|
Chapter 3 Index
A. General
B. Skin
C.
Orthopedics
D.
Genitourinary
E.
Endocrine
F.
Behavior |
|
Suicidality in Teenagers
Alex Mabe, PhD
Introduction: Each suicide attempt should be treated
seriously; each attempt is a reflection of long-term problems. Parents are
often embarrassed. Most suicide attempts see their behavior as a serious
wish to die, while most nonattempts see behavior as manipulative.
Statistics: Third leading cause of death during
adolescence: 8.3% of 9-12th graders actually attempt suicide; rate of death
is 0.7/100,000; over last three decades incidence has increased in the 15-24
age group. If 1 attempt made, 50% change of 2nd attempt.
Antecedents: Depressed Mood, Conduct Disorder a Lethal Combination.
If add in family strife, maternal depression (genetic link), overt rejection
by family and peer group problems = serious:
- Lives looked at as disorganized, unpredictable and disharmonious. This
can result from early loss experience, feeling unwanted and a burden,
family hostile, indifferent or rejecting; or from loss of significant
others.
- Problems and stress at a time when child feeling defenseless and
vulnerable. This can result from: relocations, school changes, court
placements, split with boyfriend
- Social isolation and maladjustment: results from insecurity about
attachments. Parents often aggressive, rejecting, scapegoating; parents
themselves often unhappy - fathers harsh disciplinarians or ineffectual,
may be substance abusers, depressed.
- Stages through which pass before attempt: rebellion, withdrawal,
running away
- Hopelessness and helplessness
- Trigger events: may seem inconsequential but critical eg fights,
breakups, etc.
Emergency Assessment and Treatment: Goal: Increase Hopefulness and
Social Support:
1. Assess imminent danger to self:
a. evidence of current suicide ideation and or plan,
b. risk factors: male, more than one previous attempt, history of
antisocial behavior, having a close friend or family member commit
suicide, frequent drug and alcohol use, depression, and incompatibility
with society
**c. Need to assess child’s ability to engage in nonsuicidal manner: by
answering the following four questions.
1. Can child promise abstention from suicidal behavior?
2. Is child able to deliver compliments about self or others?
3. Does the child have the capacity to assess feelings?
4. Does the child have the ability to plan ahead for suic? situations?
2. Hospitalization is usually necessary: won’t keep
outpatient appointments
3. Reduce pain, fulfill needs, give alternatives, transfuse hope, inc.
self-awareness
4. Remove potentially lethal weapons from the home
Prevention:
1. Educate the public about recognizing warning signs:
a. verbal (open talk of suicide, talk of not being here in future);
b. behavioral (drop in grades, literature or art themes, rebellion,
weight loss or gain, inc. risk taking, sudden happiness after long
depression, hostility, tension, anxiety, giving away possessions, putting
affairs in order)
2. Teach parenting skills and intervene when necessary
3. Plan approaches to improve adaptation and self-preservation:
self-esteem key
Next Page |