Youth Suicide

{ Pratik Jain, PGY 3

Discussant – Dr. Lokireddy
Objectives

 To Learn about Suicide Prevention by

awareness, intervention and methodology

 To Learn about media portrayal of suicide

in youth

 To Learn Steps for Prevention of Suicide.

 Case
 Patient is a 17 yr old single, Caucasian, female,
recently unemployed, in 11th grade, domiciled with
family (mother and father). Patient exhibits
symptoms of depression in the form of sad mood,
anhedonia, feeling worthless, helpless, hopeless,
fatigue, and decreased concentration along with
vague suicidal ideations. Her current stressors
include being new to the school and lack of friends,
being bullied by classmates via them spreading
rumors about her, and recently being sexually
assaulted which she has not mentioned to anyone.
There is no personal or family hx of mental illness or
substances abuse.
Critiques

 Glamorizes suicide

 Educational tool

 Dissuade students from seeking help

 Uptick in threats of suicide

 Copy cat suicide

 Youth Suicide

 Suicidal behavior among children and adolescents

involves a continuum from non-suicidal behavior to
suicidal ideas, attempts and suicide.
 2007 – 2015
 Male teenagers- suicide rates rose 10.8 to 14.2
per 100,000.
 Female teenagers – suicide rates rose 2.4 to 5.1
per 100,000.

 Psychological autopsy studies.

 Psychiatric Disorders among
Youth Victims
 Approx. 90% of children and adolescents who
committed suicide had a psychiatric disorder.
 > 70% rate of comorbid psychiatric disorders
 61-76% suffered from Mood disorders
 Rates of MDD range from 32 -54%
 27-62% suffered from Substance Use Disorders.
 Personality Disorder
 Gender specific suicide
risk factors
 MALE  FEMALE
 Hx of prior attempt  Hx of prior attempt

 23x increase  9x increase

 Current MDD  Current MDD

 9x increase  49x increase

 Current Substance Abuse  Current Substance Abuse

 7x increase  Less than 7x increase

 Sexual orientation  Hopelessness

Neurobiological Factors

 Fewer studies in adolescent and children than in

adults.
 Dysregulation of Serotonin neurotransmitter system
– low levels of CSF 5-HIAA in adolescent attempters.
 Neuroimaging techniques showed high white matter

hyperintensities in youth with MDD and hx of SA.

 Gene-Environment interaction
Stress - Adverse Childhood Experiences Study
Stress

 Violence, especially physical and sexual is a strong

risk factor.

 Stress at peripartum.

 Cultural factors
Video Clip - Graphic
Suicide Risk Assessment

 The likelihood of future suicide attempts.

 An important clue for an impending suicide

attempt is preoccupation with death.
Suicide Risk Assessment
Time point: {Time point:304000075}
Section I - Risk Factors

1. Does patient have a history of suicide attempts or serious suicidal behaviors?:

{yes no:314532}
If yes: Number of previous attempts: ***
Date of last attempt: ***
Did any previous attempts occur while in a hospital or prison?:
{yes no:314532}
Methods of previous suicide attempts: {Methods of
attempts:304000076}
Estimate highest level of lethality of any attempt: {Level of
lethality:304000077}
2. Does patient have a family history of suicide attempts or completions?: {yes
no:314532}
3. Does patient have any of the following symptoms?:{Symptoms:304000078}
4. Indicate recent stressor's during the past 12 months: {Stressors:304000079}
Section II - Protective Factors
1. Does the patient have any of the following protective factors?
Internal factors: {Internal factors:304000080}
External factors: {External factors:304000081}

Section III - Suicide Inquiry

1. Has patient engaged in suicidal behaviors in the past month?: {yes no:314532}
2. Does the patient report current suicidal ideation? {yes no:314532}
3. How frequently has the patient considered suicide in the past 48 hours?: *** Past
month?: ***
4. Does patient have a current plan?: {yes no:314532}
If yes: What is the lethality of the plan?: {Level of lethality:304000077}
Does the patient report intent to carry out plan?: {yes no:314532}
Does the patient have the means to carry out plan?: {yes
no:314532}
Section IV - Determination of Risk
Risk Level Risk Protective Factors
Significant risk factors or acute
High precipitating event; no protective
factors
Multiple risk factors and few
Moderate protective factors
Modifiable risk factors and/or
Low strong protective factors
Not applicable
Suicidality
Recent potentially lethal suicide
attempt or persistent ideation
with string intent or rehearsal
Suicidal ideation with plan, but
no intent or behavior
No current plan, intent, or
behavior
No current suicide ideation or
past suicide history

*If the patient has a history of suicide attempts or serious suicidal behavior, a
risk determination of Low, Moderate or High must be made.

Determination of Risk: {Determination of risk:304000082}

Section V - Plan to Reduce Risk (Complete if risk level is low, moderate or high)
Plan to reduce risk: {Plan to reduce risk:304000083}
Remarks: ***
Interventions & Treatment
 Two most significant issues:
 Identify if the destructive act is self intended or
accidental
 Identify level of risk for injury.

 Psychotherapy

 Psychopharmacology
 Treatment of Adolescent Depression Study
(TADS)
 Prevention Strategies
 Focus effort on identifying high risk children and
adolescent.
 Offer targeted intervention

 Educate mental health, medical, school professionals.

 Improve public health model strategies.

 Media coverage guidelines

 Firearms are the leading cause of death in youth

suicide.
 The End

Questions?
 References
Lewis, M. Child and Adolescent Psychiatry. A Comprehensive Textbook. 5rd ed. Lippincott
Williams & Wilkins, Philadelphia; 2002, Ch5.4.3

S stack, Media Coverage as a risk factor; Public Health Policy and Practice. J Epideminol
Community Health 2003; 57:238-240

Aaron E Carroll, Preventing Teen Suicide: What the Evidence Shows. The New York Times, The
UpShot, Aug 17, 2017

Catherine Saint Louis, For Families of Teens at Suicide Risk, ‘13 Reasons’ Raises Concerns. The
New York Times, Well-Family, May 1, 2017

Singer, PhD, LCSW. Identifying and Responding to Suicide Risk in Schools. Psychiatric Annals,
V47M8-Aug 2017

CDC, Preventing Suicide: A Technical Pakage of Policy, Programs, and Practices.

WHO, Preventing Suicide, Aresource for Media Professionals