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Signs of Suicide: A Promising School-Based Suicide Prevention Program in Military Schools

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Title: Signs of Suicide: A Promising School-Based Suicide Prevention Program in Military Schools


1
Signs of Suicide A Promising School-Based
Suicide Prevention Program in Military Schools
  • Robert H. Aseltine Jr., PhD

2
Scope of the Problem
  • Youth Suicide National and International Trends

3
Increasing Rates of Youth Suicide
  • Nationally, suicide is the 3rd leading cause of
    death among children ages 15-24 (4,405 deaths in
    2006) (CDC, 2004). Only accidents and homicides
    occurred more frequently.
  • While suicides accounted for 1.4 of all deaths
    in the U.S. annually, they comprised 12 of all
    deaths among 15-24-year-olds.
  • Adolescent suicidal behavior is deemed to be
    underreported because many deaths of this type
    are classified as unintentional or accidental
    (World Medical Association, 2004).
  • Centers for Disease Control and Prevention,
    National Center for Injury Prevention and
    Control. Web-based Injury Statistics Query and
    Reporting System (WISQARS) online. (2004)
    cited 2005 Feb 28. Available from URL
    www.cdc.gov/ncipc/wisqars.

4
US Suicide Rate Per 100,000 (15-19 year olds)
Source National Center for Health Statistics,
2004
5
Youth Suicide in Industrialized Nations Rate
per 100,000
Source Beautrais, 2002
6
Suicidal Ideation and Suicide Attempts
  • 2009 Youth Risk Behavior Survey found that
  • 26.1 felt so sad or hopeless for 2 weeks that
    they stopped doing some usual activity.
  • 13.8 seriously considered attempting suicide.
  • 10.9 made a suicide plan.
  • 6.3 attempted suicide.
  • 1.9 of those who made an attempt required
    medical attention
  • Find the data for your city/state
  • http//www.cdc.gov/HealthyYouth/yrbs/index.htm

7
Risk Factors
8
Risk Factors for Adolescent Suicide
  • MALES FEMALES
  • Mood disorder 7.5X 34.3X
  • Substance abuse 4.9 36.6
  • Conduct disorder 5.6 ---
  • Gun in home 4.5 15.0
  • Family history of suicide 2.4 ---
  • Past attempt 41.4 59.7

Source Brent et al 2002
9
Mood Disorders and Suicide
  • In 2007, 8.2 of adolescents (1 in 12 an
    estimated 2 million youth aged 12 to 17) reported
    experiencing at least one major depressive
    episode in the past year (SAMHSA, 2009).
  • 76-92 youths committing suicide meet criteria
    for mood disorder
  • Primarily major depression, bipolar disorder
  • Andrews Lewihsohn, 1992 Gould et al, 1998
    Mazza Reynolds, 2001.

10
Alcohol Abuse and Suicide
Attempt Suicide/ Past Year Attempt Suicide/Ever
Heavy alcohol use / past year
NO 3.3 10.6
YES 9.0 45.1

Drinking when down / past year
NO 3.2 7.6
YES 18.2 32.5
11
Social Context of Youth Suicide
  • Adolescence Transition from parents to peers
  • Most suicidal youth confide concerns to peers
    (Brent et al., 1988)
  • 25 of peer confidants tell an adult (Kalafat
    et al., 1993)

12
Preventing Youth Suicide
13
Brief History of School-Based Suicide Prevention
  • Two types of programs Universal vs. Selective
  • Universal programs almost universally
    disappointing
  • Temporary changes in knowledge and attitudes
  • No impact on behavior

14
SOS Signs of Suicide Prevention Programs for
Middle High Schools Diane Santoro,
LICSW Screening for Mental Health, Inc.
15
Military Children
  • More than two million American children have had
    a parent deploy to Iraq or Afghanistan
  • At least 19,000 children have had a parent
    wounded in action
  • Over 2,200 children have lost a parent in Iraq or
    Afghanistan
  • Children of military families ages 11 to 17 were
    found to have a higher prevalence of emotional
    and behavioral difficulties than children in the
    general population
  • Parental deployment places school-age children
    and adolescents at higher risk for a range of
    adverse mood and behavioral changes anger,
    apathy, anxiety, depression, withdrawal, decline
    in school performance, loss of interest in normal
    activities, and social isolation
  • National Center for Children in Poverty Trauma
    Faced by Children of Military Families May 2010

16
SUICIDE A MULTI-FACTORIAL EVENT
Psychiatric IllnessCo-morbidity
Neurobiology
Personality Disorder/Traits
Impulsiveness
Substance Use/Abuse
Hopelessness
Severe Medical Illness
Suicide
Family History
Access To Weapons
Psychodynamics/ Psychological Vulnerability
Life Stressors
Suicidal Behavior
17
What Can Schools Do?
  • School systems are not responsible for meeting
    every need of their students. But when the need
    directly affects learning, the school must meet
    the challenge. (Carnegie Task Force on
    Education)
  • Schools cannot achieve their mission of educating
    the young when students problems are major
    barriers to learning and development.
  • Schools are at times a source of the problem and
    need to take steps to minimize factors that lead
    to student alienation and despair
  • Schools also are in a unique position to promote
    healthy development and protective buffers, offer
    risk prevention programs, and help to identify
    and guide students in need of special assistance
  • Center for Mental Health in Schools at UCLA
    (http//smhp.psych.ucla.edu)

18
Implementing a Universal Prevention Program
  • Change environments and systems by applying
    intervention universally with particular
    concern for diversity
  • Enhance awareness and increase information among
    students, staff, family, and community
  • Enhance identification of those at risk and build
    capacity of school, family, community to help
  • Enhance competence related to social and
    emotional problem solving
  • Enhance protective buffers

19
SHOW DVD CLIP
20
SOS Signs of Suicide Program Goals
  • Decrease suicide and attempts by increasing
    knowledge and adaptive attitudes about depression
  • Encourage individual help-seeking and
    help-seeking on behalf of a friend
  • Reduce stigma - link suicide to mental illness
    that, like physical illness, requires treatment
  • Engage parents and school staff as partners in
    prevention by educating them to identify signs of
    depression and suicide and by providing
    information about referral resources
  • Encourage schools to develop
    community-based partnerships.

21
SOS Signs of Suicide Student Goals
  • Help youth understand that depression is a
    treatable illness
  • Educate youth that suicide is not a normal
    response to stress but rather a preventable
    tragedy that often occurs as a result of
    untreated depression
  • Inform youth of the risk associated with alcohol
    use to cope with feelings.
  • Increase help-seeking by providing students with
    specific action steps to take if they are
    concerned about themselves or others and by
    identifying resources.
  • Encourage students to engage in discussion about
    these issues with their friends and with their
    parents

22
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23
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24
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25
SOS Program Components High School Program
  • Implementation Guide
  • Educational DVD Discussion Guide
  • Brief Screen for Adolescent Depression (BSAD) -
    Parent Student Version
  • High School Student Newsletter
  • Customizable Wallet Cards
  • Posters
  • Educational Materials for Staff, Students,
    Parents

26
SOS Program Components Middle School Program
  • Implementation Guide
  • Educational DVD Discussion Guide
  • Center for Epidemiological Studies Depression
    Scale for Children (CES-DC)
  • Student Parent Newsletters
  • Customizable Wallet Cards
  • Posters
  • Educational Materials for Staff, Students,
    Parents

27
Implementation Overview
28
1. Identify and Train Your Team
  • Review program goals and assign
    roles/responsibilities
  • Review kit, video, and discussion guide
  • Review screening form and scoring
  • Designate time and date for program
    implementation
  • Review school policies for handling suicide
    disclosure, parental consent, record keeping, etc

29
2. Decide On Format
  • Provide program school-wide or select target
    student group based on grade level, class
    enrollment, or special need
  • Screening Implementation Options
  • Eliminate (do not screen)
  • Non-anonymous
  • Anonymous with number ID
  • Anonymous
  • Anonymous with Response Card

30
BASED ON THE VIDEO AND/OR SCREENING,
I FEEL THAT ? I need to talk to
someone ? I do not need to talk to someone
ABOUT MYSELF OR A FRIEND.
NAME(PRINT)_________________________________ HOM
EROOM SECTION_________________________
TEACHER_____________________________________
IF YOU WISH TO SPEAK WITH SOMEONE, YOU WILL BE
CONTACTED WITHIN 24 HOURS. IF YOU WISH TO SPEAK
WITH SOMEONE SOONER, PLEASE APPROACH STAFF
IMMEDIATELY.
31
3. Demonstrate the Program
  • Staff Training Suggestions
  • Review the signs of depression and suicide
  • Answer questions dispel myths
  • Show the video and facilitate a discussion
  • Review the Screening Form
  • Review the school protocol for handling students
    who disclose suicidal intent
  • Review school and community mental health
    resources

32
4. Prepare for Follow-Up
  • Use SAMHSAs Find Treatment Locator to identify
    additional referral resources
  • Contact local mental health facilities and verify
    their referral procedures, wait lists, insurance
    details, etc.
  • Create a Referral Resource List
  • Track student follow-up
  • Identify in advance who will be handling
    emergencies
  • Notify the nearest crisis response center about
    the program in advance in order to facilitate
    referrals.

33
On the Day of the Program
  • Introduce program
  • Show video
  • Facilitate discussion
  • Students complete screening forms and Response
    Card
  • Set expectation about when follow-up can be
    expected provide referral information
  • Follow up with students requesting help
  • Respond to requests for help track students
    seeking help using the Student Follow-Up form

34
Summary What SOS Does
  • EDUCATION about depression/suicide
  • Defines as illness ? reduces stigma
  • SCREENING for depression
  • MOBILIZES peers

35
Does SOS Work?
  • In 3 previous randomized controlled studies
  • Increase in knowledge about suicide and attitudes
    toward suicide
  • Decrease in suicide attempts
  • No effect on help-seeking
  • On SAMHSAs National Registry of Evidence-based
    Programs and Practices

36
Current Study
  • DOD schools
  • Middle school students
  • Program implemented and evaluated by school
    staff, not research staff

37
Outcome Evaluation of SOS Program among students
in military schools
  • Suicidal thoughts and behavior
  • Attitudes and knowledge
  • Help seeking

38
Outcome Evaluation
  • Involved students in 10 middle schools and 10
    high schools
  • Randomized experiment
  • ½ of schools SOS
  • ½ of schools Wait list control
  • Outcomes assessed at baseline 3 mos.
  • anonymous questionnaires during class

39
Measures
  • Attitudes/Knowledge
  • Attitudes 10 item scale
  • Knowledge 7 item scale
  • Help-seeking past 3 months
  • Treatment Y/N
  • Talked to parent/guardian, sibling, teacher or
    guidance counselor, other adult, hotline Y/N
  • Talked to adult about friend Y/N
  • Suicidal behavior past 3 months
  • Ideation Y/N
  • Plan Y/N
  • Attempts Y/N

40
Middle School Participants
  • Gender
  • Male 47
  • Female 53
  • Racial/ethnic self-identification
  • White, non Hispanic 41
  • Black, non-Hispanic 12
  • Hispanic 20
  • Multiethnic 9
  • Other 18

41
Middle School Participants (Continued)
  • ESL/ELL
  • No 81
  • Yes 19
  • Parental deployment
  • No 74
  • Yes 26

42
Effects of SOS Program on Knowledge and Attitudes
About Depression/Suicide
Treatment and controls differ at the .05 level on
knowledge only.
43
Standardized Effects of SOS on Knowledge and
Attitudes
44
Odds Ratios for Effect of SOS on Attempts in past
3 months
45
Effects of SOS Program Change in Suicidal
Ideation and Suicide Attempts
Treatment and controls do not differ at the .05
level for suicide attempts.
46
Help seeking
  • As in previous studies, no effects on
    help-seeking were found

47
Summary
  • Increase in knowledge about suicide and attitudes
    toward suicide in DOD middle school students
  • Sample size too small to estimate effect of SOS
    on suicide attempts
  • Program successfully implemented by school staff

48
Summary
  • Next steps
  • Implement in high-impact schools
  • Increase sample size
  • Long term benefits?
  • Help-seeking?

49
Acknowledgements
  • Grateful for financial support from U.S.
    Department of Defense
  • For more info on program http//www.mentalhealth
    screening.org
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