This document provides an overview of the "More than Sad" suicide prevention education program for teachers and school personnel. The goals of the program are to increase understanding of youth suicide and risk factors, and to help identify at-risk students. It reviews risk factors like depression, bipolar disorder, anxiety, substance use disorders, conduct disorder, and eating disorders. It discusses warning signs and how teachers can help, such as identifying at-risk students and referring them for help. The program includes a film and sections on understanding suicide and the problems, risk factors, and how teachers can help at-risk youth.

1. More than Sad:More than Sad:
Suicide Prevention Education forSuicide Prevention Education for
Teachers and Other School PersonnelTeachers and Other School Personnel
American Foundation for Suicide PreventionAmerican Foundation for Suicide Prevention
120 Wall Street, 29th Floor120 Wall Street, 29th Floor
New York, NY 10005New York, NY 10005
212.363.3500212.363.3500
www.afsp.orgwww.afsp.org

2. 22
IntroductionIntroduction
to the Programto the Program
Program goalsProgram goals
1.1. Increase understanding of:Increase understanding of:
 Problem of youth suicideProblem of youth suicide
 Suicide risk factorsSuicide risk factors
 Treatment and prevention of suicidal behavior in adolescentsTreatment and prevention of suicidal behavior in adolescents
1.1. Increase knowledge of warning signs of youth suicide soIncrease knowledge of warning signs of youth suicide so
those who work with teens are better prepared tothose who work with teens are better prepared to identifyidentify
andand refer at-risk studentsrefer at-risk students

3. 33
Understanding theUnderstanding the
Problem of SuicideProblem of Suicide
 In 2010, 38,364 people in the U.S. died by suicideIn 2010, 38,364 people in the U.S. died by suicide
 U.S. suicide rate = 12.1 (12 suicides for every 100,000 people)U.S. suicide rate = 12.1 (12 suicides for every 100,000 people)
 4,867 people under age 25 died by suicide (12.7% of total)4,867 people under age 25 died by suicide (12.7% of total)
 Suicide rate for youth (ages 15-24) = 10.1Suicide rate for youth (ages 15-24) = 10.1
 Suicide is the 3Suicide is the 3rdrd
leading cause of death for adolescents andleading cause of death for adolescents and
young adults (ages 15–24)young adults (ages 15–24)

4. 4444

5. 5555

6. 6666

7. 7777
Youth Suicide RatesYouth Suicide Rates
by Race/Ethnicityby Race/Ethnicity (Ages 15-24)(Ages 15-24)
*Number of suicides per 100,000
population, 2010
Ethnic Group Suicide Rate per
100,000
American Indian/Alaskan Native 20.9 per 100,000
White 11.4 per 100,000
Asian/Pacific Islander 7.3 per 100,000
Black 6.6 per 100,000
Hispanic 4.7 per 100,000

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Suicide AttemptsSuicide Attempts
 Each year,Each year, 150,000150,000 youth aged 10-24 receive medical care foryouth aged 10-24 receive medical care for
self-inflicted injuriesself-inflicted injuries
 30x30x the number who die by suicidethe number who die by suicide
 9.3% of girls and 4.6% of boys in grades 9-12 report attempting
suicide in last 12 months
 Reports of suicide attempts are 2-6x more frequent among
youth who identify as gay, lesbian or bisexual, than among
heterosexual youth; no data on GLB suicide deaths

9. 99
Suicidal IdeationSuicidal Ideation
 ““Ideation” – thinking about or planning for suicideIdeation” – thinking about or planning for suicide
 AboutAbout 14%14% of students in grades 9-12 – 1 of every 7 – reportof students in grades 9-12 – 1 of every 7 – report
seriously considering suicide in the past yearseriously considering suicide in the past year
 AboutAbout 11%11% – 1 of every 9 – report making a suicide plan– 1 of every 9 – report making a suicide plan

10. 1010
How CanHow Can
Teachers Help?Teachers Help?
Key tasksKey tasks
 IdentificationIdentification of at-risk studentsof at-risk students
 ReferralReferral for assessment and evaluation, according to school’sfor assessment and evaluation, according to school’s
protocol or policyprotocol or policy
Teachers and other school personnel must know how toTeachers and other school personnel must know how to
recognizerecognize “risk”“risk” in youthin youth

11. 1111
Film,Film, More Than Sad:More Than Sad:
Preventing Teen SuicidePreventing Teen Suicide
 Provides an overview of mental disorders in teens that mayProvides an overview of mental disorders in teens that may
end in suicideend in suicide
 Identifies behaviors that suggest a student may be at riskIdentifies behaviors that suggest a student may be at risk
 Discusses steps that teacher and other personnel can take toDiscusses steps that teacher and other personnel can take to
ensure that these students get helpensure that these students get help
 Introduces concepts that will be discussed in later sections ofIntroduces concepts that will be discussed in later sections of
this programthis program

12. 1212
Show film,Show film,
More Than Sad: Preventing Teen SuicideMore Than Sad: Preventing Teen Suicide

13. 1313
Risk FactorsRisk Factors
for Teen Suicidefor Teen Suicide
 Key suicide risk factorKey suicide risk factor for all age groups is an undiagnosed,for all age groups is an undiagnosed,
untreated or ineffectively treateduntreated or ineffectively treated mental disordermental disorder
 90%90% of people who die by suicide have a mental disorderof people who die by suicide have a mental disorder
 In teens, suicide risk is most clearly linked toIn teens, suicide risk is most clearly linked to 7 mental7 mental
disordersdisorders, often with overlapping symptoms:, often with overlapping symptoms:
Major Depressive DisorderMajor Depressive Disorder Conduct DisorderConduct Disorder
Bipolar DisorderBipolar Disorder Eating DisordersEating Disorders
Generalized Anxiety DisorderGeneralized Anxiety Disorder SchizophreniaSchizophrenia
Substance Use DisordersSubstance Use Disorders

14. 1414
Major DepressiveMajor Depressive
Disorder (MDD)Disorder (MDD)
 Key symptoms in teens areKey symptoms in teens are sad, depressed, angry or irritablesad, depressed, angry or irritable
moodmood andand lack of interest or pleasure in activities the teen usedlack of interest or pleasure in activities the teen used
to enjoyto enjoy, lasting at least, lasting at least 2 weeks2 weeks
 Other symptomsOther symptoms
Changes in appetiteChanges in appetite Worthlessness/guiltWorthlessness/guilt
Sleep disturbancesSleep disturbances Inability to concentrateInability to concentrate
Slowed or agitated movementSlowed or agitated movement Recurrent thoughts of deathRecurrent thoughts of death
Fatigue/loss of energyFatigue/loss of energy or suicide, self-harm behavioror suicide, self-harm behavior
 Symptoms represent aSymptoms represent a clear changeclear change from normal and arefrom normal and are
generally observed in severalgenerally observed in several different contextsdifferent contexts

15. 1515
FactsFacts
about MDDabout MDD
 8-12%8-12% of teens suffer from major depressionof teens suffer from major depression
 MDD is more common inMDD is more common in femalesfemales than malesthan males
 MDD is caused byMDD is caused by changes in brain chemistrychanges in brain chemistry that may resultthat may result
from stressful life events, but also from genetic or otherfrom stressful life events, but also from genetic or other
internal factorsinternal factors
 MDD may occur in teens who are appear toMDD may occur in teens who are appear to “have it all”“have it all”
 MDD in teens is often expressed throughMDD in teens is often expressed through physical complaintsphysical complaints
(stomach distress, headaches)(stomach distress, headaches)
 MDD is the mental disorderMDD is the mental disorder most frequently associated withmost frequently associated with
suicidesuicide in both teens and adultsin both teens and adults

16. 1616
Bipolar DisorderBipolar Disorder
 ““Manic-depression” –Manic-depression” – alternatingalternating episodes ofepisodes of depressiondepression andand
maniamania
 Manic symptomsManic symptoms
Inflated self-esteem/grandiosityInflated self-esteem/grandiosity DistractibilityDistractibility
Decreased need for sleepDecreased need for sleep Agitated speech/movementAgitated speech/movement
Talking much more than usualTalking much more than usual Involvement in risky activitiesInvolvement in risky activities
Flight of ideasFlight of ideas
 Manic symptoms last at leastManic symptoms last at least 1 week1 week and cause clear social,and cause clear social,
academic or work impairmentacademic or work impairment
 In many cases, manic symptoms are less severe orIn many cases, manic symptoms are less severe or
“hypomanic”“hypomanic”

17. 1717
Facts aboutFacts about
Bipolar DisorderBipolar Disorder
 Bipolar disorderBipolar disorder usually beginsusually begins with depressive episodewith depressive episode; can; can
lead to misdiagnosislead to misdiagnosis
 Bipolar disorder isBipolar disorder is less common than depressionless common than depression in bothin both
teens and adultsteens and adults
 Unlike depression,Unlike depression, occurs as frequently in boysoccurs as frequently in boys as in girlsas in girls
 Conveys especiallyConveys especially high risk for suicidehigh risk for suicide
 SuicideSuicide risk highestrisk highest
- during depressive- during depressive rather than manic episodesrather than manic episodes
- when rapid “cycling” of manic and depressive symptoms occurs- when rapid “cycling” of manic and depressive symptoms occurs
- in “mixed” episodes (depressive and manic symptoms present at- in “mixed” episodes (depressive and manic symptoms present at
same time)same time)

18. 1818
GeneralizedGeneralized
Anxiety Disorder (GAD)Anxiety Disorder (GAD)
 Key characteristic of GAD isKey characteristic of GAD is excessiveexcessive, uncontrolled worry, uncontrolled worry,,
occurring more days than not for a period ofoccurring more days than not for a period of 6 months6 months (e.g.,(e.g.,
persistent worry about tests, speaking in class)persistent worry about tests, speaking in class)
 SymptomsSymptoms
Restlessness/keyed upRestlessness/keyed up IrritabilityIrritability
Being easily fatiguedBeing easily fatigued Muscle tensionMuscle tension
Difficulty concentratingDifficulty concentrating Sleep disturbancesSleep disturbances
 GAD is one ofGAD is one of many different anxiety disordersmany different anxiety disorders that may affectthat may affect
teens – e.g., social anxiety disorder, obsessive-compulsiveteens – e.g., social anxiety disorder, obsessive-compulsive
disorder, panic disorder. All anxiety disorders share andisorder, panic disorder. All anxiety disorders share an
anxious, fearful mood, leading to other symptoms andanxious, fearful mood, leading to other symptoms and
disabilitydisability

19. 1919
FactsFacts
about GADabout GAD
 GirlsGirls are more likely than boys to have GADare more likely than boys to have GAD
 Teens who areTeens who are “perfectionists”“perfectionists” may be especially vulnerablemay be especially vulnerable
 Severe anxiety isSevere anxiety is often part of depressionoften part of depression in teensin teens
 Like depression, anxiety is often expressed throughLike depression, anxiety is often expressed through physicalphysical
symptomssymptoms (racing heart, shortness of breath)(racing heart, shortness of breath)
 Overwhelming anxiety can lead teens to feel they can’t go onOverwhelming anxiety can lead teens to feel they can’t go on
and toand to thinking about or planning for suicidethinking about or planning for suicide

20. 2020
SubstanceSubstance
UseUse DisordersDisorders
 Two main types:Two main types: substance dependencesubstance dependence andand substancesubstance
abuseabuse
 Each involvesEach involves maladaptive pattern of drug or alcohol usemaladaptive pattern of drug or alcohol use overover
12 months,12 months, leading to significantleading to significant impairmentimpairment oror distressdistress
 Symptoms ofSymptoms of substance dependencesubstance dependence
Increasing tolerance of the substanceIncreasing tolerance of the substance
Withdrawal effects when not usedWithdrawal effects when not used
Taking larger amounts, over a longer period, than intendedTaking larger amounts, over a longer period, than intended
Persistent desire or unsuccessful efforts to cut down usePersistent desire or unsuccessful efforts to cut down use
Spending considerable time obtaining, using or recovering from theSpending considerable time obtaining, using or recovering from the
substancesubstance
Giving up activities because of the substance useGiving up activities because of the substance use
Continued use despite knowing it is causing problemsContinued use despite knowing it is causing problems

21. 2121
SubstanceSubstance
UseUse Disorders…Disorders…
 Symptoms ofSymptoms of substance abusesubstance abuse
Failing to fulfill major role obligations because of substance useFailing to fulfill major role obligations because of substance use
Recurrent substance use in physically hazardous situationsRecurrent substance use in physically hazardous situations
Recurrent substance-related legal problemsRecurrent substance-related legal problems
Continued use despite persistent social or interpersonal problemsContinued use despite persistent social or interpersonal problems
caused by effects of substance usecaused by effects of substance use
 Substance dependence and abuse may exist as a singleSubstance dependence and abuse may exist as a single
disorder or in addition to another mental disorder, such asdisorder or in addition to another mental disorder, such as
major depression or an anxiety disordermajor depression or an anxiety disorder

22. 2222
Facts aboutFacts about
Substance Use DisordersSubstance Use Disorders
 Alcohol use disorders are especially common among teens,Alcohol use disorders are especially common among teens,
often beginning with the desire to be part of a peer groupoften beginning with the desire to be part of a peer group
 Although commonly used to cope with stress, depression orAlthough commonly used to cope with stress, depression or
anxiety, alcohol almost always worsens these problemsanxiety, alcohol almost always worsens these problems
 Other effects of alcohol and other drugs on teensOther effects of alcohol and other drugs on teens
Increased irritability and angerIncreased irritability and anger
Relationship problems (peers and family)Relationship problems (peers and family)
Sleep disturbancesSleep disturbances
Reduced concentration and ability to cope with stressReduced concentration and ability to cope with stress
Family conflict over substance useFamily conflict over substance use
Legal problemsLegal problems
Increased suicide riskIncreased suicide risk due todue to decreased inhibitiondecreased inhibition andand increasedincreased
impulsivityimpulsivity

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Conduct DisorderConduct Disorder
 Repetitive, persistent pattern inRepetitive, persistent pattern in children or adolescentschildren or adolescents ofof
violating rights of others, rules or social normsviolating rights of others, rules or social norms;; occurs overoccurs over 1212
monthsmonths and results in significantand results in significant impairment in functioningimpairment in functioning
 SymptomsSymptoms
Bullying/threatening othersBullying/threatening others Fire-settingFire-setting
Physical fightsPhysical fights Destroying propertyDestroying property
Using a weaponUsing a weapon Breaking into houses/carsBreaking into houses/cars
Physical cruelty to peoplePhysical cruelty to people Lying/conning othersLying/conning others
Physical cruelty to animalsPhysical cruelty to animals Staying out all nightStaying out all night
Mugging, shoplifting, stealingMugging, shoplifting, stealing Running away from homeRunning away from home
Forced sexual activityForced sexual activity Frequent school truancyFrequent school truancy

24. 2424
Facts aboutFacts about
Conduct DisorderConduct Disorder
 DislikeDislike of conduct-disordered youth because of their anti-of conduct-disordered youth because of their anti-
social behavior maysocial behavior may impede recognitionimpede recognition of this serious mentalof this serious mental
disorderdisorder
 There is aThere is a strong genetic componentstrong genetic component to the aggressivenessto the aggressiveness
seen in conduct disorderseen in conduct disorder
 Much more frequent inMuch more frequent in boysboys than in girlsthan in girls
 FrequentlyFrequently overlaps with AD/HD, depression and substanceoverlaps with AD/HD, depression and substance
use disorderuse disorder
 Associated withAssociated with high rates of suicidal ideation, suicidehigh rates of suicidal ideation, suicide
attempts and completed suicideattempts and completed suicide

25. 2525
Eating DisordersEating Disorders
 Two main types:Two main types: anorexia nervosaanorexia nervosa andand bulimia nervosabulimia nervosa
 Symptoms ofSymptoms of anorexia nervosaanorexia nervosa
Refusal to maintain body weight at minimally normal level for ageRefusal to maintain body weight at minimally normal level for age
and heightand height
Intense fear of gaining weightIntense fear of gaining weight
Disturbance in how body weight or shape is experienced, or denialDisturbance in how body weight or shape is experienced, or denial
of low body weightof low body weight
In females, delay of menarche or cessation of menstrual cyclesIn females, delay of menarche or cessation of menstrual cycles

26. 2626
Eating Disorders…Eating Disorders…
 Symptoms ofSymptoms of bulimia nervosabulimia nervosa
Recurrent episodes of uncontrollable binge eating (at least 2x perRecurrent episodes of uncontrollable binge eating (at least 2x per
week for 3 months)week for 3 months)
Recurrent inappropriate behaviors to compensate for binge eatingRecurrent inappropriate behaviors to compensate for binge eating
and avoid gaining weight (e.g., vomiting, misuse of laxatives,and avoid gaining weight (e.g., vomiting, misuse of laxatives,
excessive exercise)excessive exercise)
Self-evaluation unduly influenced by body shape and weightSelf-evaluation unduly influenced by body shape and weight
 Eating disorders are strongly linked to other mental disorders,Eating disorders are strongly linked to other mental disorders,
especially depression and anxietyespecially depression and anxiety

27. 2727
Facts aboutFacts about
Eating DisordersEating Disorders
 Far more common amongFar more common among femalesfemales than among malesthan among males
 Typically begin betweenTypically begin between agesages 13 and 2013 and 20
 10-20%10-20% of people with anorexia nervosaof people with anorexia nervosa die prematurelydie prematurely,,
often by suicideoften by suicide
 Women aged 15-24 with an eating disorder have aWomen aged 15-24 with an eating disorder have a suicidesuicide
rate 60 times the expected raterate 60 times the expected rate for young women overallfor young women overall
 People with eating disorders tend to use particularlyPeople with eating disorders tend to use particularly violentviolent
suicide methodssuicide methods
 Other characteristics that contribute to lethality of suicideOther characteristics that contribute to lethality of suicide
attemptsattempts
Perfectionistic, obsessive, secretive, socially isolatedPerfectionistic, obsessive, secretive, socially isolated
Low weight, electrolyte abnormalitiesLow weight, electrolyte abnormalities

28. 2828
SchizophreniaSchizophrenia
 Schizophrenia is a psychotic disorder that causes people toSchizophrenia is a psychotic disorder that causes people to
havehave difficulty interpreting realitydifficulty interpreting reality
 Two sets of symptoms-Two sets of symptoms- positivepositive andand negative; bothnegative; both areare
abnormalabnormal
 Positive symptomsPositive symptoms
Delusions (fixed false beliefs, e.g., that others are controlling one’sDelusions (fixed false beliefs, e.g., that others are controlling one’s
thoughts, or are trying to cause one harm)thoughts, or are trying to cause one harm)
Hallucinations (fixed false sensory perceptions, e.g. hearing voices,Hallucinations (fixed false sensory perceptions, e.g. hearing voices,
seeing or smelling things that are not there in reality)seeing or smelling things that are not there in reality)
Disorganized or incoherent speechDisorganized or incoherent speech
Excessive, purposeless movements, or catatonic, immobile behaviorExcessive, purposeless movements, or catatonic, immobile behavior

29. 2929
Schizophrenia…Schizophrenia…
 Negative symptomsNegative symptoms
Low energy or motivationLow energy or motivation
Lack of emotionLack of emotion
Difficulty expressing thoughts or elaborating responsesDifficulty expressing thoughts or elaborating responses
Difficulty integrating thoughts, feelings and behaviorDifficulty integrating thoughts, feelings and behavior
Blank facial expressionBlank facial expression
Social withdrawal, isolationSocial withdrawal, isolation
Inappropriate social skillsInappropriate social skills

30. 3030
Facts aboutFacts about
SchizophreniaSchizophrenia
 AffectsAffects both malesboth males andand femalesfemales
 Typically begins to develop inTypically begins to develop in very late adolescence or earlyvery late adolescence or early
adulthoodadulthood
 Earlier onsetEarlier onset inin malesmales (ages 15-25) than in females (ages 25-(ages 15-25) than in females (ages 25-
35)35)
 Strongly linked toStrongly linked to geneticgenetic factorsfactors
 People with schizophrenia havePeople with schizophrenia have very high rates of suicidalvery high rates of suicidal
behaviorbehavior
40% make one or more suicide attempts40% make one or more suicide attempts
10% die by suicide10% die by suicide

31. 3131
Other IndividualOther Individual
Suicide Risk FactorsSuicide Risk Factors
ImpulsivityImpulsivity
 Contributes to suicidal behavior, especially in context of depressionContributes to suicidal behavior, especially in context of depression
or bipolar disorderor bipolar disorder
 Associated with dysregulated brain chemistry; may explain why someAssociated with dysregulated brain chemistry; may explain why some
teens with these disorders engage in suicidal behaviors while othersteens with these disorders engage in suicidal behaviors while others
do notdo not
Family HistoryFamily History
 Many mental disorders run in families, due to genetic factorsMany mental disorders run in families, due to genetic factors
 Suicide attempts and completed suicide are more frequent in teensSuicide attempts and completed suicide are more frequent in teens
with a relative who has attempted or died by suicidewith a relative who has attempted or died by suicide
Prior Suicide AttemptPrior Suicide Attempt
 30-40% of teens who die by suicide have made a prior attempt30-40% of teens who die by suicide have made a prior attempt

32. 3232
Situational FactorsSituational Factors
that Increase Suicide Riskthat Increase Suicide Risk
 Although mental disorders are the most significant cause ofAlthough mental disorders are the most significant cause of
suicide in teens and adults,suicide in teens and adults, stressful life eventsstressful life events and otherand other
situational factors maysituational factors may triggertrigger suicidal behaviorsuicidal behavior
 Among teens, such factors may includeAmong teens, such factors may include
Physical and sexual abusePhysical and sexual abuse
Death or other trauma in the familyDeath or other trauma in the family
Persistent serious family conflictPersistent serious family conflict
Traumatic break-ups of romantic relationshipsTraumatic break-ups of romantic relationships
Trouble with the lawTrouble with the law
School failures and other major disappointmentsSchool failures and other major disappointments
Bullying, harassment or victimization by peersBullying, harassment or victimization by peers

33. 3333
Situational Factors…Situational Factors…
 The majority of teens who have these experiences doThe majority of teens who have these experiences do NOTNOT
become suicidalbecome suicidal
 In some teens, these stressful experiences can precipitateIn some teens, these stressful experiences can precipitate
depression, anxiety or another mental disorder, which in turndepression, anxiety or another mental disorder, which in turn
increases suicide riskincreases suicide risk
 Mental disorders themselves can precipitate stressful lifeMental disorders themselves can precipitate stressful life
events, such as conflict with family and peers, relationshipevents, such as conflict with family and peers, relationship
break-ups or school failures, which then exacerbate thebreak-ups or school failures, which then exacerbate the
underlying illnessunderlying illness

34. 3434
Situational FactorsSituational Factors
Most Relevant to SchoolsMost Relevant to Schools
History of Physical and Sexual AbuseHistory of Physical and Sexual Abuse
 Controlling for other risk factors, including individual and parentalControlling for other risk factors, including individual and parental
mental disorders, risk of suicide attempt ismental disorders, risk of suicide attempt is 5x greater5x greater in adolescentsin adolescents
with a history ofwith a history of physical abusephysical abuse
 Risk of suicide attempt is more thanRisk of suicide attempt is more than 7x greater7x greater among adolescentsamong adolescents
with a history ofwith a history of sexual abusesexual abuse

35. 3535
Situational Factors…Situational Factors…
BullyingBullying
 Common problem in schools in the U.S. and abroadCommon problem in schools in the U.S. and abroad
 Higher rates of depression, suicidal ideation and suicidal behaviorHigher rates of depression, suicidal ideation and suicidal behavior
found in both victims and perpetrators of bullyingfound in both victims and perpetrators of bullying
 Female victims and perpetrators may be especially vulnerableFemale victims and perpetrators may be especially vulnerable
 Pre-existing depression may explain suicidal behavior in some teensPre-existing depression may explain suicidal behavior in some teens
involved in bullyinginvolved in bullying
 Bullying likely leads to depression in other teens, increasing suicidalBullying likely leads to depression in other teens, increasing suicidal
behaviorbehavior

36. 3636
Situational Factors…Situational Factors…
Sexual Orientation and Gender IdentitySexual Orientation and Gender Identity
 GLBT youth have elevated rates of depression compared toGLBT youth have elevated rates of depression compared to
heterosexual/straight youth, and report more frequent suicidalheterosexual/straight youth, and report more frequent suicidal
ideation and behaviorideation and behavior
 Contributing factors include family rejection, high rates of alcohol orContributing factors include family rejection, high rates of alcohol or
drug use and social ostracism and bullying by peersdrug use and social ostracism and bullying by peers
Trouble with the LawTrouble with the Law
 Teens with a history of problems with the law have increased risk ofTeens with a history of problems with the law have increased risk of
suicide attempts and completed suicidesuicide attempts and completed suicide
 Suicide in juvenile detention and correctional facilities isSuicide in juvenile detention and correctional facilities is 4 times4 times
greater than in overall youth populationgreater than in overall youth population

37. 3737
Situational Factors…Situational Factors…
Exposure to SuicideExposure to Suicide
 Suicide risk is increased in teens exposed to another’s suicideSuicide risk is increased in teens exposed to another’s suicide
 Can result in suicide “clusters”Can result in suicide “clusters”
 Factors increasing “suicide contagion” include romanticized orFactors increasing “suicide contagion” include romanticized or
glamorized reports of the suicide and idealization of the suicide victimglamorized reports of the suicide and idealization of the suicide victim
 Social networking websites may increase exposure among teensSocial networking websites may increase exposure among teens
Access to FirearmsAccess to Firearms
 Access to firearms increases suicide risk, especially among teensAccess to firearms increases suicide risk, especially among teens
with a mental disorderwith a mental disorder

38. 3838
SuicideSuicide
Warning SignsWarning Signs
 SuicideSuicide risk factorsrisk factors endure over some period of time, whileendure over some period of time, while
warning signswarning signs signalsignal imminent suicide riskimminent suicide risk
 Clearest warning signs for suicide are behaviors that indicateClearest warning signs for suicide are behaviors that indicate
the person is thinking about or planning for suicide, or isthe person is thinking about or planning for suicide, or is
preoccupied or obsessed with deathpreoccupied or obsessed with death
Looking for ways to kill oneself (e.g., searching the internet forLooking for ways to kill oneself (e.g., searching the internet for
methods, seeking access to firearms or other means for suicide)methods, seeking access to firearms or other means for suicide)
Talking or writing about suicideTalking or writing about suicide
Talking or writing about death in a way that suggests preoccupationTalking or writing about death in a way that suggests preoccupation

39. 3939
Barriers toBarriers to
Treatment of At-Risk TeensTreatment of At-Risk Teens
 Many at-risk teens do not get needed treatment, including anMany at-risk teens do not get needed treatment, including an
estimatedestimated 2/32/3 of those with depressionof those with depression
 ReasonsReasons
Neither teens nor the adults who are close to them recognizeNeither teens nor the adults who are close to them recognize
symptoms as a treatable illnesssymptoms as a treatable illness
Fear of what treatment might involveFear of what treatment might involve
Belief that nothing can helpBelief that nothing can help
Perception that seeking help is a sign of weakness or failurePerception that seeking help is a sign of weakness or failure
Feeling too embarrassed to seek helpFeeling too embarrassed to seek help
Belief that adults aren’t receptive to teens’ mental health problemsBelief that adults aren’t receptive to teens’ mental health problems
 ButBut – depression and other mental disorders CAN be– depression and other mental disorders CAN be
effectively treatedeffectively treated

40. 4040
FactsFacts
about Treatmentabout Treatment
 Some depressed teens show improvement in 4-6 weeks withSome depressed teens show improvement in 4-6 weeks with
structuredstructured psychotherapypsychotherapy alonealone
 Most others experience significant reduction of depressiveMost others experience significant reduction of depressive
symptoms withsymptoms with antidepressant medicationantidepressant medication
 SupplementarySupplementary interventionsinterventions – exercise, yoga, breathing– exercise, yoga, breathing
exercises, changes in diet – improve mood, relieve anxietyexercises, changes in diet – improve mood, relieve anxiety
and reduce stress that contributes to depressionand reduce stress that contributes to depression
 Medication is usually essential in treating severe depression,Medication is usually essential in treating severe depression,
and other serious mental disorders (bipolar disorder,and other serious mental disorders (bipolar disorder,
schizophrenia, etc.)schizophrenia, etc.)

41. 4141
Facts aboutFacts about
Antidepressant MedicationAntidepressant Medication
 Medications work by restoring brain chemistry back to normalMedications work by restoring brain chemistry back to normal
 Most people experienceMost people experience positive changespositive changes; a small percentage; a small percentage
show agitation and abnormal behavior that may includeshow agitation and abnormal behavior that may include
increased suicidal thinking and behaviorincreased suicidal thinking and behavior
 Since 2004, FDA warning recommendsSince 2004, FDA warning recommends close monitoringclose monitoring ofof
youth taking antidepressants for worsening of symptoms,youth taking antidepressants for worsening of symptoms,
suicidal thoughts or behavior and other changessuicidal thoughts or behavior and other changes
 60%60% of teens with major depression have suicidal thoughtsof teens with major depression have suicidal thoughts
prior to getting treatment;prior to getting treatment; 30%30% have made a suicide attempthave made a suicide attempt
 Risks of medication must be weighed against the risks of notRisks of medication must be weighed against the risks of not
effectively treating depressioneffectively treating depression

42. 4242
Summary PointsSummary Points
about Treatmentabout Treatment
 No single approach or medication works for all teens with aNo single approach or medication works for all teens with a
mental disorder; sometimes different ones needs to be triedmental disorder; sometimes different ones needs to be tried
 But, studies show thatBut, studies show that 80%80% of depressed people can beof depressed people can be
effectively treatedeffectively treated
 Mental disorders can recur, even if effectively treated at oneMental disorders can recur, even if effectively treated at one
point in timepoint in time
 On-going monitoring by a physician or mental healthOn-going monitoring by a physician or mental health
professional is advisedprofessional is advised

43. 4343
IdentifyingIdentifying
At-Risk StudentsAt-Risk Students
 Most adults are not trained to recognize signs of seriousMost adults are not trained to recognize signs of serious
mental disorders in teensmental disorders in teens
 Symptoms are often misinterpreted or attributed toSymptoms are often misinterpreted or attributed to
Normal adolescent mood swingsNormal adolescent mood swings
LazinessLaziness
Poor attitudePoor attitude
Immaturity, etc., etc. …Immaturity, etc., etc. …
 The film,The film, More Than Sad: Teen DepressionMore Than Sad: Teen Depression, is designed for, is designed for
teens but also helps adults understand what depression looksteens but also helps adults understand what depression looks
like in adolescents and recognize the warning signs that alike in adolescents and recognize the warning signs that a
teen may need helpteen may need help

44. 4444
Show and discuss film,Show and discuss film,
More Than Sad: Teen DepressionMore Than Sad: Teen Depression

45. 4545
Reducing SuicideReducing Suicide
Risk in SchoolsRisk in Schools
So far, we have emphasized two key suicide prevention tasks ofSo far, we have emphasized two key suicide prevention tasks of
school personnel:school personnel:
1.1. Identify students whose behavior suggests presence of aIdentify students whose behavior suggests presence of a
mental disordermental disorder
2.2. Take necessary steps to insure that such students are referredTake necessary steps to insure that such students are referred
to a mental health professional for evaluation and treatment,to a mental health professional for evaluation and treatment,
as neededas needed
What else can schools do?What else can schools do?

46. 4646
RecommendedRecommended
Actions for SchoolsActions for Schools
Educate Students about Mental DisordersEducate Students about Mental Disorders
 Show and discuss film,Show and discuss film, More Than Sad: Teen DepressionMore Than Sad: Teen Depression withwith
studentsstudents
 Use lesson plan in Facilitator’s GuideUse lesson plan in Facilitator’s Guide
 Include school-based health or mental health professionalInclude school-based health or mental health professional
Educate Parents about Mental Disorders and Suicide RiskEducate Parents about Mental Disorders and Suicide Risk
 ShowShow and discuss bothand discuss both More Than SadMore Than Sad films at parent meetingfilms at parent meeting
 Recommend other resources for parents listed at end of manualRecommend other resources for parents listed at end of manual

47. 4747
Recommended Actions…Recommended Actions…
Support School Safety and Reduce BullyingSupport School Safety and Reduce Bullying
 Address sanctions for bullying and related behaviors in disciplinaryAddress sanctions for bullying and related behaviors in disciplinary
policiespolicies
 Initiate programs to change school culture to be inclusive and supportInitiate programs to change school culture to be inclusive and support
student diversitystudent diversity
Support Gun Safety ProgramsSupport Gun Safety Programs
 Partner with law enforcement, public health and community agenciesPartner with law enforcement, public health and community agencies
and parents to promote proper gun storage and reduce opportunitiesand parents to promote proper gun storage and reduce opportunities
for unsupervised access to firearms by youthfor unsupervised access to firearms by youth

48. 4848
Concluding StepsConcluding Steps
 Review Additional ResourcesReview Additional Resources
 Complete “Test Your Knowledge”Complete “Test Your Knowledge”
 Complete Participant Feedback FormComplete Participant Feedback Form
THANK YOU FOR TAKING THIS OPPORTUNITYTHANK YOU FOR TAKING THIS OPPORTUNITY
TO LEARN MORE ABOUT TEEN SUICIDETO LEARN MORE ABOUT TEEN SUICIDE
AND HOW YOU CAN PLAY A ROLEAND HOW YOU CAN PLAY A ROLE
IN ITS PREVENTIONIN ITS PREVENTION