1. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Risk Factors & Warning Signs of Depression and Suicide in Youth Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Riverside Trauma Center a service of:

2. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Suicide: A Major Public Health Issue National Statistics: Approx. 36,000 suicide deaths annually Every 14.6 minutes another person in this country dies by suicide Each day approximately 99 people will die by suicide Ranks as the 10 th leading cause of death 90-95% of people who complete suicide suffer from a diagnosable mental illness – most often depression

3. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Suicidality in Adults (≥18) in the US Centers for Disease Control 2008 data 35,000 Suicides 1,000,000 Attempted Suicide 2,200,000 Planned Suicide 8,300,000 Thought about Suicide

4. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Suicide: A Major Public Health Issue Youth Statistics: Suicide ranks as the 3 rd leading cause of death for young people (ages 15-24). For every suicide completed by youth, it is estimated that 100 to 200 attempts are made. According to the CDC in 2009: – 13.8% of students had seriously considered attempting suicide – 6.3% of students had attempted suicide one or more times (Only 1.9% received medical attention)

5. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Suicide: A Major Public Health Issue Massachusetts Statistics: Range of 400-600 completed suicides per year 3X more frequent than homicides Suicide rate variability by: – Age – Gender – Race – Method

6. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Definition: Suicidal Behavior An attempt to solve the problem of intense pain that results from skill deficits or psychopathology

7. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Risk Variables Cognitive Style Access to means Family History Previous Attempt(s) Demographic Risk Factors Clinical Factors Psychosocial Factors

8. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA How Does a Suicide Occur? Inhibition: Strong taboo, available support, Slowed down mental state, presence of others Facilitation: Weak taboo, method/weapon available, recent example, agitation, being alone SURVIVALSUICIDE

9. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Prevention Strategies Inhibition:Facilitation: SURVIVALSUICIDE Dr. Madelain Gould © 2001-2006Adapted from Schaefer et al, 1996 Casefinding Find affected individual Provide effective treatment Gatekeeper training Casefinding Crisis hotline Casefinding Crisis hotline Risk factor reduction Media education Restriction of firearms Postvention/Crisis Interventions Skills training

10. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Depression & Suicidality Depression is a primary risk factor for suicide and is also linked to other risk factors including: Use/abuse of alcohol and other drugs Bullying (Both victim and perpetrator) Social isolation Physical pain/poor health outcomes

11. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Signs & Symptoms of Depression:  Frequent sadness, tearfulness, crying  Expressed hopelessness  Decreased interest in activities; or inability to enjoy previously favorite activities  Persistent boredom; low energy  Social isolation, poor communication  Low self esteem and guilt  Frequent complaints of physical illnesses such as headaches and stomachaches

12. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Signs & Symptoms of Depression:  Extreme sensitivity to rejection or failure  Increased irritability, anger, or hostility  Difficulty with relationships  Frequent absences from school or poor performance in school  Poor concentration  A major change in eating and/or sleeping patterns  Talk of, or efforts to run away from home

13. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Warning Signs of Suicidal Teens Suicide Threats, direct & indirect Obsession with death Poems, essays, and drawings that refer to death Dramatic change in personality or appearance Irrational, bizarre behavior Overwhelming sense of guilt, shame or reflection Changed eating or sleeping patterns Severe drop in school performance Giving away belongings National Mental Health Association

14. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA How to Ask: Indirect vs. Direct Indirect: – “ Do you wish you could go to sleep and not wake up?” – “Do you wish you were dead?” Direct: – “Have you thought about killing yourself?”

15. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA How to Ask: Indirect vs. Direct Indirect: – “ Do you wish you could go to sleep and not wake up?” – “Do you wish you were dead?” Direct: – “Have you thought about killing yourself?”

16. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA How to ask: WHY NOT? “Have you thought about hurting yourself?”

17. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA “You’re not thinking about suicide, are you?” How to ask: WHY NOT?

18. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA The Role of Schools in Prevention & Identification How/where do we spot youth with emotional challenges? How/where in our curriculum can we address these concerns? Do we have procedures/policies for what to do when we’re concerned? How do we promote strength and resilience in our students?

19. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Impact for the survivors: A recent study indicated that over 70 people are intimately and directly impacted by the death by suicide of a young person. (Berman, 2011) But we also know that the effects go well beyond the immediate survivors.

20. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Those left behind may be at risk: Vulnerable youth Students Exposed to the suicide Students upset by the death ‘Friends’ of the Deceased Siblings

21. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA 6 months after exposure to peer suicide youth are at increased psychiatric risk: 4x more likely to develop psychiatric disorder 6x more likely to develop major depression More likely to develop Post Traumatic Stress Disorder 5X higher rate of suicidal ideation (Brent, 2010)

22. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Common reactions in childhood bereavement Shock and numbness Denial Sadness Anger Anxiety Guilt Physical Problems/ Somatic Complaints Decrease in academic performance

23. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Why grief following suicide/ homicide is more complicated Shock at the sudden/ unexpected death Social stigma/ shame Intense search for the reasons “why” Police investigation/ media involvement “Could this death have been prevented?” Fear of own self destructive impulses Violence of the death Lengthy court action precludes “closure” Anger at perpetrator ( scapegoating/ blaming) (Underwood, 1997)

24. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Domains affected by trauma (and how might they relate to school functioning?) Domain Cognitive Emotional Social/ behavioral Physiological Spiritual Symptoms Confusion, intrusive thoughts, concentration Shock, sorrow, anger, guilt, irritability Withdrawal, fighting Fatigue, stomachache, startle response, sleep “ Nothing matters, ”… why would God do this? ”

25. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Suggestions for School Response to childhood bereavement Encourage atmosphere of open expression to all reactions Communicate facts clearly (then repeat) Initiate conversations about the deceased: facilitate through artwork, collages, tape recording, journals Physical activity/ encourage peer activities Flexibility (e.g. around physical complaints) Resume routines Support rituals for the deceased Tutoring/temp reduction in academic load

26. Riverside Trauma Center a service of Risk Factors & Warning Signs of Depression and Suicide in Youth presented by : Waheeda Saif, LMHC Blue Ribbon Conference April 13 th, 2012 Reading, MA Risk Factors and Warning Signs of Depression and Suicide in Youth Waheeda Saif, LMHC wsaif@riversidecc.org 781-433-0672 X5617 Riverside Trauma Center www.riversidetraumacenter.org