chile1 suicide pp-final
TRANSCRIPT
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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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AssessingSuicidal Risk
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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AssessingSuicidal Risk
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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AssessingSuicidal Risk
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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AssessingSuicidal Risk
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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