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Upstream Suicide Prevention

Presentation given at the Texas State Suicide Prevention Symposium, San Marcos, TX, August 12, 2014
by

Phil Rodgers, Ph.D.

on 14 August 2014

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Transcript of Upstream Suicide Prevention

The Good Behavior Game...
What might be the focus of upstream suicide prevention efforts?
What is "upstream" suicide prevention?
17%
Service use for emotional, behavioral, drug, or alcohol problems.
Wilcox et al. (2008)
Poduska et al. (2008)
Upstream suicide prevention reduces risk factors or enhances protective processes that influence the likelihood that a young person will become suicidal.

Upstream approaches may be universal interventions, selective, or indicated.

Upstream approaches focus on changing factors that antecede suicidal behavior rather than on management or treatment of suicidal behavior.
The Good Behavior Game in short:
The class is divided into two teams.
The teams compete for fewest disruptions.
At the end of a period of time one or both teams win a prize.
19%
Drug abuse or
dependence disorders.
Kellam et al. (2008)
)
8%
Anti-social Personality Disorders, but...
45%
Anti-social personality disorder for those who were highly disruptive/ aggressive in 1st grade.
"There is a significant imbalance in the nation's efforts to address MEB disorders.
People await their emergence and then attempt to treat them, to cure them if possible, or to limit the damage they cause if not."
Kellam et al. (2008)
William Beardslee, Harvard Medical School
Lidia Bernik, NSPL
C. Hendricks Brown, U. of Miami
Richard F. Catalano, U. of Washington
Cheryl DiCara, Maine Suicide Prevention Program
Dorian Lamis, U. of South Carolina
Richard McKeon, SAMHSA
Jane Pearson, NIMH
Can a suicide that occurs here
Be prevented here?
Biological Factors
Predisposing
Factors
Proximal
Factors
Immediate
Triggers
Genetic Risk
Serotonergic Function
Neurochemical Regulators
Demographics
Pathophysiology
Major Mental Disorders
Substance Use/Abuse
Personality Profile
Abuse Syndromes
Severe Medical Illness
Hopelessness
Intoxication
Impulsiveness
Aggressiveness
Negative Expectancy
Severe/Chronic Pain
Public Humiliation/Shame
Access to Weapons
Severe Defeat
Major Loss
Worsening Prognosis
(Partial) Web of Causation for Suicide
Web of Causation for Heart Disease
David Knesper, University of Michigan
Adapted from Friedman, G. D. (1994). Primer of Epidemiology (5th Ed.). New York: McGraw-Hill, p. 4
Expanding the Youth Suicide Prevention Paradigm
Mental Health Intervention Spectrum
Health Promotion
Universal Prevention
Indicated Prevention
Selective Prevention
Treatment
Case Identification
Compliance
After Care
Upstream suicide prevention
aims to prevent the onset
of serious suicide risk.
Irwin Sandler, Arizona State U.
Michelle Scott, Monmouth U.
Cortney Yarholar, SPRC

Planning Group
Scott Fritz, SPTS
Effie Malley, AAS
Phil Rodgers, AFSP
Maureen Underwood, SPTS
Peter Wyman, University Rochester
Upstream Meeting Participants
1. Establish the need for upstream approaches.

2. Identify promising upstream prevention approaches.

3. Identify barriers and strategies to overcome barriers to the adoption of upstream prevention approaches

4. Identify key strategic partnerships.
Meeting Goals
1. Youth suicide rates have been "flat" during the past decade.
2. Youth suicide prevention has been narrowly focused.
3. Current focus on high-risk individuals has limited effectiveness.
4. Other fields have had success with upstream approaches.
We don’t prevent heart attacks by giving CPR.
Frieden, T. R. (2010) A framework for public health action: The Health Impact Pyramid. American Journal of Public Health, 100(4), 590-595.
“Although evidence-based clinical care can reduce disability and prolong life, the aggregate impact of these interventions is limited by lack of access, erratic and unpredictable adherence, and imperfect effectiveness.”
Thomas R. Frieden
Director CDC
Suicide prevention has generally focused on:
Raising awareness
Educating students
Training gatekeepers
Training clinicians
Screening
Identify
Intervene
Refer
Kellam et al. (2008)
What are some ideas for upstream suicide prevention?
Our task is not simple.
Age 14
Age 15
Age 18
Age 16
Age 13
Age 13
Substance
Abuse
Increased
Isolation
Came out to Family; High Number of Rejecting Behaviors
Upstream Meeting Planning Group
Scott Fritz
Peter Wyman
Why is upstream important?
"Gatekeeperization"
Let's think in terms of trajectories.
Fewer
Protective
Factors
Clinical
Depression
Suicide
Attempt
+ Family, Community, Cultural Factors
1. Reducing risk factors for suicide
Mental & behavioral health disorders
Substance use problems
Adverse life experiences
2. Promoting more competent settings
Competent classrooms
Improved parent-child relationships
3. Reducing triggering events
Lowering rates of school-wide bullying
Reducing binge drinking
4. Enhancing youth/adult protective processes
Positive youth-adult connectedness
5. Promoting protective norms
Positive coping with normative stress events
Help-seeking norms
A suicide that could have occurred here...
Effie Malley
Maureen Underwood
What is prevention?
Mental Health Intervention Spectrum
Health Promotion
Universal Prevention
Indicated Prevention
Selective Prevention
Treatment
Case Identification
Compliance
After Care
Meeting held at 2012 American Association of Suicidology Annual Conference
www.sptsusa.org
Disruptive behavior markedly decreased because of the Good Behavior Game.
Donaldson et al. (2001)
Heart disease has decreased 50% past 30 years.
Recognition of key risk factors
Biological
High Cholesterol
High Blood Pressure
Diabetes
Behavioral
Smoking
Poor Diet
Little Exercise
How have risk factors been targeted?
Health promotion
Quit smoking
Eat better
Exercise
Early ID & Treatment
Screening
Treatment
Can we do for suicide what was done for heart disease?
So, what are key risk factors for suicide?
Mood disorders
Substance abuse
Access to means
Isolation
Hopelessness
Perceived burdensomeness
Thwarted belongingness
Acquired ability to enact self-harm
Psychache
Addressing risk in substance abusers.
Setting healthy normative standards.
Primary prevention.
Depression screening with high risk populations.
Age 18
Bullying
Incident
Suicide prevention is not rocket science.
It's more difficult than that.
Suicide prevention is a big thing.
Suicide prevention is a small thing.
How can we address these before suicide risk is manifested?
We can prevent suicide at different points of it's developmental trajectory.
Full transcript