MORE THAN SAD:
SUICIDE PREVENTION EDUCATION FOR TEACHERS
AND OTHER SCHOOL PERSONNEL
AMERICAN FOUNDATION FOR SUICIDE PREVENTION
120 WALL STREET, 29TH FLOOR
NEW YORK, NY 10005
212.363.3500
WWW.AFSP.ORG
Program Goals
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1.
2.
Increase understanding of:

Problem of youth suicide

Suicide risk factors

Treatment and prevention of suicidal behavior in
adolescents
Increase knowledge of warning signs of youth
suicide so those who work with teens are better
prepared to identify and refer at-risk students
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Understanding the Problem of Suicide
 Over 40,000 people in the U.S. died by suicide in 2012.1
 Suicide Rates:


National rate is 12.7 per 100,000 people
U.S. rate for youth (ages 15-24) is 11 per 100,000 people based on
2011 data.
 Suicide is the 2rd leading cause of death for adolescents and
young adults (ages 15–24).2
Scope of the Problem (2012*)
United States




40,600 reported suicides
12.9 suicides per 100,000 population
31,780 (or 78.3%) of all deaths by suicide are male.
50.9% (20,666) of reported suicides were by firearm
US Youth aged 15-24
 4,872 reported suicides
 Suicide is 2rd leading cause of death for youth
(after unintentional injuries)
*latest year for which suicide statistics are currently available
Although the youth you work with as educators are highlighted
in the yellow box, the remaining age groups impact the youth
as they are the parents, relatives and other caregivers of the
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youth you serve.
U.S. Youth Suicide Rates per 100,000
by Age Group
Source: CDC data, 2014
Male youth die by suicide at a rate 4.34x higher than
female youth in the U.S. (AAS, 2011)
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Youth Suicide Rates
by Race/Ethnicity (Ages 15-24)
Ethnic Group
Suicide Rate per 100,000
American Indian/Alaskan Native
19.8 per 100,000
White
12.0 per 100,000
Asian/Pacific Islander
7.6 per 100,000
Black
7.1 per 100,000
Hispanic
7.3 per 100,000
*Number of suicides per 100,000
population, 2012
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Suicide Attempts
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Attempts are opportunities for us to
intervene and save lives!
Suicide Attempts
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


No complete or exact count is kept of attempts
because of those that go unreported or untreated
In 2013, over 180,000 youth between the ages of
10-24 years were hospitalized for self-inflicted
injuries.
8 % of high school students reported having
attempted suicide one or more times in the last year.
Vulnerable Populations
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
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Females attempt suicide 3x more often than males
Attempts are 2-6x more frequent among youth who
identify as gay, lesbian or bisexual, than among
heterosexual youth
Among young adults ages 15 to 24 years old, there are
approximately 100-200 attempts for every death by
suicide
Based on a 2011 survey of high school students, Hispanic
female students (15.6%) reported attempting suicide
more times than any other ethnic group.
Suicidal Ideation
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“Ideation” is defined as thinking about or
planning for suicide
Suicidal Ideation:
Based on the 2013 Youth Risk Behavior Survey of High School Students:
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17%
Reported having
seriously considered
attempting suicide in
the previous year.
13.6%
Reported having
made a plan for a
suicide attempt in
the previous year.
Risk Factors
for Teen Suicide
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
Key suicide risk factor for all age groups is an undiagnosed,
untreated or ineffectively treated mental disorder

90% of people who die by suicide have a mental disorder

In teens, suicide risk is most clearly linked to 7 mental disorders,
often with overlapping symptoms:
Major Depressive Disorder
Conduct Disorder
Bipolar Disorder
Eating Disorders
Generalized Anxiety Disorder
Schizophrenia
Substance Use Disorders
Risk Factors
PERPETUATING
CONDITIONS
PREDISPOSING
CONDITIONS
PRECIPITATING
CONDITIONS
(Unchangeable)
(of Serious Concern)
(Acute)
FAMILY
Family
history of suicide,
mental illness, substance
abuse
Race
Gender
Genetics
Unrealistic
parental
expectations
Abuse (emotional, physical,
sexual)
Major
PERSONAL
BEHAVIORAL
Loss
through death,
abandonment, divorce
Previous
suicide attempt
Mental illness
Substance abuse
Extreme Perfectionism
Poor coping/social skills
Impulsive
Current
ENVIRONMENTAL
SOCIAL
Inconsistent,
Experience
Active
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neglectful or
abusive parenting
Sexual orientation
of repeated loss
Chronic severe stress
Ongoing harassment
family conflict
Exposure to suicide of
family member
Anniversary of death
Moving often
acute Mental Illness
Severe stress/anxiety
Isolation
Rejection
Relationship break-up
Increased use of
substances
suicide cluster in
community
Access to lethal means
Bullying, harassment
Loss of freedom (e.g.,
incarceration)
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Bullying and Suicidal Behavior
 Among middle-school students, suicidal ideation and behavior
are more common in bully-victims and physically aggressive
bullies than in verbal bullies and victims who don’t bully
others. Intergroup differences largely disappeared after
controlling for delinquency and depression (Espelage & Holt,
2013)
 Among youth who were bullied during high school, suicidal
ideation and behavior was later identified only in those who
had shown symptoms of depression at the time the bullying
occurred (Klomek et al., 2011)
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What does this mean?


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Being bullied does not appear to be directly related to suicidal
behavior in youth
Depression and other underlying factors are central to the
development of suicidal behavior
Youth who bully others may be significantly more at risk than
those who are bullied
The repeated message that youth are dying by suicide because
they were bullied may well be contributing independently to youth
suicide
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Suicide Warning Signs


Suicide risk factors endure over some period of time,
while warning signs signal imminent suicide risk
Clearest warning signs for suicide are behaviors that
indicate the person is thinking about or planning for
suicide, or is preoccupied or obsessed with death

Looking for ways to kill oneself (e.g., searching the internet for
methods, seeking access to firearms or other means for suicide)

Talking or writing about suicide

Talking or writing about death in a way that suggests
preoccupation
Watch the Film
More Than Sad: Preventing Teen Suicide
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Facts about Treatment
 Some depressed teens show improvement in 4-6 weeks with
structured psychotherapy alone
 Most others experience significant reduction of depressive
symptoms with antidepressant medication
 Supplementary interventions – exercise, yoga, breathing
exercises, changes in diet – improve mood, relieve anxiety and
reduce stress that contributes to depression
 Medication is usually essential in treating severe depression,
and other serious mental disorders (bipolar disorder,
schizophrenia, etc.)
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Summary Points
about Treatment
No single approach or medication works for all teens with a
mental disorder; sometimes different ones needs to be tried
 But, studies show that 80% of depressed people can be
effectively treated
 Mental disorders can recur, even if effectively treated at one
point in time
 On-going monitoring by a mental health professional is advised
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Identifying At-Risk Students
 Most adults are not trained to recognize signs of
serious mental disorders in teens
 Symptoms are often misinterpreted or attributed to





Normal adolescent mood swings
Laziness
Poor attitude
Immaturity, etc., etc. …
The film, More Than Sad: Teen Depression, is designed for teens but also
helps adults understand what depression looks like in adolescents and
recognize the warning signs that a teen may need help
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Watch the Film
More Than Sad: Teen Depression
Discussion Questions:
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


Which of the four students in the film would you
have been most likely to recognize as depressed?
Were there any of the students you would not think
of as being depressed?
What do you think makes it hard for teens to ask
for help, even when they want it?
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Reducing Suicide
Risk in Schools
So far, we have emphasized two key suicide prevention
tasks of school personnel:
1.
Identify students whose behavior suggests presence of a
mental disorder
2.
Take necessary steps to insure that such students are
referred to a mental health professional for evaluation
and treatment, as needed
What else can schools do?
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Recommended
Actions for Schools
Educate Students about Mental Disorders



Show and discuss film, More Than Sad: Teen Depression with students
Use lesson plan in Facilitator’s Guide
Include school-based health or mental health professional
Educate Parents about Mental Disorders and Suicide Risk

Show and discuss film, More Than Sad: Teen Depression at parent meeting
Resources for Your School
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
Model School District Policy on Suicide Prevention
 Collaboration
between AFSP, The Trevor Project, the
National Association of School Psychologists, and the
American School Counselor Association
 The model provides school districts with recommended
language for school district policies that address
preventing, assessing the risk of, intervening in, and
responding to youth suicidal behavior.
Resources for Your School Cont.
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
After a Suicide: A Toolkit for Schools
 Collaboration
between AFSP and the Suicide
Prevention Resource Center
 This toolkit serves as a practical resource for schools
facing real-time crises to help them determine what to
do, when, and how.
 Includes existing material and research findings as well
as references, templates, and links to additional
information and assistance.
Accessing Help 24/7
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1-800-273-TALK
www.crisischat.org
Online Resources
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www.afsp.org
www.suicideprevetnionlifeline.org
www.suicidology.org
www.sprc.org
www.thetrevorproject.org
www.save.org
www.cdc.gov
www.samhsa.gov
www.actionallianceforsuicideprevention.org