High-Risk Populations for Suicide, as defined by SAMHSA and research. Risk Factors as Differences in Youth. Increased Risk Factors for Suicide

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1 Risk Factors as Differences in Youth High-Risk Populations for Suicide, as defined by SAMHSA and research Annual Suicide Prevention Conference November 9, 2012 Ann Duckless Claudia Ferber Mary Forsythe-Taber Youth with prior suicide attempts Youth with mental health problems Youth who are in foster/adoptive care Youth with substance abuse issues Youth who are lesbian, gay, bisexual, transgender, questioning, or two-spirited (LGBTQ2-S) Youth who are American Indian, Alaskan Native, or refugees (e.g. Bhutanese) Connect Suicide Prevention Project, Copyright, NAMI NH, What are Risk Factors? Increased Risk Factors for Suicide Risk factors are unhealthy behaviors and coping skills, and negative parts of a person s home, school, and work life. The more risk factors a person has, the more he/she is at risk for suicide and other self-destructive behaviors. Compared to the general population, individuals with a history of Prior Suicide Attempt Major Depression Mixed Drug Abuse Bipolar Disorder Schizophrenia Alcohol Abuse Have a suicide risk that is Almost 40 times greater than the 20 times greater than the 19 times greater than the 15 times greater than the Almost 9 times greater than the Almost 6 times greater than the *Note: The mental health issues above represent a smaller subset of the larger US population. It is important to consider only that there is an elevated risk for these mental health/substance abuse issues. 3 Data Source: Simon, R. (2003). Guidelines for clinically based risk management. American Psychiatric Publishing, Inc. 4 4 As many as 55,756 children ages 5-19 have a diagnosable mental health disorder and almost 14,000 have a serious emotional disturbance. Norton, S., Tappin, R., 2009 Approximately 10% of children and adolescents live with a mental illness and yet, only about 20% of them are identified and in treatment. Surgeon General, Approximately 50% of students with mental health disorders age 14 and older drop out of high school the highest dropout rate of any disability group. U.S. Department of Education, Twenty-third annual report to Congress on the Implementation of the Individuals with Disabilities Education Act, Washington, D.C., % of youth in juvenile justice systems have at least one mental disorder with at least 20 percent experiencing significant functional impairment from a serious mental illness. Skowyra, K.R. & Cocozza, J.J. (2007) Blueprint for change. National Center for Mental Health and Juvenile Justice; Policy Research Associates, Inc. The Office of Juvenile Justice and Delinquency Prevention. Available at 6 1

2 Self Stigma Devalued Social Isolation Peer relationships Loss of critical developmental years Services and supports I m dealing with depression, Stupid names don t help Working with Foster/Adoptive Youth A Swedish Study of Former Child Welfare Clients Approximately 30-85% of youth in out-of-home care have significant emotional disturbances, which places them at higher risk for suicidal behavior. (Children s Alliance of NH, 2003) Adolescents living with foster parents have about four times the rate of serious psychiatric disorders than those living with their own families. (Child Welfare League of America, 2009) National Register Data: 22,000 former child welfare clients with interventions before teen years 955,000 general population cohort peers 12,000 inter-country adoptees 9 Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden. J. Child Psychol. Psychiatry, 2006 Jul;47(7): A Swedish Study s Outcome: Former Child Welfare Clients 4 5 X more likely than peers in the general population to have been hospitalized for suicide attempts 5 8 X more likely to have been hospitalized for serious psychiatric disorders in their teens, 4 6 X in young adulthood High excess risks for psychoses and depression. Highest risk for individuals who had been in long-term foster care. Twofold excess risk after adjusting for birth parents' hospitalizations with a psychiatric diagnosis or for substance abuse, and for birth-home-related socio-economic factors (Vinnerljung, B., Hjern, A., Lindblad, F.) Link Between Substance Abuse and Suicide Compared with the general population, individuals treated for alcohol abuse and dependence are at about 10X greater risk for suicide (Wilcox et al, 2004) Those who inject drugs are about 14X at greater risk for suicide (Wilcox et al, 2004) Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden. 11 J. Child Psychol. Psychiatry, 2006 Jul;47(7):

3 Selected Substances: Emergency Room Visits for Suicide Attempts by Young Adults Suicide Thoughts, Plans, and Attempts in the Past Year Among Adults Aged 18 or Older, by Substance Dependence or Abuse *The alcohol category includes visits involving alcohol taken in combination with other drugs for all patients and visits involving just alcohol for patients age Dawn does not track alcohol-only visits for patients age 21 or older. Source: The DAWN Report, 2010 (covering 2008 calendar year) Source: 2009 NSDUH Survey Findings Percent of students answering "yes" to the suicide related items that had used the indicated substance NH YRBS Cross-Tabulation of Suicide Related and Substance Abuse Items 60% 50% 40% 30% 20% 10% 0% Students who smoked at least one cigarette during the past 30 days Students who had at least one drink of alcohol during the past 30 days Students who had Students who used 5 or more drinks of marijuana at least alcohol in a row at once during the least once during past 30 days the past 30 days Students who used Students who used Students who used any form of prescription drugs over the counter cocaine during the without a drugs to get high past 30 days prescription during during the past 30 the past 30 days days Students who used inhalents to get high one or more times during their life* Gay, Lesbian, Bisexual, Transgender, Questioning, Two- Spirited (GLBTQ2-S) Individuals Students who felt so sad or hopeless almost every day for two weeks or more in a row during the past 12 months that they stopped doing some usual activities Students who seriously considered attempting suicide during the past 12 months Students who made a plan about how they would attempt suicide during the past 12 months Connect Suicide Prevention Project, Students who attempted suicide one or more times during the past 12 months Copyright, NAMI NH, Sexual Orientation/Gender Identity Lesbian, gay, and bisexual(lgb) youth have a 4X greater risk of suicide attempts than heterosexual youth. (Source: Garofalo, R., Wolf, C., Wissow, L., Woods, E., & Goodman, E. (1999). Archives of Pediatric and Adolescent Medicine) Represent 10% of population, yet 25% of homelessness. Almost 2/3 of middle and high school LGB youth feel unsafe at school. LGB high school youth have 5X greater rate of missing school and 4X greater rate of being threatened with weapon than heterosexual youth. (Source: US YRBS, 2005) Personal risk when disclosing at an early age depends on reactions of significant others to disclosure of being LGB. 17 Parental Reactions to Disclosure in Teen Years In a study of 224 white and Latino LGB youth, ages 21-25: Family Rejection (30%) Family Ambivalence (50%) Family Acceptance (17%) Family Celebration ( 3%) Results: Most rejecting families were from Latino community. Youth from rejecting families more likely to attempt suicide (8.4X), to be depressed (5.9X), to abuse illegal substances (3.4X), and to engage in unprotected sex (3.4X) (Source: Ryan, C., Huebner, D., Diaz, R., Sanchez, J. (2009) Pediatrics, 123, ) Family Acceptance Project:

4 Individual Risk Factors for LGBT Being LGBT is not itself a risk factor for suicidal behavior BUT social stigma and discrimination unsafe schools ineffective providers are associated with mood, anxiety, and substance use disorders, and suicidal behavior. 19 Risk factors What s different for LGBT youth? More risk factors or more severe ones: Unsafe school Rejection/abuse within family Victimization Previous attempt(s) Exposure to suicide loss Specific to or mostly relevant to LGBT youth: Gay-related stress and minority stress Gender nonconformity Internal conflict regarding sexual orientation Risk Factors for Refugees in the US Direct or witnessed experiences of violence Trauma experienced with authority Language barrier Loss of social support structures, isolation Separation from ethno-cultural communities Adaptation to new social, economic, and cultural structures 22 Risk Factors for Refugees in the US (continued) Lack of help-seeking behavior What are Protective Factors? Cultural perspectives and stigma about mental health issues Excess responsibilities placed on non-traditional providers Shame associated with this new provider role Threat of being deported at any time 23 Protective factors are healthy behaviors and coping skills, and positive parts of a person s home, school, and work life. Protective factors help to lower the risk level of suicide and other self-destructive behaviors. These are strengths that we can develop and enhance for youth in our community. 24 4

5 What families can do to help their children feel connected: Children who eat regularly with their families are less likely to smoke, drink, use illegal drugs, have sex at young ages, get into physical fights, be suspended from school, or have thoughts of suicide. The Importance of Family Dinners The National Center on Addiction & Substance Abuse (CASA), Legislation as a Community Protective Factor NH RSA 193-F Pupil Safety and Violence Prevention Act addresses bullying and cyberbullying in all New Hampshire schools: All pupils have the right to attend public schools, including chartered public schools, that are safe, secure, and peaceful environments. One of the legislature s highest priorities is to protect our children from physical, emotional, and psychological violence by addressing the harm caused by bullying and cyberbullying in our public schools. YOU ARE NOT ALONE! If you or someone you know is suicidal: Small Group Presentations: Protective Factors Hotlines to Call: National Suicide Prevention Lifeline: TALK (8255) Teen Head Rest: (24/7 Line) For More Information About Mental Health: National Alliance On Mental Illness, NH: YOU ARE NOT ALONE! LGBTQ2-S Resources Trevor Helpline (24/7): u-TREVOR ( ) GLBT National Hotline (M-F 4-12 pm; Sat pm): GLBT National Youth Talking (M-F 8-12 pm): PRIDE (7743) youth@GLBTNationalHelpCenter.org Fenway GLBT Helpline: Fenway Peer Listening Line: PEER