RISK RISK Current Life Events

7. INTERACTING VARIABLES  RISK Biological Factors Psychological Factors RISK Past History Current Life Events

8. YOUTH RISK AND PROTECTIVE FACTORS: SOME EXAMPLES Risk Factors:Protective Factors: 8  History of/current self harm behavior  History of/current experiences with abuse/victimization  Living with/history of mental or substance use disorder  Prolonged stress  Highly stressful life event  Access to means  Impulsivity and or aggression  Intense emotional states (despair, hopelessness, humiliation)  Access to and receiving effective mental health care  Parent connectedness  Connectedness to peers/other supportive adults  Perceived caring by others  Perceived school and neighborhood safety  Positive community connections  Positive self-esteem, problem- solving skills, sociability

9. WHAT DOES THE RESEARCH SHOW?  CDC convened an expert panel focusing on the relationship between bullying involvement and suicide-related behaviors (Sept. 2010)  Key themes emerged in reviewing the latest research:  Bullying among youth is a significant public health problem; it is prevalent and frequently has detrimental effects  There is a strong association between bullying and suicide- related behaviors, but this relationship is mediated by other factors  Public health strategies can be applied to the prevention of bullying and suicide 9

10. BULLYING IS A SIGNIFICANT PUBLIC HEALTH PROBLEM  Young people’s involvement in bullying in any capacity (bully others, are bullied, or both) correlates with poor mental and physical health and engagement in other risk behaviors  Involvement in bullying can also have long-lasting, detrimental effects months or even years after the bullying occurs 10

11. ASSOCIATION BETWEEN BULLYING AND SUICIDE-RELATED BEHAVIORS  Is STRONG – involvement in bullying in any capacity is linked to increased risk for suicidal ideation and behavior -- HOWEVER --  Considering bullying experiences isolated from other experiences explains a relatively small amount of variation in suicidal ideation  Suicide risk will be more accurately predicted when considering the entirety of risk and protective factors for a particular youth 11

12. ASSOCIATION BETWEEN BULLYING AND SUICIDE-RELATED BEHAVIORS  Is COMPLEX :  Persistent involvement in bullying can lead to low self-esteem, isolation, depression, anxiety, despair  Bullying can precipitate suicidal behavior in already vulnerable youth  Mental and developmental disorders may manifest in ways that increase the likelihood of being involved in bullying  Bullying others may signal mental health vulnerabilities  Students who observe bullying behavior may also be at risk 12

13. PUBLIC HEALTH STRATEGIES FOR PREVENTION  Integrated approaches that focus on preventing both suicide AND bullying  Focus on shared risk and protective factors, including individual coping skills, family and school social support, and supportive school environments 13

14. PUBLIC HEALTH STRATEGIES FOR PREVENTION  Example strategy components:  Increase youths’ ability to cope with school-related problems and conflict  Help youth build positive relationships with parents, other family members, teachers, classmates, and intimate partners  Address youths’ barriers to accessing effective mental health and substance abuse treatment, and monitor youth currently in treatment  Foster supportive and connections to school and home environments and communities 14

15. D EBORAH A. T EMKIN, P H.D. Manager, Project SEATBELT Bullying Prevention Initiative Robert F. Kennedy Center for Justice and Human Rights 202-463-7575 x243 temkin@rfkcenter.org http://bullying.rfkcenter.org/ 15

16. TALKING ABOUT SUICIDE AND BULLYING SAFELY AND ACCURATELY When speaking to others about or covering suicide and bullying in the media, we must always be aware of the potential for: Suicide Contagion  Increases in suicide deaths linked with certain kinds of public visibility and media coverage about suicide  Most likely to occur among persons who are already seriously depressed or contemplating suicide 16

17. SUICIDE CONTAGION  Contagion risk has been observed when:  The number of stories about individual suicides increases  A particular death is reported in great detail across many stories  Coverage of a suicide death is placed on the front page of a newspaper/at the top of a newscast  The headlines about specific suicide deaths are framed dramatically 17

18. TALKING ABOUT SUICIDE AND BULLYING SAFELY AND ACCURATELY DO:  Emphasize the complexity of suicidal behavior  Acknowledge that bullying can be a contributing factor and or a precipitating event in youth suicide  Emphasize individual and collective responsibility for supporting the well-being of youth who are bullied AND those who bully others  Encourage help-seeking and emphasize availability of supportive resources  Emphasize the vital importance of family, school, and community support and connectedness 18

19. TALKING ABOUT SUICIDE AND BULLYING SAFELY AND ACCURATELY DO NOT:  Include details of a suicide death in titles or headlines  Describe the method used  Attribute the suicide death only to bullying or other negative life events  Normalize suicide by presenting it as the logical consequence of bullying, rejection, discrimination, or exclusion  Idealize young people who die by suicide or create an aura of celebrity around them  Use the term “bullycide” 19

20. TALKING ABOUT SUICIDE AND BULLYING SAFELY AND ACCURATELY  Know your audience!  Emphasizing the scope of the problem (i.e. sharing statistics) is more appropriate to do with elected officials  Emphasizing that suicide is preventable, suggesting helpful resources, and encouraging help-seeking is more appropriate to do with general audiences (that may include persons at-risk) 20

21. SAFE MESSAGING RESOURCES www.afsp.orgwww.reportingonsuicide.org 21

22. U.S. DEPARTMENT OF EDUCATION: WWW.STOPBULLYING.GOV  Specific recommendations for media in developing safe content around bullying: http://www.stopbullying.gov/news/media/  Other sections:  What is bullying  Cyberbullying  Who is at risk  Prevent bullying (at school & in the community; training center)  Respond to bullying  Get help now 22

23. RFK CENTER: PROJECT SEATBELT  http://bullying.rfkcenter.org/  Comprehensive information and resources for schools, homes, and communities 23

24. DISCUSSION, QUESTIONS & COMMENTS What can we as AFSP Field Advocates, Chapter volunteers, and staff do to promote public health approaches to prevention and to influence more accurate discussions around bullying and suicide in our own communities? 24