QPR Suicide Prevention Training

QPR
Question, Persuade, Refer
…ask a question…save a life
Suicide Prevention Training
Jon Mattleman, Youth/Family Resources
[email protected]
Website: http://jonmattleman.com
www.linkedin.com/in/jonmattleman
Question
Persuade
Refer
QPR
Jon Mattleman
Website: www.jonmattleman.com
Email: [email protected]
QPR
Q
P
R

QPR is not a form of counseling or
treatment…

QPR is intended to offer hope…

QPR is an approach which is easy to
understand and implement by
virtually anyone --- you do not
need to be a therapist to do it…
Q
P
Myth
 Fact
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Myth

Fact
Myth
 Fact

R
Suicide Myths
….and Facts
No one can stop a suicide…it is inevitable
If a person in a crisis get the help they need, they
may never be suicidal again
Confronting a person about suicide will only make
them angry and increase the risk of suicide
Asking someone about suicidal intent lowers anxiety,
opens up communication, and lowers the risk of an
impulsive and destructive act
Only experts can prevent suicide
Suicide prevention is everybody’s business, and
anyone/everyone can help prevent suicide
Q
P
R
More Suicide
Myths and Facts

Myth
Suicidal people keep their plans to themselves…

Fact
Actually, most suicidal people communicate their intent at
sometime preceding their attempt
Myth
 Fact

Those who talk about suicide don’t do it…
Actually, people who talk about suicide may try, or even
complete, an act of self-destruction

Myth
Once a person decides to complete suicide, there is nothing
anyone can do to stop them…

Fact
Actually, suicide is very often a preventable kind of death, and
almost any positive action may save a life
Q
P
R
Massachusetts
Suicide Facts
On the average….
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Fact
Fact
Fact
Fact
Fact
Fact
Fact
Fact
Fact
Fact
Fact
Fact
550 Massachusetts residents died by suicide each year
4,500hospital stays for self injury each year
6,500 ER visits for self injury each year
200,000 crisis calls to Samaritans each year
Males were over 3 times as likely to commit suicide than
Leading method for male: hanging/suffocation & firearms
Leading method for female : poisoning & hanging/suffocation
The highest number of suicides for males is ages 35 - 44
The highest number of suicides for females is ages 35 – 44
Over 50% had a diagnosed mental health problem
30% had a history of substance/alcohol abuse
25% had a current partner problem
Typical MA
Suburban School
Q
P
R
According to the 2012
Youth Risk Behavior Survey:

Typical Suburban High School
◦
◦
◦
◦

13% (208) of students have self injured
14% (224) of students have depressive symptoms
10.3% (165) of students have seriously thought about suicide
3.3% (53) of students have actually attempted suicide
Typical Middle School (7th and 8th Grade Only)
◦
◦
◦
◦
5.0% (42) of students have self injured
9.0% (75) of students have depressive symptoms
8.1% (67) of students have seriously thought about suicide
1.3% (11) of students have actually attempted suicide
Q
P
R
Why Do People
Commit Suicide??
It’s not that they want to die….
It’s that
they can’t
figure out how to
go on living
Q
P
QPR
R
Suicide Clues and Warning Signs
The more clues and signs observed,
the greater the risk…
Take all signs seriously
Q
P

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Direct Verbal Clues…
R
“I’ve finally decided to kill myself”
“I wish I were dead”
“I’m going to commit suicide”
“I’m going to end it all”
“If (such and such) doesn’t happen, I’ll
kill myself”
Indirect or “Coded"
Verbal Clues
Q
P
R
“I’m tired of life, I just can’t go on”
 “My family would be better off without me”
 “Who cares if I’m dead anyway”
 “I just want out”
 “I won’t be around much longer”
 “Pretty soon you won’t have to worry about
me”

Q
P
Behavioral Clues
R
 Any previous suicide
attempt
 Acquiring a gun or stockpiling pills
 Co-occurring depression, moodiness, hopelessness
 Putting personal affairs in order
 Giving away prized possessions
 Sudden interest or disinterest in religion
 Drug or alcohol abuse, or relapse after a recovery
 Unexplained anger, aggression, and/or irritability
Q
P
R
Situational
Clues
Loss of any major relationship
 Being fired or being expelled from school
 A recent unwanted move
 Death of a spouse, child, or best friend --- especially if by
suicide
 Diagnosis of a serious terminal illness
 Sudden unexpected loss of freedom/fear of punishment
 Anticipated loss of financial security
 Loss of a cherished therapist, counselor, or teacher
 Fear of becoming a burden to others

Q
P
R
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Tips for Asking
“The Question”
If in doubt, don’t wait, ask the question
If the person is reluctant, be persistent
Talk to the person alone in a private setting
Allow the person to talk freely
Give yourself plenty of time
Have your resources handy; phone numbers,
counselor’s name, and/or any other information
that might help
Remember:
How you ask the question…
is less important than the fact that…
you ask it
Q
P
How To Ask the
Suicide Question…
R
Less Direct Approach:
◦ “Have you been unhappy lately?” “Have you
been very unhappy lately?” “Have you been
so very unhappy lately that you’ve been
thinking about ending your life?”
◦ “Do you ever wish you could go to sleep and
never wake up?”
How To Ask the
Suicide Question…
Q
P
R
Direct Approach:
◦ “You know, when people are as upset as you seem to be,
they sometimes wish they were dead. I’m wondering if
you’re feeling that way, too?”
◦ “You look pretty miserable, I wonder if you’re thinking
about suicide?”
◦ “Are you thinking about killing yourself?”
NOTE: If you can not ask the question,
find someone who can
How To Persuade
a person…
Q
P
R

Listen to the problem and give them your
full attention

Remember, suicide is not the problem, only
the solution to a perceived insoluble problem

Do not rush to judgment

Offer hope in any form
Q
How To Persuade a person
P
R
“Will you go with me to get help?”
 “Will you let me help you get help?”
 “Will you promise me not to kill yourself
until we’ve found some help?”

YOUR WILLINGNESS TO LISTEN AND
TO HELP CAN REKINDLE HOPE…
AND YOU…
CAN MAKE ALL THE DIFFERENCE
Q
How To Refer a Person
P

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R
Suicidal people often believe they cannot be helped,
so you may have to work hard…
The safest option involves taking the person directly
to someone who can help…
The next safest option is getting a commitment from
them to accept help, then making the arrangements
to get that help…
Another option is to give referral information and try
to get a good faith commitment not to complete or
attempt suicide...
Any willingness to accept help at some time, even if
in the future, is a good outcome…
Q
P
R
Remember
Since almost all efforts to persuade
someone to live instead of attempt
suicide will be met with agreement and
relief (eventually)…
Don’t hesitate to get involved
or to take the lead
Q
For Effective QPR
P
R

Say: “I want you to live,” or “I’m on your side…we’ll get
through this.”

Get Others Involved…Ask the person who else might be
of help
Family?
Friends?
Brothers?
Sisters?
Pastors? Priest? Rabbi?
Physician?
Q
P
R
For Effective QPR

Join the Team --- offer to work with
clergy, therapists, psychiatrists or
whomever is going to provide the
counseling or treatment if
appropriate/possible.

Follow up with a visit, a phone call, or a
card, an email, a text, etc. in whatever way
feels comfortable to you let the person
know you care about what happens to
them. Caring may save a life.
Q
P
R
Remember
WHEN YOU APPLY QPR,
YOU PLANT THE SEEDS OF HOPE...
HOPE AND INTERVENTION
HELP PREVENT
SUICIDE
Your actions and using QPR
could save a life……
Question
Persuade
Refer
Q
For further information
P
R
Jon Mattleman
Email:
[email protected]
Website:
www.jonmattleman.com
Injury Surveillance Program, MA Department of Public Health
Spring 2014
Suicide and self-inflicted injuries among Massachusetts residents are a significant yet largely preventable public health
problem. The purpose of this bulletin is to provide information for practitioners and prevention specialists on the
magnitude, trends, and risk factors for suicides and self-inflicted injuries. While suicide refers to completed suicides,
nonfatal self-inflicted injuries can include both suicide attempts and non suicidal self-injury. The MDPH Suicide
Prevention Program works in collaboration with multiple state, national, and local partners to reduce these injuries.
2011 Suicide Data:
 In 2011, there were 5881 suicides that
occurred in Massachusetts; a rate of
8.9/100,000 persons. The number of
suicides was 2.9 times higher than
homicides (N=202).
Number of Deaths
Figure 1. Suicides and Homicides in MA,
2003-2011
700
600
500
400
300
200
100
0
Suicides
424
432
468
455
513
503
538
600
588
Homicides
140
183
181
194
181
170
181
212
202
Year
Source: Massachusetts Violent Death Reporting System, Massachusetts Department of Public Health
Figure 2. Number of Suicides and Hospital Discharges and
Emergency Department Discharges for Nonfatal Self-Inflicted Injury,
MA 4
588
Completed Suicides (2011)
 Massachusetts has lower rates of suicides
compared to the US. The US age adjusted
rate in 2010, the most recent year for
which data are available, was
12.1/100,000 compared to 8.7/100,000 for
Massachusetts.(CDC)
 During the period of 2003-2011,
approximately 4,500 persons died of
suicide in Massachusetts. Suicide rates
increased an average of 4% per year. The
overall increase was 35%; from 6.6 to
8.9.2 There were 164 more suicides in
2011 than in 2003.
 The increase in suicide rates was primarily
among White, non-Hispanic males whose
rates increased an average of 5% per year
between 2003 and 2011.2
 Samaritans’ organizations in
Massachusetts responded to 198,080
crisis calls in 2012.3
1
4,398 Hospital Discharges
6,252
for Self-Inflicted Injuries
(FY2012)
Emergency Department
Visits for Self-Inflicted
Injuries (FY2012)
Sources: Massachusetts Violent Death Reporting System, Massachusetts
Department of Public Health; Massachusetts Hospital Discharge Database,
Massachusetts Emergency Department Discharges Database, Massachusetts
Center for Health Information and Analysis
Suicides and Self-Inflicted Injuries in Massachusetts: Data Summary
This number represents the final count for 2011 and may
differ from previously reported preliminary numbers.
2
This trend was statistically significant.
3
This number includes repeat callers (individuals contacting
hotlines more than once). Samaritans, Inc.; Samaritans of Fall
River/New Bedford, Inc.; Samaritans of Merrimack Valley;
Samaritans on the Cape & Islands.
4
Hospital Discharges and Emergency Department Visits are
MA residents. Deaths are MA occurrent.
1
Suicides and Hospitalizations for Nonfatal Self-inflicted Injuries by Age Group and Sex
Number of Suicides
Figure 3A: Suicides in MA, by Age Group,
2011 (N=588)
180
160
140
120
100
80
60
40
20
0
155
108
106
81
73
31
5
5-14
20
9
15-24 25-34 35-44 45-54 55-64 65-74 75-84
85+
Age Group (years)
Source: Massachusetts Violent Death Reporting System, Massachusetts Department of Public Health
25.0
19.1
<5
0.0
14.7
12.0
6.4
6.8
14.0
2.0
5.0
4.8
3.9
10.0
11.7
15.0
8.1
18.5
20.0
19.4
22.9
Female
Male
*
Rate per 100,000 Persons
Figure 3B: Rate of Suicides in MA by Sex and Age
Group, 20115
<5
<5
5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group (years)
Source: Massachusetts Violent Death Reporting System, Massachusetts Department of Public Health
140.0
120.0
Nonfatal Self-Inflicted Injuries,
Hospital Discharges in FY12:
 The overall rate of hospital
discharges for self-inflicted injury
among MA residents was
66.8/100,000 (N=4,398).
 Females had a higher rate
(72.5/100,000, N=2,462) than males
(60.7/100,000, N=1,936).
 Females had higher rates of hospital
discharges for self-inflicted injury
than males for all age groups except
75-84 and 85+ year age groups.
 Among females, the highest rate was
in the 15-24 year age group
(120.2/100,000, N=559). Among
males, the highest rate was in the 3544 year age group (105.9/100,000,
N=447).
15.5
17.0
11.4
24.5
24.6
20.3
96.9
81.0
112.6
105.9
Males
56.1
50.6
15.6
20.0
74.6
60.0
113.7
103.2
80.0
40.0
Females
120.2
100.0
2.8
Rate per 100,000 Persons
Figure 4. Hospital Discharge Rates for Nonfatal
Self-inflicted Injury by Sex and Age Group, MA
Residents, 2012 (N=4,398)
Suicides:
 Most suicides occur in the middle age
population: 26% of all suicides were
among individuals age 45-54.
Between 2003 and 2011 the suicide
rates among this age group
increased an average of 6.4% per
year.
 Suicides among males exceeded
females by 3 to 1. In 2011, there
were 441 suicides among males
(13.8/100,000) compared with 147
among females (4.3/100,000).
 Among males, the highest rate of
suicide was among those 45-54
years of age (22.9/ 100,000, N=113).
 Among females the highest rate of
suicide was also among those 45-54
years of age (8.1/100,000, N=42).
0.0
5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
5
Rates are not calculated on counts less than 5.
Age Group (years)
Source: Massachusetts Hospital Discharge Database, Massachusetts Center for Health Information
and Analysis
Suicides and Self-Inflicted Injuries in Massachusetts: Data Summary
2
Suicides by Race/Ethnicity and Suicide and Nonfatal Self-inflicted Hospitalizations by
Method
Age-adjusted Rate per 100,000
Figure 5. Average Annual Suicide Rates in MA, by Sex
and Race/Ethnicity, 2007-2011 (N=2,742)6
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
14.5
Male
Female
Total
9.0
7.8
6.5
5.9
4.0
4.1
3.7
White
4.0
2.3
1.2
0.8
Black
Hispanic
 From 2007-2011 the average annual ageadjusted suicide rate was highest among
White, non-Hispanic males (14.5/100,000,
N=1,898).7
 Similarly White, non-Hispanic females had
a higher rate (4.0/100,000, N=555) of
suicide compared to Black, non-Hispanic ,
Asian non-Hispanic, and Hispanic
females.7
6
Rates are age-adjusted using the Standard US Census
2000 population. The five most recent years of data
were used to improve the stability of the rates.
Asian
7
Statistically significant at the p < .05 level. Please refer
to the Methods section for an explanation on statistical
significance.
Race/Ethnicity
Source: Massachusetts Violent Death Reporting System, Massachusetts Department of Public Health
Figure 6A and B: Suicides and Hospital Discharges for Nonfatal Self-Inflicted Injury by Method,
Massachusetts
Figure 6A.
Figure 6B.
Suicides in MA, 2011
(N=588)
Males (N=441)
Firearm
2%
Other
10%
Poisoning/
Overdose
16%
Firearm
25%
Females (N=147)
Hanging/
Suffocation
49%
Other
13%
Hanging/
Suffocation
38%
Poisoning/
Overdose
47%
Hospital Discharges for Nonfatal Selfinflicted Injuries, MA Residents,
FY2012 (N=4,398)
Other
Cut/ 7%
pierce
14%
Poisoning/
Overdose
79%
Source: Massachusetts Violent Death Reporting System, Massachusetts Department of Public Health and Massachusetts Hospital Discharge Database,
Massachusetts Center for Health Information and Analysis
 In 2011, suicide methods varied by sex. For males, suffocation/hanging (N=217) and firearm (N=110) were
the most common methods used. For females, the leading methods were poisoning (N=69) and
suffocation/hanging (N=56).
 In FY2012, the leading method of nonfatal self-inflicted injuries resulting in hospitalization was poisoning.
This did not vary by sex.
Suicides and Self-Inflicted Injuries in Massachusetts: Data Summary
3
Circumstances Associated with Suicide in Massachusetts
Circumstance data provides
useful information for better
understanding what may have
precipitated a suicide and informs
prevention programming.
Information presented shows
circumstances known.
 51% of suicide victims had a
documented current mental
health problem such as
depression or other mental
illness.
Figure 7a. Circumstances Associated with Suicide in
MA, 20118
Current Mental Health Problem
51%
Circumstance
Current Treatment for Mental Illness
37%
Alcohol and/or Other Substance
Problem
27%
Intimate partner problem
23%
History of suicide attempts
21%
Job and/or Financial Problem
 37% were currently receiving
some form of mental health
treatment.
16%
0%
10%
20%
30%
40%
50%
60%
 27% had an alcohol and/or
other substance use problem
noted.
Percent of Suicides
Source: Massachusetts Violent Death Reporting System, Massachusetts Department of Public Health
 23% had a noted problem with
a former or current intimate
partner (such as divorce,
break-up or argument.)9
Figure 7b. Circumstances Associated with Suicide in MA,
by Age Group, 20118
 21% had a history of suicide
attempts.
Current Mental Health Problem
 16% had a job problem, such
as increased pressure at work,
feared layoff, recent layoff
and/or financial problem.
Circumstance
Current Treatment for Mental Illness
15-24
Intimate partner problem
25-44
Alcohol and/or Other Substance Problem
45-64
Job and/or Financial Problem
65+
History of suicide attempts
Physical health problem
0%
10% 20% 30% 40% 50% 60% 70%
Percent
Source: Massachusetts Violent Death Reporting System, Massachusetts Department of Public Health
8
More than one circumstance may be noted
for a suicide.
9
“Intimate Partner Problem” refers to any
problem with a current or former intimate
partner and may or may not involve violence.
There were differences in circumstances when analyzed by age group. In 2011:
 15-24 year olds had a higher percent of current mental health problem compared to persons 65
and over.
 45-64 year olds had a higher percent of current treatment for mental health problem than 25-44
year olds and persons 65 and over.
 45-64 year olds had a higher percent of job/financial problem than persons 25-44.
 Individuals ages 65 and over had the highest percent of physical health problem compared to all
other age groups.
Suicides and Self-Inflicted Injuries in Massachusetts: Data Summary
4
Suicidal Thoughts and Behaviors in Youth
The MA Youth Risk Behavior Survey,
(MA YRBS) an anonymous written self
report survey of youth in public high
schools in MA, indicated that in 2011:
 18% of high school students
reported a self-inflicted injury that
was not a suicide attempt
Percent of Respondents
Figure 9. Suicidal Thinking and Behavior among MA
High School Students, YRBS, 2011
20
18
16
14
12
10
8
6
4
2
0
18.0
13.0
 13% of students seriously
considered suicide during the past
year, 12% made a suicide plan and
7% made an attempt
12.0
7.0
2.0
Non-suicidal
self injury
Seriously
considered
suicide
Made a
suicide plan
Attempted
suicide
Attempted
suicide with
injury
Source: Massachusetts Youth Risk Behavior Survey, 2011, weighted data
80
attempted suicide 10
Percent of students who
Figure 10. Attempted Suicide by Number of Victimization
Types, YRBS, 2009, 2011
70
69.3
61.4
60
50
40
29.0
30
20.0
20
10
3.0
1
2
3
Number of Victimization Types
Survey findings from the MA YRBS
can also show the relationship
between victimization and suicide
attempts. As the number of
victimization types experienced
increases, so does the percent of
those students attempting suicide.
The victimization types from YRBS
include:
 students who had ever been bullied
on school property during the past
12 months
7.7
0
0
 25% of high school students
reported feeling so sad or
depressed daily for at least two
weeks during the previous year
that they discontinued usual
activities. A significantly larger
percentage of females (32%) than
males (19%) reported feeling this
way (not depicted)
*4
*5
Source: Massachusetts Youth Risk Behavior Survey, questions on survey in 2009 and 2011, weighted data
 students who did not go to school
on one or more of the past 30 days
because they felt they would be
unsafe at school or on their way to
or from school
 students who had been threatened
or injured with a weapon such as a
gun, knife, or club on school
property one or more times during
the past 12 months
 students who had ever been hurt
physically by a date or someone
they were going out with
* Estimates may be unreliable due to small numbers, interpret with caution
 students who responded that
someone had ever had sexual
contact with them against their will.
10
Attempted suicide one or more times in the past 12 months
Suicides and Self-Inflicted Injuries in Massachusetts: Data Summary
5
Resources
For more information on suicide data or to learn more about suicide prevention activities in Massachusetts,
please contact:
Injury Surveillance Program
Bureau of Substance Abuse Services
Bureau of Health Information, Statistics, Research, and Evaluation
Massachusetts Department of Public Health
250 Washington Street, 6th Floor
Boston, MA 02108
Phone: 617-624-5648 (general injury)
Phone: 617-624-5664 (MAVDRS)
http://www.mass.gov/dph/isp
Massachusetts Suicide Prevention Program
Bureau of Community Health and Prevention
Massachusetts Department of Public Health
250 Washington Street, 4th Floor
Boston, MA 02108
Phone: 617-624-6076
http://www.mass.gov/dph/suicideprevention
Massachusetts Department of Public Health
250 Washington Street, 3rd Floor
Boston, MA 02108
1-800-327-5050
TTY 1-888-448-8321
http://www.mass.gov/dph/bsas
Massachusetts Coalition for Suicide Prevention
Phone: 617-297-8774
[email protected]
24-hour help lines
Samaritans:
1-877-870-HOPE (4673)
Samariteens:
1-800-252-TEEN (8336)
National LifeLine:
1-800-273-TALK (8255)
TTY: 1-800-799-4TTY (4889)
Methods
General Notes:
All suicides and self-inflicted injuries were ascertained using guidelines recommended by the Centers for Disease Control and Prevention and are
based upon the International Classification of Disease codes for morbidity and mortality. The most recently available year of data for each data
source was used for this bulletin. All rates reported in this bulletin are crude rates with the exception of Figure 5. Age-adjusted rates are used for
Figure 5 to minimize distortions that may occur by differences in age distribution among compared groups. Rates presented in Figure 1 of this
bulletin cannot be compared to bulletins published prior to 2008 due to a methodology change. In prior bulletins individuals less than 10 were
excluded in both the numerator and denominator due to the rarity of children <10 completing suicide. For consistency with other publications the
analysis was modified to include all ages for both numerator and denominator. This change results in slightly lower rates. Prior to data year 2010
death data was from the Massachusetts Registry of Vital Records and Statistics and included Massachusetts residents regardless of where the
death occurred.
Data Sources:
 Death Data: MA Violent Death Reporting System, MA Department of Public Health. The National Violent Death Reporting System is a Centers for
Disease Control and Prevention funded system in 18 states that links data from death certificates, medical examiner files, and police reports to
provide a more complete picture of the circumstances surrounding violent deaths. The Massachusetts Violent Death Reporting System (MAVDRS)
operates within the Injury Surveillance Program at the Massachusetts Department of Public Health. MAVDRS captures all violent deaths (homicides,
suicides, deaths of undetermined intent and all firearm deaths) occurring in MA and has been collecting data since 2003. Data reported are for
calendar year. Data were analyzed by icd-10. Data Includes Massachusetts occurrent deaths regardless of residency.
 Statewide Acute-care Hospital Discharges: MA Inpatient Hospital Discharge Database, MA Center for Health Information and Analysis. Data
reported are for fiscal years (October 1 -September 30). Deaths occurring during the hospital stay and transfers to another acute care facility were
excluded from the counts presented. All discharge diagnoses were analyzed to ascertain injury.
 Statewide Emergency Department Discharges at Acute Care Hospitals: MA Emergency Department Discharge Database, MA Center for Health
Information and Analysis. Data reported are for fiscal years (October 1 -September 30). Deaths occurring during treatment or those admitted to the
hospital were excluded from the counts presented. All discharge diagnoses were analyzed to ascertain injury.
 Suicide Crisis Data: Samaritans, Inc.; Samaritans of Fall River; Samaritans of Merrimack Valley; Samaritans on the Cape & Islands.
 MA Youth Risk Behavior Survey: MA Department of Education, MA Department of Public Health, and CDC MMWR Vol. 61, No. 4, June 2012.
 Population Data: National Center for Health Statistics. Postcensal estimates of the resident population of the United States for July 1, 2010-July 1,
2011, by year, county, single-year of age (0, 1, 2, .., 85 years and over), bridged race, Hispanic origin, and sex (Vintage 2011). Prepared under a
collaborative arrangement with the U.S. Census Bureau. Available from: http://www.cdc.gov/nchs/nvss/bridged_race.htm as of July 18, 2012
following release by the U.S. Census Bureau of the unabridged Vintage 2011 postcensal estimates by 5-year age group on May 17, 2012.
 U.S. injury rates and U.S. population were accessed from Centers for Disease Control and Prevention, National Center for Injury Prevention and
Control. Web-based Injury Statistics Query and Reporting System (WISQARS)
Statistical Significance: A result that is statistically significant is one that is unlikely to have occurred by chance alone, and is therefore, likely to
represent a true relationship between a risk factor such as race, age, or sex and a disease or injury of interest. Statistical significance does not
necessarily imply importance and should not be the only consideration when exploring an issue. Because a rate is not “statistically” significant
does not mean there is not a real problem that could or should be addressed.
This publication was supported by cooperative agreements #U17/CCU124799, #U17/CCU122394 and #U17/CE001316 from the Centers for Disease Control and
Prevention. Its contents are solely the responsibility of the authors and do not represent the official views of the Centers for Disease Control and Prevention.
Suicides and Self-Inflicted Injuries in Massachusetts: Data Summary
6
Preventing Suicidal Behavior Among College and University Students
Suicidal Behavior Among College and University Students
Suicide is a leading cause of death among youth attending colleges and universities in the United States; however,
despite a rise in previous decades the rate has been stable or decreasing since the early 90s (Schwartz, 2006; Schwartz,
2011). College and university students have significantly lower risk of suicide than peers their age not in school
(Schwartz, 2011).
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Male students (ages 18 to 24) are more than twice as likely as female students to have died by suicide (Drum,
Brownson, Burton, Denmark, & Smith, 2009). However, female graduate students aged 25 and older die by suicide
at a rate similar to their male counterparts (SPRC, 2004).
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A recent large-scale study found that approximately 18% of undergraduates reported having seriously considering a
suicide attempt at some point, while 6% reported serious suicidal ideation in the past 12 months (Drum et al., 2009).
A 2005 study by Westefeld and colleagues found that 24% of college youth considered suicide. Another study found
that suicidal ideation among college students ranged from 32% to 70% (Gutierrez, Osman, Kopper, Barrios, & Sacks,
2000).
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Estimated rates of suicide attempts by college youth range from about 1% (American College Health Association,
2009; Furr, Westefeld, McConnell, and Jenkins, 2001) to 5% (Westefeld et al., 2005).
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Commuter students; older students; gay, lesbian, bisexual, and transgender students; and international students are
groups that face a higher risk for suicide and have less adequate services available to them than the general
population of college students (Russell, Van Campen, Hoefle, & Boor, 2011; SPRC, 2004).
Suicide Risk and Protective Factors Among College Youth
Students who have specific risk factors are more likely to think about, attempt, or die by suicide.
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A key risk factor for suicide death is previous attempts. All attempts should be taken seriously, and youth who have
attempted suicide need follow-up care.
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Most people who die by suicide have a mental illness and/or substance use disorder. College students who attempt
suicide are significantly more likely to suffer from depression and eating disorders than those who don’t (Haas et al.,
2008).
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A major suicide risk factor for college youth is substance or alcohol abuse (Lamis & Bagge, 2011; Westefeld et al.,
2006). Numerous studies have shown that alcohol and substance abuse increases the risk of attempting suicide
(Arria, O'Grady, Caldeira, Vincent, Wilcox, & Wish, 2009; Lamis, Malone, Langhinrichsen-Rohling, & Ellis, 2010).
College students who binge drink alone are more likely than their counterparts who drink socially to experience
depression and suicidal ideation. Students who are solitary binge drinkers are more than four times as likely to have
made previous suicide attempts (Gonzalez, 2012).
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College youth who have reported suicidal ideation are significantly more likely to engage in risky behavior such as
carrying a weapon, fighting, boating or swimming after drinking alcohol, driving after consuming alcohol or riding
with a driver who has consumed alcohol, and rarely or never wearing seat belts (Barrios et al., 2000).
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There is much less research on protective factors, but a number of studies have found that social support, such as
having an emotional connection to friends and family and being involved in extracurricular activities, is one of the
important protective factors for college youth (Marion & Range, 2003; Westefeld et al., 2006).

Another protective factor for college youth is having a reason for living, especially having feelings of responsibility
towards family or friends, fear of social disapproval, or moral objections to suicide (Ellis & Lamis, 2007; Westefeld et
al., 2006). One study found that in preventing suicide in college students, it was more important to have a reason to
live than to have a reason not to die (Westefeld, Scheel, & Maples, 1998).

Having reduced access to lethal means, especially firearms, is also a protective factor for college students (Schwartz,
2011).
Implications for Suicide Prevention
The majority of students who contemplate suicide do not seek professional help (Drum et al., 2009), and nearly 80% of
students who die by suicide never received services at their campus counseling centers (Kisch, Leino, and Silverman,
2005). This may be due in part to the fact that only 26% of college youth are aware of their campus mental health
resources (Westefeld et al., 2005).
A comprehensive approach to suicide prevention that targets groups of students who are at higher risk is recommended
(Surgeon General of the United States, 1999). A model comprehensive campus suicide prevention program should
include screening to identify high-risk students, training for campus mental health services staff to be able to identify
and address risk factors, crisis management, educational programs to train gatekeepers on the signs and what to do if
someone is considering suicide, social marketing to encourage help-seeking behavior, social networking to encourage
socialization, coping skill development, and restriction of access to lethal means. Ideally, many campus organizations
should work together to promote mental health awareness, well-being, and suicide prevention (SPRC, 2004).
Important Resources for Suicide Prevention
American Association of Suicidology, Warning Signs of Suicide at www.suicidology.org/stats-and-tools/suicide-warningsigns and other resources at www.suicidology.org
Suicide Prevention Resource Center at www.sprc.org. See Promoting Mental Health and Preventing Suicide in College
and University Settings, 2004.
The Jed Foundation at www.jedfoundation.org See Campus MHAP: A guide to campus mental health action planning.
Active Minds at www.activeminds.org
Means Matter at www.hsph.harvard.edu/means-matter/index.html
Half of Us Campaign at www.halfofus.com
Transition Year at www.transitionyear.org
ULifeline at www.ulifeline.org
Higher Education Mental Health Alliance at www.hemha.org
National College Depression Partnership at www.nyu.edu/ncdp/
Screening for Mental Health, Inc. at www.mentalhealthscreening.org
If you or someone you know is suicidal, please contact a mental health professional
or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
The National Center for the Prevention of Youth Suicide, a program of the American Association of Suicidology, works to
reduce the rate of youth suicide attempts and deaths. AAS is the oldest national organization devoted to understanding
and preventing suicide. Learn more at www.suicidology.org/NCPYS
2
Depression:
Signs and Symptoms
Depression can be scary topics to acknowledge and discuss, especially
for young people who may have difficulty expressing their feelings.
Most people who are depressed reveal their need for help through nonverbal messages. Learn to recognize the following warning signs of
depression.
Signs and Symptoms to Look For:
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Feeling worthless, withdrawn, helpless, and overwhelmed: “Nobody cares.”
Loss of hope for future, sense of futility: “Things will never get better.”
Loss of interest in previously enjoyed activities: “I don’t care anymore.”
Feelings of guilt, self-blame, self-hatred: “It’s my fault; I hate myself.”
Isolation, loss of interest in friends, being alone: “Leave me alone.”
Fear of losing control, hurting self or others: “I don’t know if I’m in control.”
Abrupt change in personality: mood changes, irritability, agitation, and
apathy.
Change in behavior: poor school performance/attendance, change in routine.
Change in sleeping pattern, insomnia, extreme difficulty getting out of bed.
Marked anxiety over schoolwork, money, relationships, illness.
Pressure toward perfectionism, high self-criticism, extreme drive to succeed.
Drug and alcohol use, increased risk-taking behavior, impulsivity.
Preoccupation with death or morbid topics, ambivalence towards living.
Suicidal talk, plans, or statements: “I should just kill myself.”
Suicidal gestures: taking pills, self-mutilation.
Giving away personal possessions, putting affairs in order.
Recent loss: through death, divorce, separation, job, finances, status, selfesteem.
In children, depression can be seen as agitation, hyperactivity, and
restlessness.
Cutting & Self-Harm
Self-Injury Help, Support, and Treatment
Self-harm can be a way of coping with problems. It may help you express feelings you can’t put into words,
distract you from your life, or release emotional pain. Afterwards, you probably feel better—at least for a
little while. But then the painful feelings return, and you feel the urge to hurt yourself again. If you want to
stop but don’t know how, remember this: you deserve to feel better, and you can get there without hurting
yourself.
Understanding cutting and self-harm
Self-harm is a way of expressing and dealing with deep distress and emotional pain. As counterintuitive as it
may sound to those on the outside, hurting yourself makes you feel better. In fact, you may feel like you have
no choice.
Injuring yourself is the only way you know how to cope with feelings like sadness, self-loathing,

emptiness, guilt, and rage.
The problem is that the relief that comes from self-harming doesn’t last very long. It’s like slapping on a
Band-Aid when what you really need are stitches. It may temporarily stop the bleeding, but it doesn’t fix the
underlying injury. And it also creates its own problems.
If you’re like most people who self-injure, you try to keep what you’re doing secret. Maybe you feel ashamed
or maybe you just think that no one would understand. But hiding who you are and what you feel is a heavy
burden. Ultimately, the secrecy and guilt affects your relationships with your friends and family members and
the way you feel about yourself. It can make you feel even more lonely, worthless, and trapped.
Myths and facts about cutting and self-harm
Because cutting and other means of self-harm tend to be taboo subjects, the people around you—and possibly
even you—may harbor serious misconceptions about your motivations and state of mind. Don’t let these
myths get in the way of getting help or helping someone you care about.
Myth: People who cut and self-injure are trying to get attention.
Fact: The painful truth is that people who self-harm generally do so in secret. They aren’t trying to
manipulate others or draw attention to themselves. In fact, shame and fear can make it very difficult to come
forward and ask for help.
Myth: People who self-injure are crazy and/or dangerous.
Fact: It is true that many people who self-harm suffer from anxiety, depression, or a previous trauma—just
like millions of others in the general population. Self-injury is how they cope. Slapping them with a “crazy”
or “dangerous” label isn’t accurate or helpful.
Myth: People who self-injure want to die.
Fact: Self-injurers usually do not want to die. When they self-harm, they are not trying to kill themselves—
they are trying to cope with their pain. In fact, self-injury may be a way of helping themselves go on living.
However, in the long-term, people who self-injure have a much higher risk of suicide, which is why it’s so
important to seek help.
Myth: If the wounds aren’t bad, it’s not that serious.
Fact: The severity of a person’s wounds has very little to do with how much he or she may be suffering.
Don’t assume that because the wounds or injuries are minor, there’s nothing to worry about.
Signs and symptoms of cutting and self-harm
Self-harm includes anything you do to intentionally injure yourself. Some of the more common ways include:
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cutting or severely scratching your skin
burning or scalding yourself
hitting yourself or banging your head
punching things or throwing your body against walls and hard objects
sticking objects into your skin
intentionally preventing wounds from healing
swallowing poisonous substances or inappropriate objects
Self-harm can also include less obvious ways of hurting yourself or putting yourself in danger, such as
driving recklessly, binge drinking, taking too many drugs, and having unsafe sex.
flags you can look for (but remember—you don’t have to be sure that you know what’s going on in order to
reach out to someone you’re worried about):
http://helpguide.org/mental/self_injury.htm
Depression
Resources
Families for Depression Awareness
http://www.familyaware.org/
Families for Depression Awareness is a national non-profit organization helping
families recognize and cope with depressive disorders. They offer publications such
as Depression Wellness Guides, outreach, information, and free online depression
and bipolar tests (https://www.familyaware.us/moodtest/).
National Institute of Mental Health:
http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml
Depression publications from the National Institute of Mental Health.
WebMD:
http://www.webmd.com/depression/guide/depression_support_resources
Support and resources regarding depression.
Ideas for Feeling Better:
http://helpguide.org/mental/depression_tips.htm#
Self-help and coping strategies for depression.
Depression.com
http://www.depression.com/
Understanding, treating, and living with depression
a presentation for parents
by Jon Mattleman
The Secret Life of a
Massachusetts Teen
Do you wonder...
•
•
•
•
What teens are really thinking?
Why they don’t share their fears?
How we can better support teens?
How we can become better parents?
Parents will leave my workshop with...
•
•
•
I have 30 years experience
as
a
mental
health
counselor and trainer, and
have spoken to thousands
of parents in schools,
community groups, and
religious organizations. My
presentation
style
is
engaging,
warm,
respectful,
humorous,
accessible, and energetic.
•
Strategies they can implement immediately
New ways of understanding teens
Innovative techniques for engaging teens
Confidence, courage, and new language
“Jon's many years of working with teens become quickly
apparent by the insightful information he presents, in a very
funny and right-on-target way. His connection with the
audience was visible by the many heads shaking in
agreement and the flurry of questions parents were anxious
to ask. My only advice is to reserve a big room - we had
close to 150 parents attend on a cold and snowy night!"
Susan Griffin, PTO President, Belmont
Contact Jon at: [email protected]
Learn more about Jon at: http://jonmattleman.com
Programs and Services Offered by:
Jon Mattleman, MS Counseling
E-mail: [email protected]
Website: http://jonmattleman.com
I have 30 years experience as a mental health counselor and trainer with a focus on issues facing youth and
parents. I am committed to ensuring productive communication, collaborative problem-solving, and supportive
relationships with and for my clients. My areas of expertise include innovative and effective parenting
strategies, depression in children and teens, and suicide identification, prevention, and intervention.
Individual Parent Consultation:
Living with and parenting a teen is challenging. While we love them, there are many times when their words, actions, and
behaviors are maddening --- to say the least! Often parents find themselves at a loss as they watch their child engage in
damaging behaviors to themselves and others. Parent consultations are one or two session intensive meetings where we:
 Discuss the real (and often secret) motivators of your teen’s behavior
 Learn new language to more effectively communicate and engage with your teen
 Explore new ways of assisting and supporting your teen
 Arrive at decisions to actively address issues and give provide direction to you and your teen
One Session Evening Parent Group:
When your children were young, you freely exchanged valuable information with other parents about toilet training, preschools, and babysitters. Now that your children are older and you may not interact as often with the parents of your
children’s friends --- or sometimes, you don’t even know who they are --- you have lost a valuable resource and support.
The “One Session Evening Parent Group” is held in a parent’s home and is facilitated with no more than ten parents at a
time. Together we create a safe environment in which to openly discuss issues such as depression, drugs, and alcohol;
and/or have an opportunity to establish common ground rules regarding issues such as curfews, parties, and Internet use.
This highly interactive (and fun!) session may have a specific topic focus, e.g. Make Peace and Not War With Your Teen,
or may be an open agenda discussion. Parents will leave sessions with skills they can implement immediately and a
renewed sense of direction and hope.
“The Secret Life of a Massachusetts Teen” Presentation:
“The Secret Life…” is a high energy presentation for large groups which actively focuses on what teens are really
thinking, what they fear, why they do not share their fears, and how parents can more effectively support their teen.
Parents will leave the workshop with strategies they can implement immediately, new ways of understanding teens, and
innovative techniques for engaging teens. The Belmont High School PTO President had this to say about Jon’s
presentation: “Jon's many years of working with teens become quickly apparent by the insightful information he presents,
in a very funny and right-on-target way. His connection with the audience was visible by the many heads shaking in
agreement and the flurry of questions parents were anxious to ask. My only advice is to reserve a big room - we had close
to 150 parents attended on a cold and snowy night!"
QPR Suicide Prevention Training:
Did you know that there are 500 suicides a year in Massachusetts and that the Massachusetts Samaritans Suicide
Prevention Hotline receives over 185,000 calls a year? Virtually every community has experienced suicide, yet few have
taken steps to better understand this complex issue. I am a certificated QPR (Question, Persuade, Refer) trainer and have
worked with hundreds of parents to help them understand suicide and to keep their children and community safe. The
QPR Suicide Prevention model is based upon the following: suicide can be prevented in most cases, the person most
likely to prevent an individual from dying by suicide is someone they already know, and that prior to making a suicide
attempt a person typically sends warning signs of their distress and suicidal intent to those around them. Participants will
leave this training understanding the myths of suicide, learning the signs of self injury and suicidal ideation, and knowing
how to identify and how to be of real assistance to a person in distress.
QPR Training
10.30.2014
What did you find most valuable about this workshop?
What might you change about the workshop? (if anything)
What is one thing you have learned/thought about from this workshop that you
might/will try?
Feedback to leader:

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