Chapter 10 Youth Suicide

What is NSSI and in what way can it be viewed as life sustaining?

NSSI (nonsuicidal self-injury) is defined as behaviors where children or teenagers intentionally inflict physical harm, usually causing tissue damage, to their own body without the intent to die. Examples of NSSI include: deliberately cutting one's arm or leg, burning, bone breaking, hairpulling, etc. Also, NSSI is primarily a mechanism to relieve overwhelming negative feelings, relieve tension and cope with stress, and diminish feelings of dissatisfaction and emptiness. Ironically, seen in this light NSSI becomes a life-sustaining act for youth rather than an exit strategy; it is a life preserver and a way in which to disrupt emotional disorganization initially.

Discuss some of the gender differences related to suicide between males and females.

There are behavioral differences between males and females in relation to suicide. For instance, girls are more likely to report attempting suicide than boys, and girls are also more likely than boys to benefit from existing prevention programming. Unfortunately, boys are more likely to die from suicide than are girls. According to statistics, between the ages of 10 and 24, boys completed 81% of suicides and girls completed 19%. Additionally, females often develop a plan to commit suicide. These are some of the notable differences between males and females in relation to suicide.

List and briefly explain the seven (7) intervention steps recommended to defuse a suicide crisis.

There are seven intervention steps recommended to defuse a suicide crisis. They are listed below: 1. Listen and show respect for the feelings a suicidal youth expresses. 2. Reinforce the young person for seeking help. Admitting suicide ideation or attempting suicide brings shame and embarrassment so it is important that these feelings be acknowledged. 3. Be specific about assessing lethality. A social worker, counselor, or practitioner should ask direct questions such as "Are you thinking about killing yourself?" or "How do you plan to kill yourself?" 4. Make decisions. Youth who give indications that they will attempt suicide within the next few hours should be hospitalized for consistent care and monitoring. 5. Have the youth sign a written contract. 6. Use the resources that are available. For instance, community mental health agencies and private therapists are often the primary resources for helping children and their families after a suicide attempt or acute suicidal ideation. 7. Counseling for the young person should be indicated. Practitioners should use treatments that are: -Intensive at the beginning of treatment to deal with immediate concerns and provide a safe environment -Focus on family to understand the circumstances and to build positive relationships. -Contain a life skills training component to improve interpersonal functioning -Explore vulnerabilities for cognitive restructuring to enhance purpose and meaning in life -Target other maladaptive behaviors such as substance misuse.

Describe the three (3) strategies used to identify and assess suicide risk?

The three strategies used to identify and assess suicide risk include: 1. Recognizing signs of depression and familiarity with its various forms and manifestations. 2. Clinical interviews (interviews for suicide ideality): These interviews are conducted with parents, teachers, and the child or adolescent who appears to be at risk for suicide. Within these interviews, the interviewer will attempt to assess the history of the presenting problem (depression, anxiety, loneliness), the family constellation and family relationships, a developmental, medical and academic history, the status of the child's interpersonal relationships, verbal and behavioral warning cues, any current stressors that may trigger a suicide attempt, etc. 3. Self-Report Inventories: Researchers have developed a number of inventories to help identify suicidal children and adolescents. For one, The Suicide Risk Screen is a practical and effective method for identifying suicide-risk student. Other scales used are the Beck Hopelessness Scale and the Scale of Suicide Ideation. The Scale of Ideation specifically includes questions related to attitudes about living or dying, the characteristics and specificity of suicidal ideation, and background factors such as previous suicide attempts. Lastly, the Columbia Suicide Severity Rating Scale is another inventory that counselors can utilize. All in all, these self-report inventories have proved to effectively prevent suicidal behavior among youth.

In identifying the warning signs of suicide, explain 1) Suicide motivations 2) Verbal messages 3) Behavioral changes 4) General risk factors

The warning signs of suicide include: 1. Suicide motivations: There a number of motivators behind youth committing suicide. For one, suicide can be a method of self-punishment to deal with guilt or shame. Also, suicide may seem to provide absolution for past behaviors. Suicide may even be motivated by perverted revenge, a perceived means to get back at those who caused the individual pain, such as parents who got divorced. In addition, retaliatory abandonment is another motivation for suicide. For instance, a boy who has been dumped by his girlfriend can "retaliate" by showing her how awful she was to cause him to end it all. Lastly, children or adolescents may attempt suicide not intending to end their lives but rather as a cry for help. 2. Verbal messages: Most children who feel self-destructive give verbal hints that life is too much to handle and not worth living. Suicidal children and adolescent may say some of these things: - "I don't see how I can go on", "I wish I were dead", "There's only one way out of my problems", "I won't be around much longer", "I'm tired of living", "You'll be sorry you treated me this way,", etc. Not only do suicidal children and adolescents speak such statements, but they also talk about death, wonder aloud what it will be like to be dead, and they may be preoccupied by thoughts of others who have died. In addition, they may joke about killing themselves. 3. Behavioral changes: Common behavioral changes of those who are at risk of suicide attempt include: Mood swings or fluctuations A change from happy and positive interactions with others to withdrawal and negativity Apathy or a lack of activity, such as neglect of hobbies that once were important to the person. Changes in sleeping or eating patterns-insomnia or lethargy, lack of appetite or ravenous hunger. Giving away prized possessions A decline in a child's productivity and performance at school An increase in truancy at school More acting out in class at school Possible drug or alcohol use and hanging out with the "wrong crowd" at school and after school hours Higher levels of social activity than the average student if the youth is at risk for school dropout as well 4. General risk factors: Suicidal children typically have a rigid and unrealistic style of thinking. When children seek to escape from a situation, join a dead friend or family member, be punished for their actions, get revenge or hurt someone else, control their death, or solve a problem that they see as intolerable or unresolvable, they are at risk for self-destructive behavior. Negative outlook Poor self-image Youth who engage in non-suicidal self-injury

Describe the interpersonal, family, and psychosocial characteristics that are associated with youth suicide:

There are a number of interpersonal, family and psychosocial characteristics that are associated with youth suicide. These characteristics are listed below: 1. Substance Use, Misuse and Abuse: Alcohol and drug use are often related to adolescent risk for suicide. Adolescents who are chemically dependent are at higher risk for suicide. This is more problematic for girls because they are more likely to commit suicide with substances than in other ways. Also, substance use is one factor that predicts the transition from suicidal ideation to suicide attempts. 2. Under- and Overachievement: Academic underachievement has been linked to suicide. For example, impaired academic functioning could be a possible consequence of suicidal thoughts and even suicide attempts. According to a study done by the Substance Abuse and Mental Health Services Administration, one out of five high school students receiving mostly D and F grades attempted suicide contrasted with one out of twenty-five who received mostly A grades. On the other side of the coin, perfectionism, overachievement, and living up to high expectations are characteristic of many academically talented suicidal children and adolescents. For instance, talented girls with high levels of impulsivity and aggressiveness and low levels of harm avoidance may be particularly at risk for suicide. 3. Catastrophic Worldview: A negative or catastrophic view of the world and the future is associated with suicide risk. Some children and adolescents view the world as an unpredictable, dangerous, and hostile place. Consequently, some young people feel desperate and helpless and are potential victims of a suicide crisis. 4. Cluster Suicides: Cluster suicides are suicides that imitate or are a copycat response to a previous suicide. These are two types of copycat suicides: mass clusters or point clusters. A mass cluster is media relate while a point cluster is more local. In addition, when a child or adolescent commits suicide, the act becomes normalized for others in a way. After witnessing one suicide, those who have already been experiencing despair may begin to see suicide as a viable response to their stress and feelings of hopelessness. So, it is essential that follow-up treatment is provided following a suicide crisis. 5. Lesbian, Gay, Bisexual, Transgender, and Queer (LBTQ) Youth: Suicide is the leading cause of death for LBTQ youth, mainly because of the debilitating effects of growing up in a homophobic society. Suicide attempts by LGBTQ youth are often linked with sexual milestones such as self-identification as homosexual, coming out to others, or resulting loss of friendship and family acceptance. So, this group needs special attention in order to reduce suicide attempts. 6. Disruptive and Violent Families:Suicidal youth often come dysfunctional, disintegrated, and violent families, especially when there is a history of sexual or physical abuse. Also, family interactions that are characterized by anger, emotional ambivalence, and rejection are also associated with self-destructive behavior in youth. In addition, depressed male teenagers with depressed fathers are seven times more likely to attempt suicide as young adults than depressed male teenagers with unaffected fathers. Not only that but adolescents are more likely to have serious suicidal thoughts if they engage in fewer activities with parents. Lastly, suicide is more prevalent among young people whose families have a history of suicide. 7. Connectedness and Poor Communication: Adolescents who grow up in an environment where communication of their thoughts and feelings is unsafe do not learn to express their distress to others. As their negative feelings and thoughts increase, these children may withdraw into themselves, all the while making it difficult for others to recognize and respond to their increasing pain, depression, and suicidal feelings. This isolation can be a warning sign of low connectedness and belonging which is a warning sign for suicide attempts. 8. Loss and Separation : Suicidal youth are more likely than other youth to have experienced the loss of a parent through separation, divorce, or death. Even when youth have not lost a parent or other close relative, suicidal thoughts may arise in response to the loss of a friendship or dating partner.

Describe the intrapersonal and psychological characteristics that are associated with youth suicide:

There are a number of intrapersonal and psychological characteristics that are associated with youth suicide. They are listed down below: 1. Self-Image: Low self-esteem, poor self-concept and feelings of worthlessness are typical of suicidal children and they may predispose a child or adolescent to suicide ideation. For instance, according to research done by the CDC, teens who perceived themselves to be underweight and overweight were more likely to report thoughts and attempts of suicide compared to those who said they were "about the right weight." This is probably a manifestation of self-concept or self-esteem. 2. Anger: Anger, aggression, and anger control difficulties are also predictors of risky suicidal behavior. For instance, those who act aggressively toward their peers, are victims of violence, or witness such hostility are at increased risk for suicidal behavior. 3: Impulsivity: Impulsivity is often related to a suicidal response in young people. For instance, impulsive children are often influenced by others' responses to suicide and by the impact that a suicide has on others. Additionally, impulsivity is related to a risk-taking style. Young people may be ambivalent about ending their lives, but an impulsive or daredevil reaction to stressors often leads to them taking their lives. Therefore, impulse control may be a key predictor of the outcome of a suicidal crisis. 4. Loneliness: Loneliness and isolation are implicated in suicide. For instance, teenagers who feel lonely and isolated in a period marked by developing social relationships do not experience the support of friends. Lacking these nurturing and bonding relationships leads to children feeling expendable and unnoticed- feelings that often lead to suicide ideation. Additionally, according to the interpersonal theory of suicide, social isolation is the strongest, most reliable predictor of suicidal ideation, attempts, and actual suicide among all populations. 5. Burden on Others: If youth feel like a burden to "people in their lives", they experience higher levels of depression and suicidal ideation. This also is a risk factor for lower meaning in life. 6. Hopelessness and despair: Young people who experience hopelessness view the future in a pessimistic light. Not only that but hopelessness is a significant sign in recognizing suicide intent and behavior. It is especially predictive of suicide when the person feels hopeless about not belonging as well as seeing themselves as a burden to others. 7. Depression: Depression and related mental disorders are a strong contributing factor to youth suicide. For instance, depression is linked to suicidal thoughts and behaviors among children and adolescents in both clinical and non-clinical settings. Also, studies show that 14% of young people ages 12 to 17 have experienced at least one major depressed episode in their lifetimes, and about half of them thought about killing themselves. 8. Thinking Patterns: Faulty thinking and irrational beliefs are prevalent among suicidal youth. Some thinking patterns that are common to suicidal children and adolescents include: cognitive constriction, dichotomous thinking, cognitive rigidity, and cognitive distortion. Cognitive constriction is the inability to see options for solving problems and the conviction that bad feelings will never end. Then, there is dichotomous thinking which is when the individual is able to see only two solutions to the problem: continue to exist in a living hell or find relief through death. Additionally, cognitive rigidity is a rigid style of perceiving and reacting to the environment, which restricts a person's ability to cope with stress and to formulate realistic alternative approaches to problems. Lastly, cognitive distortion is when one overestimates the magnitude and insolubility of problems.

Share two significant facts/statisitcs regarding suicide rates that reflect the scope of the problem.

Suicide is a serious problem that is affecting our nation's youth each year. For one, suicide is the third leading cause of death among adolescents in the United States after unintentional injury and homicide. Also, every day, five young people under the age of 20 commit suicide, and every 6 hours a young person completes suicide. These appalling statistics reflect the scope of this problem.