This document discusses depression, suicide risk factors, warning signs, and prevention strategies among children and adolescents. Some key findings include that depression onset is occurring earlier, and it often coexists with other disorders. Research estimates that 28% of adolescents will experience depression, and up to 7% of those who develop major depression may attempt suicide. Risk factors include stress, loss, family history, and untreated psychological disorders. Warning signs can include threats, previous attempts, depression, risk-taking behaviors, and fascination with death. Prevention strategies involve education, screening, intervention, referral, and developing a supportive school environment.

1. Depression
& Suicide:
Risk Factors, Warning
Signs, Prevention, &
Postvention

2. Depression Statistics
Research indicates that the onset of
depression is occurring earlier in life today
than in the past
It often coexists with other mental health
problems such as chronic anxiety and
disruptive behavior disorders.

3. Some Findings…
 Research through the University of Oregon
estimates that 28% of all adolescents (ages 13-
19) will experience at least one episode of major
depression.
3-7% for ages 13-15
1-2% for children under age 13
 Up to 7% of adolescents who develop major
depressive disorder may eventually commit
suicide

4. Some More Findings…
 Before puberty, boys and girls are equally likely
to develop depressive disorders
 By age 15, girls are twice as likely as boys to
have experienced a major depressive episode.
 Depression in adolescence, frequently co-occurs
w/ other disorders such as anxiety, disruptive
behavior, eating disorders or substance abuse.

5. Risk Factors for Depression
Stress
Having experienced significant loss
Having attention, learning, and/or conduct
issues
Experiencing trauma, abuse, or a long-
term illness or disability
Family history of depression
Other untreated psychological disorders

6. More Depression Risk Factors
Poor academic functioning
Poor physical health
Poor coping and/or social skills
Low self-esteem
Behavior Problems
Poor School and Family Connectedness
Substance Abuse

8. The Hard Reality: Suicide Stats
Although youth suicide rates have
declined slightly since 1992, it is still the 3rd
leading cause of death among 10-24 year
olds—following homicide and automobile
accidents.
The suicide rates for 10-14 year olds
increased 196% between 1983-98.

9. More Suicide Statistics…
Suicide rates among certain
subpopulations, such as Black males,
White females, Asian youth, American
Indian youth, and sexual minority youth
have all increased.
Hispanic students had the highest rates of
suicidal ideation and behavior and were
more likely to attempt suicide

10. Suicide Statistics continued…
 Completed suicides are only part of the picture. It is
estimated that for every youth who dies by suicide,
100-200 youth attempt it—2-6% of children.
 In a typical high school classroom, it is likely that
three students (1 boy, 2 girls) have attempted
suicide in the past year.
 For every student who attempts suicide, only one
receives medical attention—the other two get up
and go to school the next day.

11. A Prime Example:
Megan Meier Story Video—Youtube.com

12. Depression: Signs & Symptoms
Characteristics that usually occur in
children, adolescents, and adults include:
Persistent sad and irritable mood
Loss of interest or pleasure in activities
once enjoyed
Significant change in appetite/weight
Difficulty sleeping or oversleeping
Physical signs of agitation or excessive
lethargy/loss of energy

13. More Depression Signs
Feelings of worthlessness/inappropriate
guilt
Difficulty concentrating
Recurrent thoughts of death or suicide

14. Child Specific Signs of Depression
 Difficulty maintaining relationships
 Frequent vague, nonspecific physical complaints
(headaches, stomachaches)
 Frequent absences from school or unusually
poor school performance
 School refusal or excessive separation anxiety

15. More Child Specific Signs
 Outbursts of shouting, complaining, unexplained
irritability, or crying
 Chronic boredom or apathy
 Lack of interest in playing with friends
 Alcohol or drug abuse
 Reckless behavior

16. Depression: Child Specific
 Withdrawal, social isolation, and poor
communication
 Excessive fear of or preoccupation with death
 Extreme sensitivity to rejection or failure
 Unusual temper tantrums, defiance, or
oppositional behavior

17. Depression: Child Specific
 Regression (i.e., acting babyish, resumption of
wetting or soiling after toilet training)
 Increased risk-taking behavior
 Note: the presence of one (or even all) of these
signs and symptoms do not necessarily signal
clinical depression—but are causes or concern
and may suggest the need for professional
evaluation.

18. Some Precipitating
Circumstances for Suicide
(Triggers):
Breaking up with a boyfriend/girlfriend
Academic crisis or school failure
Family conflict/dysfunction
Rejection by friends
After a natural disaster, school
shooting, terrorist attack, etc.

19. More Triggers…
Getting into trouble with authorities
Death of a loved one or significant
person/loss
Knowing someone who died by suicide
Bullying or victimization

20. Triggers Continued…
 Abuse
 Trauma exposure
 Serious illness or injury
 Anniversary of the death of a loved one
 Forced or extended separation from friends or
family

21. Who’s at risk for suicide??
Situational Stress (i.e., family stress,
traumatic death of a loved one, physical or
sexual abuse, family violence, traumatic
event, etc.)
Children who exhibit risk factors and who
have been directly impacted and/or by
tragic events are most likely to consider
suicide.

22. Who’s at risk??
Environmental risks including the
presence of a firearm in the home,
poverty, a family history of suicide, etc.
Mental illness including depression,
conduct disorders, emotional problems,
and substance abuse

23. Gender Characteristics…
Adolescent girls have higher rates of
depression and are twice as likely to
carefully plan and attempt suicide.
Boys are more likely to act impulsively and
are almost 5 times as likely than females
to die by suicide.

24. Warning Signs
 Suicide notes. These are a very real sign of
danger and should be taken seriously.
 Threats. Threats may be direct statements (“I
want to die.” “I am going to kill myself.”) or,
unfortunately, indirect comments such as:
(“The world would be better without me” “Nobody
will miss me anyway”).

25. Warning Signs-continued
Threats continued: Indirect clues by
teenagers may be offered through joking or
comments in school assignments—
particularly creative writing or artwork.
Previous Attempts: Be very observant of
students who have tried suicide before as
they are likely to do it again.

26. More Warning Signs
 Depression: As previously mentioned,
depressed students are more likely to commit
suicide.
 “Masked Depression”: Sometimes risk-taking
behaviors can include acts of aggression,
gunplay, and alcohol/substance abuse. While
the student does not acted depressed, their
behavior suggests that they aren’t concerned
with their own safety.

27. More Suicide Warning Signs
Final Arrangements: This takes on many
forms such as students giving away prized
possessions.
Efforts to hurt oneself: Self-Injury
behaviors are warning signs in both
children and teenagers. Common
behaviors include running into traffic,
jumping from heights, and
scratching/cutting/marking the body.

28. More Suicide Warning Signs
 Inability to concentrate or think clearly: these
problems may be reflected in classroom
behavior, homework habits, academic
performance, household chores, even
conversation.
 Changes in physical habits and appearance:
Include inability to sleep or sleeping all of the
time, sudden weight gain or loss, and/or
disinterest in appearance or hygiene.

29. More Warning Signs
 Sudden changes in personality, friends, and/or
behaviors: Parents, teachers, and friends are
often the best observers of sudden changes in
behavior—including withdrawing, skipping
school, loss in involvement in activities, and
avoiding friends.
 Fascination w/ death and suicidal themes: These
might appear in classroom drawings, work
samples, journals, or homework.

30. Warning Signs
Plan/Method/Access: A suicidal child or
adolescent may show an increased
interest in guns and other weapons. They
may also seem in have increased access
to guns, pills, etc., and/or may talk about
or hint at a suicide plan. The greater the
planning, the greater the potential for
suicide.

31. What can be done to help suicidal
students??
 Know the warning signs!! Review the warning
signs as needed.
 Do not be afraid to ask students about their
feelings.
 Share your concerns with a school psychologist,
administrator, or guidance counselor.
 Ask if your school has a crisis team and/or plan.

32. Children & Adolescents
…Adolescents can cognitively understand
the concept of death. It is not clear that
they internalize the end of their own lives
—particularly younger adolescents
It would not be uncommon for students
even as old as 16 to view death as
magical, temporary, and reversible.

33. Children & Adolescents
 Unlike adolescents, children are less cognitively
able to understand the concept of death and its
implications.
 Contrary to popular belief, children and
adolescents do not necessarily attempt suicide
as a “cry for help”—the reasons they give are
more similar to adults
 Only 10% were trying to get attention

34. Children & Adolescents
 When asked, one-third of children and
adolescents are asked, the main reason for
trying to kill themselves is they wanted to die
 Another third wanted to escape from a hopeless
situation or a horrible state of mind.
 Again, only 10% were trying to get attention
 Only 2% saw getting help as the chief reason for
trying suicide

35. Three Levels of Concern
1) Suicidal Thinking:
Means a person is thinking about suicide
but has no plan. About 3-4% of adolescents
will have considered suicide in the last two
weeks. These thoughts are much more
likely, and more likely to be serious, if the
child has previously made a suicide, is
depressed, or is pessimistic. Students who
are both depressed and have previously
attempted suicide are likely to be seriously
thinking about suicide.

36. Three Levels of Concern
Suicidal Plans:
Means that you are thinking about suicide
and have a way to do it in mind.
*Share examples/vignettes

37. Three Levels of Concern
 Suicide Attempts:
Means you have actually tried to hurt yourself.
These can be medically serious or not serious.
They can be psychologically serious or not.
About 40% of teenagers will have thought about
suicide for only a half hour or so before they try
something. The most frequent reason for these
impulsive suicide plans are relationship
problems.
*More examples/vignettes

38. Depression:
What Adults Can Do to Help
Stay in frequent contact w/ children and
know the warning signs of depression
Parents, school personnel, and other
adults play key roles in monitoring the
effectiveness of and helping ensure
compliance with treatment plans.

39. What Schools Can Do
Facilitate prevention, identification, and
treatment for depression in children and
adolescents by:
Developing a caring supportive school
environment for children, parents, and faculty
Preventing all forms of bullying, as a
vigorously enforced school policy.
Establishing clear rules and enforce them
fairly
Having suicide and violence prevention plans
in place and implement them.

40. What Depressed Teens Can Do
(With Our Support):
Try to make new friends. Healthy
relationships with peers are central to
teens’ self-esteem and a social outlet.
Participate in sports, job, school activities,
or hobbies. Staying busy helps teens
focus on positive activities rather than
negative feelings or behaviors.

41. More for Depressed Teens…
Join organizations that offer programs for
young people. Special programs geared to
the needs of adolescents help develop
additional interests.
Ask a trusted adult for help. When
problems are too much to handle alone,
teens should not be afraid to ask for help.

42. Suicide: Planning & Prevention
 Create a culture of connectedness in which
students (both at risk and their peers) trust and
seek the help of school staff members.
Encourage openness by taking all threats
seriously.
 Awareness Education; Screening; Crisis and
mental health team coordination; collaboration
with community services; reliance on evidence-
based strategies; and clear intervention and
‘postvention’ protocols.

43. Suicide: Prevention/Intervention
 Assess Risk: (i.e., asking “Have you ever
thought about suicide?”; “Have you ever
attempted suicide?”; “Do you have a plan to
harm yourself now?”
 Warn Parents: parents must be notified—with
the exception of when it appears the student
might be a victim of parental abuse. Encourage
their participation in prevention efforts. Offer to
follow through on referral efforts if they are not
comfortable doing so.

44. Suicide: Prevention/Intervention
 Provide Referrals: consider cultural,
developmental, and sexuality issues when
making referrals—to help the student identify
caring adults at home and at school; appropriate
coping strategies; and community resources.
 Document and Follow-up: Principal needs to be
in close contact with counseling personnel—
especially when concerns regarding an
‘anniversary date’ associated with youth suicide.

45. Suicide Postvention
(After the Fact)
 Activate the school crisis team. Verify the death
and assess the impact on the school community
(including staff members and parents).
 Contact the victim’s family to offer support and
determine their preferences for student
outreach, expressions of grief, and funeral
arrangements/attendance
 Determine what and how information is to be
shared. Tell the truth.

46. More Suicide Postvention…
 Inform students through discussion in
classrooms and smaller venues, not assemblies
or school-wide announcements.
 Identify at-risk youth. Provide support and
referral when appropriate. Those at particular
risk to imitate suicidal behavior are those who
might have facilitated the suicide, failed to
recognize or ignored the warning signs, or had a
relationship or identify with the victim.

47. Suicide Postvention, continued…
 Focus on survivor coping and efforts to prevent
further suicides. This is a time for key prevention
information. Emphasize that no one thing or
person is to blame and that help is available.
 Advocate for appropriate expressions of
memorialization. Do not dedicate a memorial
(e.g., tree plaque, or yearbook). Do contribute to
a suicide prevention effort in the community or
establish a living memorial such as a
scholarship or student assistance program.

48. Even more Suicide Postvention…
Evaluate the crisis response.
Media representatives should be
encouraged to follow the American
Association of Suicidology guidelines.
These guidelines recommend not making
the suicide front page news or publishing
a picture of the deceased, but instead
emphasizing suicide prevention,
recognition of warning signs, and where to
go for help.

49. Resiliency Factors
 Family support and cohesion, including good
communication
 Peer support and close social networks
 School and community connectedness
 Cultural and religious beliefs that discourage
suicide and promote healthy living

50. More Resiliency Factors
Adaptive coping and problem solving
skills, including conflict resolution
General life satisfaction, good self-esteem,
sense of purpose
Easy access to effective medical and
mental health resources

51. Depression Resources
• Merrell, K. W. (2001). Helping children overcome
depression and anxiety: A practical guide. New York:
Guilford
• National Institute of Mental Health. (2001). Depression in
children and adolescents (Fact Sheet for Physicians).
Bethesda, MD: Author
• National Institute of Mental Health. (2001). Let’s talk about
depression [for teens]. Bethesda, MD: Author
• Seeley, J., Rohde, P., Lewinsohn, P. & Clarke, G. (2002).
Depression in youth: Epidemiology, identification, and
intervention. In M. Shinn, H. Walker, & G. Stoner (Eds.),
Interventions for academic and behavior problems II:
Preventive and remedial approaches (pp. 885-912).
Bethesda, MD: National Association of School

52. Suicide Resources on the Web
 American Association of Suicidology: www.suicidology.org
 American Foundation for Suicide Prevention. www.afsp.org
 Signs of Suicide (SOS). www.mentalhealthscreening.org
 Teen Screen Program. www.teenscreen.org
 Centers for Disease Control. www.cdc.gov
 National Suicide Hotline 1-800-SUICIDE

53. More Web Resources
 Save a Friend: Tips for Teens to Prevent Suicide.
http://www.nasponline.org/resources/crisis_safety/savefriend_
 Times of Tragedy: Preventing Suicide in Troubled
Children and Youth, Part I.
http://www.nasponline.org/resources/crisis_safety/suicidept1_
 National Association of Secondary School Principals,
“Taking the Lead on Suicide Prevention and Intervention
in the Schools.” www.nasponline.org/resources/
principals/nassp2006.aspx This would be a valuable

54. More Web Resources
 American Academy for Child and Adolescent
Psychiatry. www.aacap.org
 Depression and Bipolar support Alliance
(DBSA). www.dballiance.org
 National Institute of Mental Health Suicide
Prevention Resources.
http://nimh.nih.gov/suicideprevention/_index.cfm
 National Mental Health Association.
www.nmha.org

55. Web Resources
Suicide Awareness/Voices of Education
(SAVE). www.save.org
U.S. Department of Health and Human
Services, National Strategy on Suicide
Prevention.
http://www.mentalhealth.samhsa.gov/suicidepr