Safe and Effective Messaging for Suicide Prevention

Transcription

1 Safe and Effective Messaging for Suicide Prevention This document offers evidence-based recommendations for creating safe and effective messages to raise public awareness that suicide is a serious and preventable public health problem. The following list of Do s and Don ts should be used to assess the appropriateness and safety of message content in suicide awareness campaigns. Recommendations are based upon the best available knowledge about messaging. 1, 2, 3 They apply not only to awareness campaigns, such as those conducted through Public Service Announcements (PSAs), but to most types of educational and training efforts intended for the general public. These recommendations address message content, but not the equally important aspects of planning, developing, testing, and disseminating messages. While engaged in these processes, one should seek to tailor messages to address the specific needs and help-seeking patterns of the target audience. For example, since youth are likely to seek help for emotional problems from the Internet, a public awareness campaign for youth might include Internet-based resources. 4 The Do s Practices that may be helpful in public awareness campaigns: Do emphasize help-seeking and provide information on finding help. When recommending mental health treatment, provide concrete steps for finding help. Inform people that help is available through the National Suicide Prevention Lifeline ( TALK [8255]) and through established local service providers and crisis centers. Do emphasize prevention. Reinforce the fact that there are preventative actions individuals can take if they are having thoughts of suicide or know others who are or might be. Emphasize that suicides are preventable and should be prevented to the extent possible. 5 Do list the warning signs, as well as risk and protective factors of suicide. Teach people how to tell if they or someone they know may be thinking of harming themselves. Include lists of warning signs, such as those developed through a consensus process led by the American Association of Suicidology (AAS). 6 Messages should also identify protective factors that reduce the likelihood of suicide and risk factors that heighten risk of suicide. Risk and protective factors are listed on pages of the National Strategy for Suicide Prevention. Do highlight effective treatments for underlying mental health problems. Over 90 percent of those who die by suicide suffer from a significant psychiatric illness, substance abuse disorder or both at the time of their death. 7-8 The impact of mental illness and substance abuse as risk factors for suicide can be reduced by access to effective treatments and strengthened social support in an understanding community. 9 The Don ts Practices that may be problematic in public awareness campaigns: Don t glorify or romanticize suicide or people who have died by suicide. Vulnerable people, especially young people, may identify with the attention and sympathy garnered by someone who has died by suicide. 10 They should not be held up as role models. Don t normalize suicide by presenting it as a common event. Although significant numbers of people attempt suicide, it is important not to present the data in a way that makes suicide seem common, normal or acceptable. Most people do not seriously consider suicide an option; therefore, suicidal ideation is not normal. Most individuals, and most youth, who seriously Continued > > Suicide Prevention Resource Center GET-SPRC ( ) Education Development Center, Inc. 55 Chapel Street, Newton, MA

2 Safe and Effective Messaging for Suicide Prevention consider suicide do not overtly act on those thoughts, but find more constructive ways to resolve hem. Presenting suicide as common may unintentionally remove a protective bias against suicide in a community. 11 Don t present suicide as an inexplicable act or explain it as a result of stress only. Presenting suicide as the inexplicable act of an otherwise healthy or high-achieving person may encourage identification with the victim. 12 Additionally, it misses the opportunity to inform audiences of both the complexity and preventability of suicide. The same applies to any explanation of suicide as the understandable response to an individual s stressful situation or to an individual s membership in a group encountering discrimination. Oversimplification of suicide in any of these ways can mislead people to believe that it is a normal response to fairly common life circumstances. 13 Don t focus on personal details of people who have died by suicide. Vulnerable individuals may identify with the personal details of someone who died by suicide, leading them to consider ending their lives in the same way. 14 Don t present overly detailed descriptions of suicide victims or methods of suicide. Research shows that pictures or detailed descriptions of how or where a person died by suicide can be a factor in vulnerable individuals imitating the act. Clinicians believe the danger is even greater if there is a detailed description of the method. 15 Acknowledgment SPRC thanks Madelyn Gould, PhD, MPH [Professor at Columbia University in the Division of Child and Adolescent Psychiatry (College of Physicians & Surgeons) and Department of Epidemiology (School of Public Health), and a Research Scientist at the New York State Psychiatric Institute] for her extensive contributions and guidance in drafting and editing this document. 1 Gould, M. S., Jamieson, P. & Romer, D. (2003). Media contagion and suicide among the young. American Behavioral Scientist, 46(9), Gould, M.S. (1990). Suicide clusters and media exposure. In S. J. Blumenthal & D. J. Kupfer (Eds.), Suicide over the life cycle (pp ). Washington, DC: American Psychiatric Press. 3 Chambers, D. A., Pearson, J. L., Lubell, K., Brandon, S., O Brien, K., & Zinn, J. (2005). The science of public messages for suicide prevention: A workshop summary. Suicide and Life-Threatening Behavior, 35(2), Gould, M. S., Velting, D., Kleinman, M., Lucas, C., Thomas, J. G., & Chung, M. (2004). Teenagers' attitudes about coping strategies and help seeking behavior for suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 43(9), U.S. Department of Health and Human Services. (2001). National strategy for suicide prevention: Goals and objectives for action. Rockville, MD: Author. 6 Rudd, M. D., Berman, A. L., Joiner, T. E., Nock, M. K., Silverman, M. M., Mandrusiak, M., Van Orden, K., and Witte, T. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), Shaffer, D., Gould, M. S., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., & Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53 (4), Conwell Y., Duberstein P. R., Cox C., Herrmann J.H., Forbes N. T., & Caine E. D. (1996). Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. American Journal of Psychiatry, 153, Baldessarini, R., Tondo, L, & Hennen, J. (1999). Effects of lithium treatment and its discontinuation on suicidal behavior in bipolar manic-depressive disorders. Journal of Clinical Psychiatry, 60 (Suppl. 2), Fekete, S., & A. Schmidtke. (1995) The impact of mass media reports on suicide and attitudes toward self-destruction: Previous studies and some new data from Hungary and Germany. In B. L. Mishara (Ed.), The impact of suicide. (pp ). New York: Springer. 11 Cialdini, R. B. (2003). Crafting normative messages to protect the environment. Current Directions in Psychological Science, 12(4), Fekete, S., & A. Schmidtke. op. cit. 13 Moscicki, E.K. (1999). Epidemiology of suicide. In D. G. Jacobs (Ed.), The Harvard Medical School Guide to suicide assessment and intervention (pp ). San Francisco: Jossey-Bass. 14 Fekete, S., & E. Macsai, (1990). Hungarian suicide models, past and present. In G. Ferrari (Ed.), Suicidal behavior and risk factors (pp ). Bologna: Monduzzi Editore. 15 Sonneck, G., Etzersdorfer, E., & Nagel-Kuess, S. (1994). Imitative suicide on the Viennese subway. Social Science and Medicine, 38(3), Suicide Prevention Resource Center GET-SPRC ( ) Education Development Center, Inc. 55 Chapel Street, Newton, MA

3 Talking About Ethnicity & Inequality in Public Education Youth, Ethnicity, & Public Health Outcomes in Hawai i Earl S. Hishinuma, Ph.D. (hishinumae@dop.hawaii.edu) Professor & Associate Chair of Research Department of Psychiatry, University of Hawai i at Mānoa November 7, 2015; Hawai i State Teachers Association (HSTA) Campus Center, University of Hawai i at Mānoa, Honolulu, Hawai i

4 Objectives 1. Health & Psycho-Social Disparities a. less on education achievement 2. Special Education Disparities 3. Student-Teacher Ethnicity Incongruence 4. Life Expectancy as a Primary Health Outcome 5. Summary of Trends 6. Implications

5 Preface 1. Will mostly present on risk factors a. Important to also emphasize protective factors 2. Careful not to stereotype a. We are more similar than different 3. Important to examine trends in the results so that health disparities are appropriately addressed 1. Will be presenting a lot of numbers 2. Will summarize results/trends

6 Youth Risk Behavior Survey (YRBS) Centers for Disease Control & Prevention (CDC) National and local survey administered every odd-numbered year to high school and middle school students Health-related questions in several domains Hawai i results Confidence intervals not included (somewhat large) Race/ethnicity*: Native Hawaiians includes part-native Hawaiians Other = mixed/non-native Hawaiians, Hispanics, African Americans *Hawai i Health Data Warehouse. (2011, August). Race-ethnicity documentation. Honolulu, HI: Hawai i Health Data Warehouse.

7 YRBS Hawai i % (2013): Item Euro Hawaiian Filipino Japanese Other Asian Overweight or obese (based on body-mass index [BMI]) Fruit/vegetable 5 or more times/day past week Non-school-work-related screen time of not more than 2 hours/school day Other Pac Is. Other From: Hawai i Health Data Warehouse, State of Hawai i. (2015, November 5). Hawai i School Health Survey: Youth Risk Behavior Survey Module, (report title and years), Report Created: 5/30/14.

8 YRBS Hawai i % (2013): Item Euro Hawaiian Filipino Japanese Other Asian Alcohol binge drinking past 30 days Methamphetamine lifetime Prescription drugs without M.D. - lifetime Electronically bullied lifetime Forced by date to do unwanted sexual things past year Other Pac Is. Other Adult to talk to

9 YRBS Hawai i % (2013): Item School-Related Euro Hawaiian Filipino Japanese Other Asian Attend at least 1 physical education class past week Teacher/adult at school to talk to Other Pac Is. Other

10 YRBS Hawai i % (2013): Item School-Related Euro Hawaiian Filipino Japanese Other Asian Other Pac Is. Other Alcohol past 30 days Marijuana past 30 days Offered, sold, or given illegal drugs past year Bullied past year Physical fight past year (2011) Threatened/injured with weapon past year (2011) Did not go to school because felt unsafe past 30 days

11 Leading Causes of Death in Hawai i: Suicide = 2 nd leading cause of death for year olds Suicide = 1 st leading cause of fatal injuries for year olds From: Department of Health, State of Hawai i. (2012, September). Injuries in Hawai i, Honolulu, HI: Department of Health, State of Hawai i.

12 Suicide Rates by Ethnicity & Age:

13 YRBS Hawai i % (2013): Suicidality Item Euro Hawaiian Filipino Japanese Other Asian Sad/hopeless past 2 weeks Made plan to kill self past year Seriously considered attempting suicide past year Tried to kill self past year Suicide attempt resulted in injury that had to be treated by doctor/nurse past year Other Pac Is. Other

14 YRBS: Limitations Only Hawai i public school students Approximately 15% of Hawai i s youth are in private schools Surveyed only those with parent permission, youth assent, & present on the day of administration (i.e. not absent, suspended, dropped out of school) Therefore, probably under-estimations of risk Youth self-report Survey data are anonymous; therefore, cannot link data across the years for longitudinal analysis Some of the lower-proportion ethnicities were not disaggregated

15 Youth Incarceration Over-representation at Hawai i Youth Correctional Facility: Native Hawaiians (approx. 50%-55%, expected 25%-30%) Samoans African Americans Under-representation: European Americans Filipino Americans Japanese, Chinese Americans From: Kassebaum, 1995a/b.

16 Hawai i DoE Special Education %: K-12 By Ethnicity ( ) Disability Asian European Hawaiian Hispanic Portu. Other Overall All Disabilities Hearing-Vision Intellectual Disability Severe Emotional Disturbance Speech-Language Learning Disability* Other *Learning disability not primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage. Note: Data from Department of Education, State of Hawai i.

17 Hawai i DoE Special Education %: Ages 6-21 By Ethnicity (2011) Disability European Asian NHOPI* Mixed All Students (public school) All Disabilities Autism Emotional Disturbance Hearing Impairment Intellectual Disability Multiple Disabilities Orthopedic Impairment Other Health Impairment Specific Learning Disabilities Speech or Language Impairment Traumatic Brain Injury Visual Impairment NHOPI = Native Hawaiian and Other Pacific Islander (likely includes part-native Hawaiians) From: Individuals with Disabilities Education Act (IDEA) 2011 Child Count and CCD.

18 Hawai i DoE Student vs. Teacher Ethnicity ( ) Ethnicity Students % Teachers % Native Hawaiian Filipino European (+ Portuguese) Japanese Hispanic Samoan Chinese African American Other Pacific Islanders 5.5? Other? 29.3 From: Department of Education, State of Hawai i. (2014). Superintendent s annual report, Honolulu, HI: Department of Education, State of Hawai i.

19 Life Expectancy (Hawai i, 2000) Years Park, C. B., Braun, K. L., Horiuchi, B. Y., Tottori, C., & Onaka, A. T. (2009). Longevity disparities in multiethnic Hawai i: An analysis of 2000 life tables. Public Health Records, 124,

20 Summary Native Hawaiians life expectancy Special education, substance use, suicidality, incarceration + less screen time, adults to talk to at school Other Pacific Islanders Overweight, life expectancy Marijuana (school)? Physical fights, threatened with weapon, not go to school because felt unsafe, incarceration, suicidality + physically active, fruits/vegetables, less screen time

21 Summary European Americans (Caucasians) Substance use, electronically bullied Autism, speech-language impairment + adult to talk to Portuguese Special education Other (mostly Mixed/non-Hawaiian) Dating violence victimization, bullied (school), suicidality Autism

22 Implications Important to disaggregate data by ethnicity But careful not to stereotype by ethnicity Ethnicity typically accounts for only a small amount the effect What are other factors? Are the measures valid? If so, what do we need to do to reduce & eliminate health disparities What is the role of culture? Additional emphasis on PREVENTION Development of innovative programs that tap into strengths & positive youth-family development Systems approach for positive, sustained changed

23 Implications Possible Roles of the Hawai i Department of Education Educate the next generation (K-12) in PREVENTION & healthy behaviors Have youth teach their parents/families Incorporate culturally appropriate prevention & intervention strategies Partner with other agencies/entities outside of the DoE (e.g., Department of Health, health insurance companies, media)

24 THANK YOU! Earl S. Hishinuma, Ph.D. Professor & Associate Chair of Research Department of Psychiatry University of Hawai i at Mānoa hishinumae@dop.hawaii.edu