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Depression, Bullying and Suicide

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Depression, Bullying and Suicide Depression, Bullying and Suicide Sally Boeve, MD Medical Director, Intermountain Centers for Human Development Assistant Professor, University of Arizona, Department of Psychiatry 28th Annual Southwestern Conference on Medicine Tucson Osteopathic Medical Foundation May 4, 2019 Disclosures Stipend from the Tucson Osteopathic Medical Foundation/Southwestern Conference on Medicine Stipend from Arizona Health Net Quality Improvement Committee Learning Objectives 1. Review epidemiology of depression, suicide, and bullying 2. Review most recent literature on bullying 3. Understand protective factors for suicide prevention, including those we can impact 2015 Suicide CDC Data Rates 2nd leading cause of death for people ages 10-34 in 2016 Ages 15-24: 12.3 suicides per 100,000 persons (5491 youth; 2,061 ages 15 to 19 ) (All cause death rate is 70/100,000) Males 19.1/100,000 (4X higher) Females 5.3/100,000 Ages 5-14: 1 suicide per 100,000 youth (All cause death rate is 13/100,000) 12% of the 44,193 suicides in the U.S. 18% of high school students reported having seriously considered suicide during the previous 12 months 80% of student suicides: NO prior treatment Suicide 2015 CDC Completed Suicide per 100,000 people Hispanic Black Asian American/Pacific Islander Other White American Indian/Alaskan Natives 0 5 10 15 20 25 Rates have increased in every group over recent years except Hispanic youth where rates have decreased. Depression and Suicide – special populations Sexual and Gender Minority (SGM) Youth (gay, lesbian, bisexual or any same sex contact) In 2015 questions were added about sexual identity to the National Youth Risk Behavior Survey (YRBS), 8% endorsed being gay, lesbian or bisexual Nationwide suicide attempts at least once in past 12 months No sexual contact Heterosexual students Opposite sex only Not sure Any same sex contact Sexual minority students 0 5 10 15 20 25 30 35 Suicidal behavior trends – Burstein et al 2019 1.1 million U. S. ER visits for suicidal thoughts and attempts in 2015, children 5-18 43% were 5-10yo 3.5% of all ED visits Greater recognition? Higher rates of depression? Kids under more stress? Youth Risk Behavior Scale (YRBS) 2015 YRBS 2015 YRBS 2015 CDC – 7% of males had carried a gun in AZ 9th Grade CDC-Kaiser Adverse Childhood Experiences (ACE) Study (1995-1997) 17K after 2 waves 2/3 Experienced at least one ACE, more than 1 in 5 reported 3 or more ACES Found a graded dose-response relationship Population Studied: 54% Female 75% White 11% Hispanic/Latino 46% were 60 and over 25% had some college 40% had college degree Nadine Burke Harris’ Ted Talk - CDC presentation graphics ACES (over first 18 years of life) - CDC Presentation Graphics - CDC Presentation Graphics Bullying Definition Any unwanted aggressive behavior(s) by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated. Bullying may inflict harm or distress on the targeted youth including physical, psychological, social or education harm. - CDC 2014 (Gladden et al) Cyberbullying – willful and repeated harm inflicted through computers, cell phones, and other electronic devices – Hinduja & Patchin 2015 CDC PHIL Bullying epidemiology Rates in studies range from 2-57% (larger studies showing 15-23%) Peaks in middle school, decreases through high school Cyberbullying can peak in later middle school years and rise into high school YRBS 2015 YRBS 2015 Bullying - Waasdorp et al, (2017) 80 Change over Time 70 60 50 40 30 20 10 0 2005 2010 2014 Victimized Perpetrated Adults do enough Bullying – Ten Year Trends 4th-12 graders – Waasdorp et al, (2017) 246306 Students in 109 Maryland schools across 10 years Improvement in 10/13 indicators Decrease prevalence in bullying and victimization for in person (physical, verbal, relational) and cyberbullying Most recent years show greatest improvements in school climate and reductions in bullying Increase in perceptions that adults do enough to stop bullying and students’ feelings of safety and belonging at school Blue Whale Challenge (BWC) Wikipedia: A series of tasks assigned to players by administrators over a 50 day period Initially innocuous before introducing elements of self-harm Final challenge requires the player commit suicide ?Russian rock band Lumen lyrics “Why scream/When no one hears/What we’re talking about?” features “a huge blue whale” that “can’t break through the net” ?Reference to beached whale, stranded leading to death Initially innocuous “get up at 430am”, “watch a horror movie” Later involve self harm, then instructed to commit suicide on the final day Administrators were initially found to be children aged 12 and 14, not predatory adults 3 arrests of adults Momo Challenge Wikipedia: Enticed by a user named Momo to perform a series of dangerous tasks including violent attacks, self-harm and suicide People presenting themselves as a character named Momo on WhatsApp messages try to convince people to contact them through their cell phone Instructed to perform a succession of tasks Refusal to do so is met with threats Messages subsequently accompanied by frightening or gory pictures 2019 claimed that Momo was being inserted into seemingly innocuous YouTube and YouTube Kids videos about Peppa Pig and Fortnite. “moral panic?” Social Media and suicide – BWC study Searched all public social media posts and new articles on the Blue Whale Challenge (BWC) from 1/1/13-6/30/17 Goal 1 - Describe how much earlier social media posts about the BWC emerged before identification of the game by media reports with goal of prevention by early detection 95,555 social media posts and articles about BWC were collected Twitter (50%) Tumbler (28%) YouTube (12%) 53% females/ 47% males First US news article related to BWC published 4 mos after first English language US social media post and 9 mos after the first US social media post in any language Goal 2 - Characterize whether posts were pro or anti BWC to understand the attitude and nature of posts 28% Pro- BWC (interest, curiosity or participation) 52% Anti- BWC 19% News Articles Goal 3 - Explore geographic origin and spread of posts about BWC First message in Russia 3/14 then to Indonesia, U.S., France, Italy, Kenya and Ukraine First post was 12/15 on Twitter authored in Russian First English post in English 5/16 on messaging forum called 4chan First US news article 9/16 (4 mos after first poast in English; 9 mos after first post) At end posts were in 127 countries Bullying No AACAP Practice Parameter These are the Practice Parameters Listed when Bullying is searched Anxiety Disorders Assessment of Children and Adolescents Conduct Disorder Depressive Disorders Oppositional Defiant Disorder Suicidal Behavior Cyberbullying effects Negative emotions: sadness, anger, frustration, embarrassment, fear (Brighi et al 2012, Hinduja & Patchin 2010, Kowalski & Limber 2013, Wang,et al 2010). These emotions have been correlated with delinquency and interpersonal violence (Aseltine et al 20000, Broidy & Agnew 1997, Mazerolle et al 2000, Mazerolle & Piquero, 1998) Cyberbullying associated with: low self esteem, depression, suicidal ideation, academic difficulties, experience with school bullying School delinquency and violent behaviors including assaultive conduct, carrying a weapon to school and substance use have all been associated (Hay & Meldrum 2010, Hinduja & Patchin 2007, Nixon 2014. Bullying - Wolke and Lereya 2015 Effects in children Bullies Victims Suicidality and self- Increased Risk Increased Risk harm behavior Somatic problems No relationship Increased Risk Anxiety No relationship Increased risk Depression Girls – no relationship Increased Risk Boys – Increased Risk (internalizing sx) Bullying – Wolke and Lereya 2015 Effects ages 18-50 Bullies Victims Suicidality and self-harm No relationship Increased Risk for young adult behavior males Somatic problems No relationship Increased Risk Anxiety No relationship Increased risk Depression No relationship Increased Risk (internalizing sx) Antisocial PD Increased Risk Increased Risk Psychosis No relationship Increased Risk Substance Use Increased Risk Increased risk for tobacco only Lower education and Increased risk Increased risk employment Social relationship problem Increased risk Increased risk More likely to become young More likely to become a young mother parent Bullying - Effects – Wolke and Lereya 2015 Effects on health estimated to cost 1.4 million per individual 50% say they would rarely or never tell their parents 35-60% would not tell their teacher Fear of reprisal or shame Rarely asked about peer relationships by professionals Bullying – Brain Impact - Graziano et al (2019) 186 adults, 93 males, 45 females with current dx of MDD Medication free 88 were bullied prior to age 18 Depression + Bullying vs. Depression – Bullying Both groups had similar levels of depression Controlled for demographics Controlled for early life stress (ELS) Bullying and the brain (Graziano et al 2019) All had Depression so both groups showed: Decreased volume: amygdala, anterior cingulate cortex and hippocampus Reduced white matter integrity: cingulum bundle, supero-lateral medial forebrain bundle, uncinated fasciculus and superior longitudinal fasciculus Individuals with a history of early life stress (ELS) exhibit similar changes independent of concurrent depression (shown by prior studies) “White
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