Bullying, Depression and Suicide
Considerations for HealthCare Providers 01 02 03 Bullying Facts Depression Facts Suicde Facts
04 05 06 Assessment Intervention 01
Bullying Bullying
Bullying is unwanted aggressive behavior Threats Spreading rumors Attacking Verbally or Physically Specifically excluding someone Cyberbullying
2020 Stopbullying.gov,Resources for Pediatricians, accessed 1- 15-2021 Symptoms Associated with Bullying
Difficulty falling asleep or staying asleep Stomach upset or pain Headaches Heart palpitations Dizziness Bedwetting Depression / Anxiety School avoidance Reduced academic performance
2020 Stopbullying.gov,Resources for Pediatricians, accessed 1-15-2021 Bullying – Childhood ACES
Bullied Child Bystanders
Child Who Bullies Who Is At Risk of Bullying
Appearing “Different” In the Individual Group Characteristics learning disabilities Introverted children physical disabilities Depression/Anxiety LGBTQ youth Social isolation Minority status children in a campus Physical characteristics Bullying and Suicide
○ Bullying is not shown to cause suicidal behavior, but is associated with increased suicidal risk
○ Both children who bully AND those bullied have increased risk for depression and suicidal ideation
○ Most children who are bullied do NOT experience suicidal ideation
2020 CDC – Suicide and Bullying and Schools; https://www.cdc.gov/violenceprevention/pdf/bullying-suicide-translation-final-a.pdf 02
Depression Background
. •6-9% prevalence of depression in adolescents •Up to 28% reported in primary care settings •60% recurrence in adulthood •18% get treatment Risk factors for Depression
Biological Environment Family Hx Female Poverty Obesity Trauma Medical Illness ACES Personality Poor coping skills Low self esteem Internalizers Presentation
Adolescents • Anhedonia, boredom, hopelessness, hypersomnia, weight change, irritability, concentration problems, substance use, suicide attempts Children • Irritability , behavioral problems, Concentration problems, Somatic symptoms, restlessness, lack of interest in play, hallucinations ● DSM 5 diagnostic criteria are the same for all ages EVIDENCE for Treatments for Depression
Am Fam Physician. 2012 Sep 1;86(5):442-448. 03
Suicide Teens at Risk - Suicide Rates by Age 20 18 16 14 12 10 8 6 4 2 0
0-10 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 Rate 100,000 per People Rate Age Taking Away Means Prevents Suicide Statistics
● Approximately 1 million deaths per year, worldwide
● Roughly 44,965 deaths in U.S. in 2016
○ 1 death in U.S. every 11.9 minutes Suicide Statistics
● 2nd leading cause of death for 15-34 year olds
● Rates of suicide
○ 1 10-24 year old dies every 90 minutes
● Among high school students, each year
○ 1 in 6 seriously considered suicide
○ 1 in 12 make a suicide attempt
NIMH (2020) Suicide Prevention (nih.gov) Risk Factors for Suicide in Youth
• Previous suicide attempt(s) •Local epidemics of suicide • History of mental disorders, •Bullying or Isolation, particularly clinical •Barriers to accessing mental health depression treatment • History of alcohol and •Easy access to lethal methods •Family history of suicide substance abuse •Family history of child maltreatment • Feelings of Hopelessness • Impulsive or aggressive tendencies
CDC 2020 Suicide Risk and Protective Factors|Suicide|Violence Prevention|Injury Center|CDC 04 Healthcare Role - Screening Screening for Bullying
• How are things going at school? • What do you think of other kids in your class? • Does anyone get picked on or bullied? • What is lunchtime like? (or recess) • Is anyone texting, tweeting, or posting mean things on social networks? Screening for Depression
Pfizer (2020) www.phqscreeners.com Screening for Suicide in Youth
Columbia Suicide Screener
https://cssrs.columbia.edu/documents/clinical-practice- screener-recent/ 05
Intervention STOP BULLYING Cyberbullying – Tips for Parents •The Takeaway. Don’t threaten to take away your child’s device or cut their time online.
•Document. If there is online evidence, save a screenshot.
• Support. Talk with your child about the experience.
•Report. If a classmate is bullying, you can report it to the school. If the bullying involves threats of physical harm, you can consider reporting to the police. Assertiveness Skills for Kids
• Look the bully in the eye. • Stand tall and stay calm. • Walk away. • Not respond to electronic messages and cut off communications with those who are sending unwanted messages. • Show bullying texts, posts, or e-mails to a parent or other trusted adult.
Teach your child how to say in a firm voice.
• “I don’t like what you are doing.” • “Please do not talk to me like that.” • “Why would you say that?”
Campus Safety: Teach kids to stay in groups, avoid unsupervised areas Bullying – Parent Strategies
• Teach your child when and how to ask for help.
• Encourage your child to make friends with other children.
• Support activities that interest your child.
• Alert school officials to the problems, and work with them on solutions. School Accommodations For Bullying
Priority seating Close monitoring of student during unstructured time Regular (private) check ins with student emotions and difficulties with bullying Assist youth with social inclusion
pairing with a friendly “buddy”
ensuring child is included in recess games
supporting youth participation in afterschool activities
Treatment For Depression Evidence Based Treatment - CBT
Thoughts
Behavior Feelings Cognitive Behavioral Therapy - Overview
Mood Behavioral Education Monitoring Activation
Health Relaxation and behaviors (sleep Cognitive Stress hygiene, Restructuring management exercise, ect)
Problem solving skills Interpersonal therapy for Adolescents
Depression rooted in problems in social relationships Grief Isolation Conflict Medications – SSRIs and Dosing
• Fluoxetine (6 and •Citalopram (7 and up) up) 10-20 mg once daily 20-40 mg once daily
•Escitalopram (7 and • Sertraline (6 and up) up) 10-20 mg once daily 25-200 mg once daily School Accommodations For Depression
Priority seating Provision of notes or additional handouts to support learning Reduction in course work - example: only 1 term paper per semester instead of two; only 10 math questions for daily homework instead of 20. Option for flexible or extended deadlines on projects Options for provision of make-up work if depressive symptoms or flare-ups impair academic performance Extended time on tests Regular access to the school counselor Flexible pass to take a 10 minute break when feeling overwhelmed - this may be to go to the restroom or to the counselor's office briefly Management of Suicide Primary Goal – Keeping Youth Safe
Decision re: Outpatient or Inpatient care Short term Safety Planning with Youth and Caregiver Conclusion
Depression / Bullying / Suicide Detection is Key Problems are connected A Ask about bullying B Important Issue for Use a standardized Pediatrics depression screen Screen for Suicide Treatments School Accommodation C Cognitive Behavioral Therapy Medication Management THANKS!
Stephanie Chapman, PHD [email protected]
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