Students with Suicidal Ideations. Mental Health Programs for. School of Medicine and Public Health. Ateneo de Manila University.

Transcription

1 Mental Health Programs for Students with Suicidal Ideations Ma. Luz S. Casimiro-Querubin, MD, FPPA Professor Ateneo de Manila University School of Medicine and Public Health

2 Lecture Objectives Discuss the concepts related to suicide in children and adolescents Discuss the risk factors associated with suicide and self-harm (global and local data) Propose school based interventions from a conceptual framework of normal human development

3 Conceptual Map Developmental Theory Sequential stages Milestones : physical (biological), cognitive and emotional Sheridan, M Fahlberg, V. 1994

4 World Health Organization 1 Million suicides/year 16/100,000 population mean mortality rate 1 death/40 seconds Gender factor M>F (4:1) WHO data; July 2015

5 Global Epidemiologic Data Suicide is the 3rd leading cause of death 20% of children and adolescents suffer from disabling mental disorder 50% of adult mental disorders have their onset in adolescents J. Child Psychology and Psychiatry. March 2008

6 WHO : Adolescent Data 20% of adolescents will experience a mental health problem in any given year In the Philippines, 42% of students showed signs of depression and/or anxiety* Comparison of 2003 vs data 0.5%-1.0% finding ways to commit suicide 2.8%-7.5% self-inflicted harm * feeling hopeless everyday for 2 weeks in the past 12 months

7 WHO : Adolescent Data Risk Factors Exposure to violence Humiliation Devaluation Poverty

8 Definitions Suicidal ideation Thoughts of dying by killing oneself Suicidal plans Details related to killing oneself Suicide attempt Act of killing oneself

9 Prevalence and Transition Rates Prevalence rate 9.2% suicidal ideation 3.1% suicidal plan 2.7% suicide attempt 60% of transition from ideation to attempt happens on Y1 British J. of Psychiatry V. 192;

10 Transition Rate from Ideation 33.6% suicide plan 29.0% suicide attempt 56% suicide ideation + suicide plan 15% suicide ideation only British J. of Psychiatry V. 192;

11 Risk Factors Female gender Younger age Less educated Unmarried / single Presence of a mental disorder British J. of Psychiatry V. 192;

12 Age-specific suicide rates, females, Maria T Redaniel, May A Lebanan-Dalida and David Gunnell, Suicide in the Philippines: time trend analysis ( ) and literature review, BMC Public Health 2011, 11:536

13 Age-specific suicide rates, males,

14 The incidence of suicide in males increased from 0.23 to 3.59 per 100,000 between 1984 and 2005 while rates rose from 0.12 to 1.09 per 100,000 in females. (Redaniel, Dalida and Gunnell, 2011) Almost one per 100 households (0.7%) has a member with mental disability (DOH-SWS, 2004) Intentional self- harm is the 9th leading cause of death among years old. (Adolescent and Youth Health Program, Department of Health)

15 Global school-based health survey, 2011 (mental health) Mental Health Indicator Total % Boys Girls Ever seriously considered attempting suicide during the past 12 months 16.3% 11.5% 20.5% Actually attempted suicide one or more times during the past 12 months Had no close friends WHO Global School Based Health Survey, 2010

16 Psychosocial Distress and Substance Use Study conducted in 4 countries Distress Indicators Often worry Often lonely Feeling sad/hopeless Suicide plan Page,R. et.al. Sage Journals published online May 2010

17 Suicide vs. Self-Harm Differentiating factor : intent What motivates the act? Suicide attempt vs. non-suicidal self-injury

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19 Spiral Downwards

20 Predictors of Poor Self-Esteem Family stressors violence and abuse; separation or loss Community stressors public image School stressors academic pressure; peer comparison

21 Effect of Life Experiences :QC Most common adverse life experiences with a dose response relationship on suicidal behavior 43.6% - neglect 22.8% - psychological abuse 22.5% physical neglect

22 Parental Domestic Violence: Philippines 2051 adolescents (15-19 years old) 11% of males and 19% of females positive for depressive symptoms F>M More than half witnessed parental domestic violence Hidin and Gultiano. Aemrican Journal of Public Health 2002

23 Interventions Context Environmental stressors Resources Gaps Then : identify strategies

24 Context Paradigm of normal human development School age children and adolescents span 7-21 years old

25 Psychosocial Development Age 7-11 years Industry vs. Inferiority Wants to learn, stick to tasks, do things well and learn from others. Possibly competitive. Consciously putting problem-solving and language skills to work.

26 Psychosocial Development Need for social interaction Develop pride in accomplishments and abilities. Encouraged and commended by parents, teachers and peers

27 Industry A sense of competence and belief in skills develops. Prior mastery of trust, autonomy and initiative provides the basis for increasing self-discipline, application and industry.

28 Inferiority Repeated failure and criticism leads to frustration and inadequacy The mistrusting child will doubt the future The shame-and-guilt filled child will experience defeat and inferiority

29 Adolescent Development Tremendous physical growth Sexual development hormones, physical changes Greater sexual interest

30 Adolescent Development Growing capacity for abstract thought Intellectual interests expand Mostly interested in the present; less of future Deeper moral thinking

31 Psychosocial Development Struggle with sense of identity Desire for independence and privacy Moodiness Greater influence of peer group Worry about self-image and body

32 Adolescent Development (14-18) Intense self-involvement Feelings of love and passion Popularity is important Greater capacity for setting goals

33 Adolescent Development (19-21) Firmer sense of identity Increased emotional stability Peer relationships remain important More serious relationships Deeper moral reasoning

34 What can we do? Invest in early childhood development If that has been missed, invest in the current stage of development Presence Attention Communication

35 School Based Mental Health Programs Identify a CIRCLE OF GATEKEEPERS Parents and surrogates Run parenting workshops and give incentives for attendance Teachers and school staff Incorporate human development, stress management, mindfulness techniques in faculty development

36 School Based Mental Health Programs Build a Community for Health Promotion Curriculum based programs Classroom discussion choice of readings Homeroom activities discussion of the news Physical education, arts and crafts, home economics Extra curricular activities Competitive sports Skills building

37 School Based Mental Health Programs Low yield Suicide screening Individual counselling Medium yield Peer counselling

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