STOP Suicide DC Department of Mental Health

Julie Goldstein Grumet, PhD

Project Director

SAMHSA Grants

Linking Adolescents at Risk of Suicide to Mental Health Services: 2005-2009

State/Tribal Youth Suicide Prevention Grant: 2009-2012

Facts and Statistics Suicide accounts for 13% of all adolescent deaths Most suicides result from

untreated depression 3rd leading cause of death for

youth (15-24 years) 1 in 5 teens seriously consider

suicide For every suicide, 6-8 peoples’

lives impacted GLBT individuals 3x more likely

to attempt

Risk Factors for Youth Suicide

Strongest Predictors Previous suicide attempt Current talk of suicide/making a plan Strong wish to die/preoccupied with

death(i.e., thoughts, music, reading) Depression (hopelessness, withdrawal) Substance use Recent attempt by friend or family

member

Being expelled from school /fired from job Family problems/alienation Loss of any major relationship Death of a friend or family member,

especially if by suicide Diagnosis of a serious or terminal illness Financial problems (either their own or

within the family) Sudden loss of freedom/fear of punishment Feeling embarrassed or humiliated in front

of peers Victim of assault or bullying

Other Risk Factors

Warning Signs Threatening suicide Getting a gun or stockpiling pills – accessing

means Purposeless – no reasons for living Anxiety or agitation Impulsivity/increased risk taking Insomnia Unexplained anger, aggression, irritability Substance abuse – excessive or increased Hopelessness Withdrawal from friends/family/society Recklessness – risky acts/unthinking Mood changes

“STOP” (School-Based Teen Outreach

Program) for Suicide: Goals

Increase number of adolescents identified as at risk and assessed for suicide

Enhance ability of mental health providers to identify and assess for risk of suicide

Improve coordination of care provided to students at risk for suicide and families

Improve family/caregiver education and access to MH services

STOP Suicide Project: Components

Screening for students Columbia University TeenScreen

Teacher/Staff/Parent Gatekeeper Training

Question, Persuade, Refer (QPR) Gatekeeper Training

Classroom based prevention program

Signs of Suicide (SOS)

DC Public Schools

Approximately 70,000 youth under age 18 in DC Approximately 20,000 youth enrolled in public middle

schools and high schools (does not include charter) 79% African American; 12% Hispanic; 7% Caucasian 68% graduation rate 19% truancy rate 70% free and reduced lunch 49% passed DC CAS for elementary reading and math

(DC CAS); 40% passed secondary math; 41% passed secondary reading (taken in Grades 3-8 and 10)

D.C. Suicide Statistics 16th leading cause of death for residents 18 youth suicides between 2000-2008 (age

11-24) (OCME)

Lowest suicide rate in country

But so many risk factors!

Risk FactorsD.C. exceeds national average for: Childhood death rate Youth under 18 whose parents do not have full time jobs Youth living in a single parent household Youth who live in poverty Youth dropout Violent crime is three times national average 3% residents have HIV 3rd highest jurisdiction for abuse/neglect High gang involvement

(Sources: Annie E. Casey Foundation, 2008; Children’s Bureau of the Administration on Child, Youth, and Families, 2004; FBI, 2003; HIV Office of the Department of Health, 2009)

The Youth Risk Behavior Survey (High School Youth) (CDC, 2007)

In the past 12 months (In D.C.) 29% felt sad or hopeless for 2 weeks (27%) 15% have seriously considered suicide (15%) 11% have made a plan (12%) 7% have made an attempt (12%)* 2% required emergency room care (4%)

Youth Risk Behavior Survey (Middle School Youth) (DCPS, 2007)

24% report suicidal ideation 13% made a plan 13% tried to kill themselves

DMH TeenScreen Program 2005-2008 Public and public charter schools Primarily screened in schools with DMH School

Mental Health Clinician (we are in approx. 58 schools)

Staff included Project Director/PI; Evaluator; Case Manager (for one year)

6th – 12th graders Active consent

DC DMH TeenScreen 22 screening days (2005-2008) 13 middle schools; 9 high schools Approximately 5700 consent forms distributed 1021 returned (18%) (range of 4% to 95%) 96 (9%) parents refused consent 34 (3%) youth refused assent on day of screen 126 (12%) absent or sick on screening days 786 youth screened total

A Word About Consent Handed out at Back-to-School Night, in class

multiple times Youth distributed consents Teachers called homes $5 gift cards to Target; movie passes, $5 gift card

to McDonald’s, Washington Wizards tickets, extra credit

Received greater percentage of consents when targeted smaller groups (one class, one teacher, one grade)

Consent was opt in or opt out Youth who were absent were not screened – letter

sent home 23% youth report never receiving the consent

form (though this isn’t possible) Town Hall Forums

Demographics 2/3 High School; 1/3 Middle School 60% Female; 40% Male 66% African American; 27% Latino; 7%

Other More 9th and 12th graders

Demographic Characteristics of Youth Overall and for Youth Who Screened Positive for any Mental Health Issue Using TeenScreen All Youth

Screened Positively Screened Youth-Total

High School Overall

Positive High School

Middle School Overall

Positive Middle School

Total 786 37% (N=293)

503 35% (N=178)

283 41% (N=115)

Race Black

66% (N=516)

64% (N=188)

61% (N=309)

60% (N=106)

73% (N=208) 70% (N=80)

Latino

27% (N=212)

26% (N=75) 31% (N=158)

31% (N=55) 19% (N=53) 17% (N=20)

Other or Mixed

7% (N=58) 10% (N=30) 7% (N=36) 10% (N=17) 8% (N=22) 13% (N=15)

Gender Male 40%

(N=313) 32% (N=95) 37%

(N=186) 30% (N=54) 45% (N=127) 36% (N=41)

Female 60% (N=473)

68% (N=198)

63% (N=317)

70% (N=124)

55% (N=156) 64% (N=74)

Grade 6 9% (N=71) 9% (N=25) N/A N/A 25% (N=71) 22% (N=25) 7 12% (N=95) 16% (N=47) N/A N/A 34% (N=95) 41% (N=47) 8 15%

(N=116) 15% (N=43) N/A N/A 41% (N=117) 37% (N=43)

9 20% (N=160)

18% (N=53) 32% (N=160)

30% (N=53) N/A N/A

10 14% (N=112)

14% (N=41) 22% (N=112)

23% (N=41) N/A N/A

11 12% (N=91) 11% (N=32) 18% (N=91) 18% (N=32) N/A N/A 12 18%

(N=140) 18% (N=52) 28%

(N=140) 29% (N=52) N/A N/A

Results 37% youth screened positive overall 13% report thoughts of killing themselves in past

three months 10% report making a suicide attempt 6% unhappy or sad in last three months 10% irritable or in bad mood 1-2% anxious, withdrawn, substance abuse issues

Results for High School Youth (N=503)

35% HS youth screened positive

All HS youth: 10% reported suicidal ideation 11% reported a previous attempt 19% bad or very bad problem with anger 12% reported feeling unhappy or sad Less than 1% reported problems with drugs or alcohol

Of those who screened positive for anything: Anger and depression two biggest issues (41% and

30%, respectively)

Results for Middle School Youth (N=283)

41% of MS youth screened positive

All MS youth: 17% reported suicidal ideation 8% reported making a suicide attempt 14% reported feeling unhappy or sad 25% reported anger/irritability 1% problems with substances

Of those who screened positive for anything: Anger and depression also biggest issues (48% and 31%) 17% reported anxiety 14% reported problems with friends

Results of TeenScreen for All Youth

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Symptom* N=786

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Female

HSMS

Risk Factors for Current Suicidal Ideation in an Urban Population*

HS Youth with Suicidal Ideation 47% made a previous attempt 47% problems with depression

or anger 24% problems with anxiety 12% troubles with friendship 8% withdrawing from others 6% substance abuse

MS Youth with Suicidal Ideation 34% made a previous attempt 51% feel depressed 72% report problems with

anger 32% problems with anxiety 24% have difficulties with

friends 28% withdrawing from others 7% drug or alcohol problems

*small N

Comorbid Mental Health Issues in High School Youth Who Report Suicide Ideation or History of a Suicide Attempt Using TeenScreen

0

0.050.1

0.15

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0.250.3

0.35

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0.5

Anxiou

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Symptom* N=70

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Suicidal Ideation

Suicide Attempt

Comorbid Mental Health Issues in Middle School Youth Who Report Suicidal Ideation or History of a Suicide Attempt Using TeenScreen

0

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Suicidal Ideation

Suicide Attempt

So Who is at Risk? Anger is a huge risk factor followed by depression Substance abuse is not endorsed by this population Previous attempt is a risk factor for current suicidality MS youth with current ideation seem to be more

socially isolated HS girls 136% more likely than HS boys to report

suicidality (OR=2.36, CI=1.35; 4.13, p<.05)

Girls more likely than boys to endorse any suicidal behaviors

Greater percentage of MS youth report suicidal thoughts Greater percentage of HS youth report attempts

A Word About Attempts Most were not objectively “lethal” Impulsive Issues with self-report: Youth reported more than

just past three months Most had never told anyone before

Suicide Among Urban Youth Lack of appropriate coping skills Depression likely exhibited as a behavioral issue Lack of access to treatment No diagnosis Long waiting lists Inability of caregivers/pediatricians/teachers to

recognize Minimization/Stigma

Referrals33% needed a referral; 5% needed no referral2% immediate evaluation to hospital/private provider

Where did they go? 47% to SMHP 23% to other school personnel 20% to outpatient providers 2% to other services

Did they go? 52% kept one appointment after one month post-screen 68% kept one appointment by six months post-screen

Parent Satisfaction Surveys Attempted to contact all parents

of positively screened youth 17% (N=43) took survey;

received gift card 81% felt consent form was easy

to understand 79% would recommend

screening to others On average, youth met with

counselor 3 times (range 1-15; mode=2)

Parent Identified Components that Assisted with the Linkage

Benefits to providing school-based suicide prevention screening and treatment

Emotional issues greatly interfere with academic success

Prevention programs – find them early!

Youth have often never told anyone before

Helps to raise awareness/reduce stigma

Parents more likely to follow through – youth get the services

Challenges to Implementing School-based Suicide Prevention Program

Lack of parental consent School activities/access to youth can change quickly – field

trips, class or school wide tests, fire drills, absent youth, substitute teachers, hall walkers

Hard to get in touch with some parents post-screening Parents minimize the results Youth minimize the results Lack of appropriate staff to administer, follow up Lack of good local referral sites – school personnel

inundated Long waiting periods screening to treatment Language barriers Principals don’t want to endorse screening; prevention

more palatable

Recent Publications Brown, M. and Goldstein Grumet, J. (April 2009). School

based suicide prevention with African American youth in an urban setting. Professional Psychology: Research and Practice, (40) 2, 111-117.

Helpful websites www.suicidology.org

(American Association of Suicidology) www.mentalhealth.org/suicideprevention

(National Strategy on Suicide Prevention) www.sprc.org

(Suicide Prevention Resource Center) www.QPRinstitute.org

(QPR Gatekeeper Training) www.teenscreen.org

(Columbia University TeenScreen Project)

Contact information

Julie Goldstein Grumet

(202) 698-2470

Julie.goldstein@dc.gov