Addressing Youth

Depression &

Suicidal Ideation in

a Post-Pandemic

World

Cirecie West-Olatunji,

Ph. D.

Xavier University of

Louisiana

1

Learning Objectives2

Acquire

•Acquire new knowledge about suicidality related to vulnerable youth.

1

Increase

• Increase awareness about how marginalized, vulnerable, and at-risk youth are uniquely impacted by environmental influences.

2

Augment

•Augment understanding of suicide prevention and intervention skills.

3

Overview3

Suicide rates for Youth

Suicide and Infectious Disease

Suicide & Environmental Influences

Suicide Prevention & Intervention

Teletherapy & Telesupervision

Culture-centered Theory and Social Justice

Secondary Traumatic Stress Among Service Providers

Transforming Your Practice

Definitions4

Suicide: Death caused by self-directed injurious behavior with any intent to die.

Suicide attempt: A non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury.

Suicidal ideation: Thinking about, considering, or planning for suicide

(Centers for Disease Control [CDC], 2014)

Suicide

Rates in

the U.S.

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Data from the National Vital Statistics System, Mortality (Hedegaard, Curtin, & Warner, 2020) indicate:

• From 1999 through 2018, the suicide rate increased 35%, from 10.5 per 100,000 to 14.2.

• The rate increased on average approximately 1% per year from 1999 to 2006 and by 2% per year from 2006 through 2018.

• In 2018, the suicide rate for males was 3.7 times the rate for females (22.8 and 6.2, respectively).

• From 1999 through 2018, suicide rates among females were highest for those aged 45–64; among males, the rates were highest for those aged 75 and over.

• In 2018, suicide rates were higher in the most rural counties compared with the most urban counties for both males and females.

• Suicide is the 10th leading cause of death for all ages in the United States

Suicide

and

Disaster-

affected

Clients

6

MHA Suicide Prevention Summit 2021-July

Highly traumatic, especially for children

Complicated grief issues

Responses of family and support members are often accompanied by guilt and shame

Suicide Rates for Disaster-affected Clients

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Young adults are at higher risk

to develop psychological

concerns (Riaz et al., 2015).

Technological disasters cause

significantly more intense and

enduring patterns of social,

economic, cultural and

psychological outcomes than

natural disasters.

Terrorism causes increased

levels of post traumatic stress

disorder (PTSD) than natural

disasters.

Females suffer more after a

natural disaster than their male

counter parts.

Pandemics as

Disasters8

Suicide

and

Infectious

Disease

9

MHA Suicide Prevention Summit 2021-July

Hospitalization with infection has been associated with an elevated risk of suicide (Lund-Sorenses, Benros, Madsen, et al., 2016)

While activating the immune system can aid in fighting the infection, immune activation may also modify neurochemistry to cause individuals to feel suicidal (Kaltwassser, 2019, July)

Coronavirus and Suicide

Prevalence

In the U.S., suicide rates are at their highest

levels since World War II.

Factors, such as:

economic stress

social isolation

reduced access to religious services

overall national anxiety (probably due to

the toxic political climate) (Czeisler, Lane,

Petroysky et al., 2020).

Coronavirus and Suicide Prevalence

❑ Of note, there have been increases in:Health care provider suicide (ex.: New York–Presbyterian

Hospital emergency room director Lorna Breen, who died

by suicide in April)

Firearm sales

❑ Certain populations are more at risk for potential suicidal

thoughts, including: people who have contracted COVID-19,

those with preexisting conditions/immuno-compromised

individuals, and

those with histories of substances abuse (Reger, Stanley,

& Joiner, 2020)

❑ Suicide rates among young Americans and people of color were rising even before the pandemic.

❑ For Black children, in particular, there were 2.55 suicides per 100,000 children in 2007; in 2017, suicide rates for this population rose to 4.82 per 100,000.

Youth Suicide &

Environmental Influences

12

Race-based Stress

Bullying (online and face-to-face)

Body Image Concerns

Human Trafficking & Sexual Abuse

Race-based Stress

13

Suicide rates among young Americans and people of color were rising even before the pandemic.

For example, among Black children, there were 2.55 suicides per 100,000 children in 2007; in 2017, suicide rates for this population rose to 4.82 per 100,000.

Bullying14

Children who self-reported frequently bullying others are at

high and long-term risk for suicide-related behaviors.

Youth who self-report being frequently bullied by others are

at increased risk of suicide-related behaviors as well as

negative physical/mental health issues.

Young people who self-report both being bullied and

bullying others have the highest rates of negative mental

health outcomes such as, depression, anxiety, and suicidal

ideation.

(Centers for Disease Control [CDC], 2014)

Body

Image15

Body dissatisfaction has been linked to

risk-taking behaviors and mental health

problems.

Body dissatisfaction and a pressure to

be thin have been linked to depressive

symptoms and symptoms of anxiety

disorders, such as social anxiety or

panic disorder.

Impact of social media:

One study showed that, for youth,

Internalization of ideal body shapes, as

presented in the media, predicted

negative emotions about appearance.

(Mental Health Foundation, 2019)

Human Trafficking & Sexual Abuse16

Many victims are women and girls, though men and boys are also impacted

Victims include all races, ethnicities, sexual orientations, gender identities, citizens, non-citizens, and income levels

Victims are trapped and controlled through assault, threats, false promises, perceived sense of protection, isolation, shaming, and debt

Victims do not have to be physically transported between locations to be victimized

Mental health outcomes:

• depression,

• stress-srelated disorders,

• disorientation,

• confusion,

• phobias and panic attacks. •

• Feelings of helplessness, shame, humiliation, shock, denial or disbelief.

(Centers for Disease Control [CDC], 2021)

Social Activism & Suicide Prevalence

Two salient perceptions can impact suicidal ideation:

Thwarted belongingness

Perceived burdensomeness (Dreesman, 2020)

Climate Crises & Suicide

Prevalence

Initially, rates increase but

tend to stabilize except for

certain vulnerable

populations, such as people

with comorbidity and pre-

existing conditions.

Overall, however, suicide

rates decrease during the

active recovery period due

to a strong sense of

community and purpose.

Buffers19

Immediate supports

Social supports

Planning for the future

Engagement with helper

Core values/beliefs

Sense of purpose

Interventions20

Be Present/Engage

Acknowledge suicidal thoughts

Listen to understand

Validate the feelings, the experience

Evaluate hopelessness, burden and disconnection

Passive vs. Active Intent (methods and timing)

Evaluate Capability

Evaluate “Buffers”

Predict and Prepare

Mobilize Resources

Social Distancing & Emotional Wellbeing

21

Stay mindful of your emotions (how are you feeling?, what are you feeling?, where are you feeling it?)

Have a plan (what’s your “go to”? What coping mechanisms have you identified? How to you restore comfort, emotional safety, and emotional calm?)

Alternate between alone time and social time; maintain a balance between alone time, such as reading a book, journaling, or meditating, and social time, such as connecting via telephone, FaceTime, Skype, etc. or face-to-face with co-habitants.

Avoid catastrophizing as a result of binging on news from television, radio, social media, emails, etc.

Pay attention to your body; eat well with nourishing foods, stay hydrated, and be creative about getting daily exercise.

Use of

Teletherapy22

Cognitive rehabilitation and cognitive-behavioral therapy using smartphone apps has been shown to be beneficial (Baumel A, Correll CU, Hauser M, Brunette M, Rotondi A, Ben-Zeev D, et al., 2016)

In a study conducted in the UK, teletherapy was found to be as effective in reducing PTSD symptoms as in-person interventions among veterans (Turgoose, Ashwick, & Murphy, 2017).

The results of a recent study indicated that, for clients with eating disorders (ED), the application of evidence-based teletherapy interventions by a teletherapy-trained therapist led to significant improvement of ED symptoms (Spoch & Anderson, 2019)

Online Clinical Supervision

*=Adapted from Martin, Kumar, & Lizarondo, 2017)

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Set Clear Expectations & Goals for Telesupervision

A range of options for online clinical supervision should be utilized, responding to individual learning needs,

accessibility of technological tools, etc.

Online clinical supervision should be embedded in

pedagogical principles of counselling and psychotherapy.

Telesupervision protocols should not supersede a

strong supervisory relationship

Be ready to deal with technology challenges and

have a back up plan

Availability of supervisor between clinical supervision

sessions can enhance the supervisee’s perception of

the effectiveness of supervision

Adhere to responsible use of technology (using a secure

platform, maintaining confidentiality for client and supervisee, ensuring safety)

Revisit and evaluate the supervisory process and

relationship frequently using informal and formal

mechanisms

TEN MOST COMMON ERRORS

DURING SUICIDE INTERVENTION WITH YOUTH(Adapted from Neimeyer & Pfeiffer, 1994)

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Superficial Reassurance

Avoidance of Strong Feelings

Professionalism

Inadequate Assessment of Suicidal Intent

Failure to Identify Precipitating Event

Passivity

Insufficient Directedness

Advice Giving

Stereotypic Responses

Defensiveness

Crisis Interventions for Youth25

crisis intervention techniques

cognitive-behavioral exercises

eye movement desensitization and reprocessing (EDMR)

psychopharmacological treatment

brainspotting

Disaster Mental Health Models

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Crisis Intervention Models

Psychological First Aid

Culture-centered Disaster Mental Health Counselling

Crisis Interventions27

crisis intervention techniques

cognitive-behavioral exercises

eye movement desensitization and reprocessing (EDMR)

psychopharmacological treatment

Psychological

First Aid28

Psychological First Aid is an

evidence-informed model utilized in

disaster response to assist those

impacted in the hours and early

days following emergency, disaster,

and terrorism (Uhernik, & Husson,

2009).

Psychological First Aid

Culture-

centered

Disaster

Mental

Health

Counseling

(C-DMHC)

Training

Model

(West-

Olatunji,

2010)

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STEP 7 Transformation: participants integrate the experience into their own personal and professional identities

STEP 6 Praxis: participants formulate advocacy action

STEP 5 Empowerment: participants are able to appropriately intervene with empowerment as the goal

STEP 4 Integration: participants integrate knowledge into clinical conceptualization

STEP 3 Context: participants acknowledge the sociopolitical context

STEP 2 Respect: participants recognize that community members have equally valid realities and funds of knowledge

STEP 1 Awareness: participants recognize that they bring their own biases into the environment

Culture-

centered

Theory

and

Social

Justice

30

Facilitates counselors’

efforts to reach out to

culturally diverse individuals

and communities.

Enables counselors to

better conceptualize and

intervene with culturally

diverse clients.

Promotes awareness,

knowledge, and skills in

order to prevent cultural

encapsulation (Pederson,

1991; Sue & Sue, 2008).

Secondary

Traumatic

Stress

The presence of burnout, or secondary traumatic stress, may potentially affect the counselor, the work setting, and the client. (Wilkerson & Bellini, 2006)

Researchers need to be able to educate counseling professionals about the risk factors, symptoms, and effects of secondary traumatic stress.

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Secondary

Traumatic

Stress (cont.)

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Over the past decade,

scholars have examined the

concept of burnout within

specific counseling specialty

areas:–school counselors (Wilkerson, 2009; Wilkerson

& Bellini, 2006)

substance abuse counselors

(Wallace, Lee, & Lee, 2010)

rehabilitation counsellors (Garske, 2007; Templeton & Satcher, 2007)

Transforming Your Practice33

Include suicide risk assessment and intervention strategies as core elements of training and practice (Moutier, 2014).

Include

Restrict lethal means. Restrict

Provide increased and enhanced quality of support in the aftermath of suicide.

Provide

Reach out to the family, friends, and colleagues of suicidal individuals as, in some cases, it can trigger more attempts in the aftermath of suicide.

Reach out

Take social action to speak out and encourage others to do so.

Take

Selected References

Be Real. Somebody Like Me: A report investigating the impact of body image anxiety

on young people in the UK. [Internet]. 2017. Available

from: https://www.berealcampaign.co.uk/research/somebody-like-me

Credos. Picture of Health? [Internet]. 2016. Available

from: http://www.adassoc.org.uk/wp-content/uploads/2016/08/Picture-of-

health_FINAL.pdf

Moutier, C. (2014). Tactics of the War on Suicide. Depression & Anxiety (1091-4269),

31(12), 961–963. https://doi.org/10.1002/da.22345

Riaz, M. N., Malik, S., Nawaz, S., Riaz, M. A., Batool, N., & Shujaat, J. M. (2015).

Well-Being and Post-Traumatic Stress Disorder due to Natural and Man-Made

Disasters on Adults. Pakistan Journal of Medical Research, 54(1), 25–28. Retrieved

from

http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=102056010&site=eho

st-live&scope=site

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