Chile1 Suicide Pp-final

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Suicide: Perspectives from

the United StatesJohn S. Westefeld, Ph.D., A.B.P.P.

Counseling Psychology ProgramUniversity of Iowa


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This is my first time in Chile and I am very happy to be herewith you. Thank you very much for inviting me to your

beautiful country!

Me encuentro por primera vez en Chile y estoy muy

feliz de estar aqu con ustedes. Muchas gracias

por invitarme a su lindo pas!

wordpress.com


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Con mi familia y la ciudad de Iowa City, Iowa, USA

With my family and Iowa City, Iowa, USA


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En esta

temporada hace

mucho fro all!

But now, it is

very cold there!


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Mi sincera gratitudhacia Ginna Moreanopor su ayuda con esta

presentacin.

Sincere appreciation isexpressed to Ginna

Moreano for herassistance with this

presentation.


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Outline

I. Data

II. Assessing Suicidal Risk

III.Prevention, Intervention, & PostventionIV. The College Student Reasons for Living

Inventory(Westefeld, Cardin, and Deaton, 1992)

V. Physician Assisted Suicide (PAS)

VI. Current Issues in Suicidology in the U.S.

VII.Questions and Comments


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Primary Reference

American Association of Suicidology andmy own writing and research


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Suicide Data2010(Source: American Association of Suicidology)

Number Per Day

Nation 38,364 105Males 30,277 83

Females 8,087 22

Whites 34,690 95Nonwhites 3,674 10


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Causes of Death:

Suicide #10, Heart Disease #1Causes of death Ages 15-24:

1. Accidents12,341

2. Homicide4,678

3. Suicide4,600


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ATTEMPTS

No official statistics25 attempts for every completion959,100 attempts/year estimated

METHODSAbout half by firearmsThen suffocation/hanging

STATE RANKINGS

Wyoming (1), Alaska (2), Montana (3),Nevada (4), New Mexico (5) Iowa (37), D.C. (51)


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Assessing Suicidal Risk

Evaluando el Riesgo de

Suicidio


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AssessingSuicidal Risk

A. Typical suicidal person? Nobut a fewgeneralities:

Dont really want to die, want to stopliving

Helpless/hopeless

Wants help, but hard to ask

Suicidal erosion

Ambivalence


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B. Situation cluesespecially loss

C. Depressive symptoms: Sleep/eating disturbance

Lack of concentration

Frequent crying spells

Loss of sex drive

Apathy

Personal appearance deteriorates Increased use of alcohol/drugs

Psychomotor agitation/retardation

Feelings of worthlessness/guilt


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D.Verbal cluesHow do they answer thequestion?E. Behavioral clues:

Previous attempt Gives away valued possessions

Procures weapon

Suicide note

Organizes personal affairs (e.g. will) Sudden, unexplained improvement in mood

Plan of action: the more specific the plan, thehigher current risk


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F. Testingbut controversial

G. Miscellaneousa. Family history

b. Psychiatric disorder

c. Impulsivity

d. Response to Life Maintenance Agreement

e. Low self esteem

f. Exposure to anothers suicide/suicidal behavior

g. Experiencing violence/victimization

h. Ideation


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H. Look for a pattern or clustering ofclues, not symptoms in isolation


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Prevention, Intervention, &Postvention

Prevencin, Tratamiento, y Despus

del Tratamiento


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Suicidal Prevention

Community workshops

School/college workshops

Appropriate media publicity

Warning signs, what to do, resources


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Suicidal InterventionCounseling with a suicidal persondepends on

orientation and diagnosis

a. Relationship and ventilation

b. Identify what is still meaningful/when person

feels betterc. Mobilize all appropriate resources

d. What are they trying to say with suicidal behaviorhow else can they say it?

e. Mitigate hopeless/helplessf. Life Maintenance Agreements

g. Set limits for yourself

h. Medication, as appropriate- but be careful

i. Hospitalization


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Suicidal Interventioncounseling with a suicidal persondepends on

orientation and diagnosis

j. Spirituality/Religion, but only if appropriatek. Cognitive/Behavioral Therapyl. Frequent contact and emergency clarity of access

m. Focus on skill deficits (e.g. tolerance for distress)n. Self esteemo. Monitor risk in an ongoing wayp. Restriction of lethal means

q. Social supportr. Consults. Family?t. Documentu. Treatment of diagnosed disorder


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Suicidal Postvention

a. Reactions:A normal response to anabnormal event- varies in terms of HOWand WHEN we react

b. Possible emotional response

Hard to trust

LonelinessDepression

Anxiety

Integration (eventually)

Shock

Denial

Shame/Embarrassment

Guilt

Anger


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Suicidal Postvention

c. What to do Varies a great deal

Information- the above, pamphlet, AAS Counseling- maybe now, maybe later


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The College Student Reasons forLiving Inventory (Westefeld, Cardin,

and Deaton, 1992)

El Inventario Sobre las Razones del

Estudiante Universitario Para Vivir


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Assessing Suicidal Risk

in College Students

The College Student Reasons for LivingInventory (Westefeld, Cardin & Deaton, 1992)Asks how much emphasis college students

place on various reasons for livingevenwhen they are contemplating suicide

Used for both assessment and treatment ofsuicidal risk


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Factor Analysis

6 Factors:

Survival and Coping Beliefs

College and Future-Related Concerns Moral Objections

Responsibility to Friends and Family

Fear of Suicide Fear of Social Disapproval


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Physician Assisted Suicide (PAS)

El Suicidio Asistido Por el Mdico


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PhysicianAssistedSuicide(PAS)

Allows terminally ill people to selfadminister a lethal dose of medicine

Criteria: adult, resident of the state,capable, diagnosed with a terminalcondition that will lead to death in 6

months


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PhysicianAssisted Suicide (PAS)

A major controversy in U.S.

Exists in 3 states out of 50 in U.S.


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Physician Assisted Suicide (PAS):

Steps Two oral requests 15 days apart to physician

Written request to physician signed by two

witnesses

Psychologist or psychiatrist must examine patientto see if there is any question about mental

status Patient must be notified of alternatives to PAS

Patient has option of notifying next of kin

Patient may revoke request at any time


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PhysicianAssisted Suicide (PAS)

Remains a verycontroversial issue


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Current Issues in Suicidologyin the United States

Temas Actuales Sobre el Suicidio en

Los Estados Unidos


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Current Issuesin Suicidology

in the U.S. Physician Assisted Suicide (PAS)

Rational Suicide

Lowering the Suicide Rate

Suicide in Older Adults and Children

Training, Crisis Centers/Hotlines


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Current Issuesin Suicidology in the U.S.(continued)

Social Media

Bullying

Multicultural Considerations

Suicide in the Military

Suicide in the LGBTQ Population


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Thank you very much!

Muchas Gracias!


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Questions and Comments?Preguntas y Comentarios?

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Chile1 Suicide Pp-final