Crisis and suicide prevention services struggle with demand after celebrity suicides NIH study identifies importance of support for critical suicide prevention services.

Thoughts about this article? "The United States may lack the resources needed to meet increases in demand for suicide prevention services that occur after celebrity suicides, according to a recent study of crisis mental health services. The study, conducted by a team of researchers, which included scientists from the National Institute of Mental Health (NIMH), part of the National Institutes of Health, highlights the need for suicide prevention hotlines to procure additional funds, allocate existing funds more efficiently, and develop contingency plans to accommodate increases in call volumes, particularly for the first two days after a celebrity suicide. The findings appear in the journal Psychiatric Services. “Suicide prevention is a significant public health concern and a top priority for NIMH,” said Joshua A. Gordon, M.D., Ph.D., director of NIMH. “This study highlights the importance of the National Suicide Prevention Lifeline and other crisis mental health services, and the need to build surge capacity of these services that could help save lives.” 

Suicide is the second leading cause of death for people in the U.S. between the ages of 10 and 34, and the suicide rate continues to rise. Suicide rates generally follow predictable patterns, with increases in the spring and a second, smaller increase in early summer. But certain events, like highly-publicized celebrity suicides, can serve as “shocks” that cause a sudden spike in suicide deaths. To test the ability of crisis mental health services to meet a sudden increase in demand for help, this study looked at increases in suicide rates within 30 days of Robin Williams’ suicide on Aug. 11, 2014. It also looked at changes in help - and information-seeking related to suicide, and changes in the percent of calls the National Suicide Prevention Lifeline (NSPL) was able to answer after Williams’ death. Daily calls to the National Suicide Prevention Lifeline (including Veterans Crisis Line) initiated and answered, August 3 to September 7, 2014. Daily calls to the National Suicide Prevention Lifeline (including Veterans Crisis Line) initiated and answered, August 3 to September 7, 2014. American Psychiatric Association. The researchers used data from the Centers for Disease Control and Prevention National Center for Health Statistics’ Compressed Mortality File (link is external) to compare the number of suicide deaths and the method of suicide in the 30 days before and after Aug. 11, 2014, and for the same time period in 2012 and 2013. In 2012-2014, there was an average of 113-117 suicide deaths per day; after Williams’ suicide, the average rate increased to 142 suicide deaths per day, something not observed in 2012 or 2013. Approximately two-thirds of the people who died by suicide immediately after the actor’s death used the same method of suicide as Williams. The study also examined the number of calls placed to NSPL immediately before and after Williams ended his life to measure whether media coverage of his death prompted more people to reach out for help. The day after he died, the number of calls increased by up to 300 percent - from between 4,000 to 6,000 calls per day to 12,972. However, without capacity to respond to this increased demand for crisis services, the fraction of answered calls decreased from an average of 73 percent to 57 percent, which highlights a gap in the ability of the NSPL to respond to surges in calls for help. To measure information-seeking behavior, the study looked at visits to the Suicide Prevention Resource Center (SRPC) (link is external) and Suicide Awareness Voices of Education (SAVE) (link is external) websites. In the week before Williams died, the SPRC website averaged 2,315 visits per day. The day after his death, there were 5,981 visits to the site. The SAVE website averaged 4,239 visits per day in the week before he died, and 24,819 visits on August 12. Average daily visits to both sites remained consistently higher for the rest of the month of August. The study suggests that both efficient allocation of existing funds and procuring new funding will be critical to continue meeting the demand for crisis mental health services, including surge capacity.> “Crisis mental health services, such as suicide prevention hotlines and websites, provide effective counseling and vital resources for people in suicide distress. We need to ensure these services have sufficient resources to serve the public 24/7, especially in times of increased demand,” said Jane Pearson, Ph.D., chair of the Suicide Research Consortium in NIMH’s Division of Services and Intervention Research. “Shocking events, like Mr. Williams’ suicide, disrupt normal patterns in suicide rates, and cause an increase in both calls for help and imitative suicides,” said lead researcher Rajeev Ramchand, Ph.D (link is external)., of the Cohen Veterans Network. “This highlights the need for additional and consistent support for crisis mental health services, including hospital emergency departments, law enforcement, poison control centers, and health departments, as well as the mental health resources that serve as referral sources.” " Reference Ramchand, R., Cohen, E., Draper, J., Schoenbaum, M., Reidenberg, D., Colpe, L., Reed, J., & Pearson, J. (in press). Increases in demand for crisis and other suicide prevention services after a celebrity suicide. Psychiatric Services in Advance. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900007 (link is external). For more information on this and other mental health continuing education, please visit, Psychologist Continuing Education

Ketamine Cousin Rapidly Lifts Depression Without Side Effects

Neurons in a subsection of the adult rat hippocampus are stained with a monoclonal antibody (yellow) that enhances learning and memory. A portion of this antibody is where GLYX-13 came from. Source: Dr. Joseph Moskal, Ph.D., Northwestern University GLYX-13, a molecular cousin to ketamine, induces similar antidepressant results without the street drug side effects, reported a study funded by the National Institute of Mental Health (NIMH) that was published last month in Neuropsychopharmacology. Background Major depression affects about 10 percent of the adult population and is the second leading cause of disability in U.S. adults, according to the World Health Organization. Despite the availability of several different classes of antidepressant drugs such as selective serotonin reuptake inhibitors (SSRIs), 30 to 40 percent of adults are unresponsive to these medications. Moreover, SSRIs typically take weeks to work, which increases the risk for suicide. Enter NMDA (N-methyl-D-aspartate) receptor modulators. In the 1970s, researchers linked the receptors to learning and memory. Biotech and pharmaceutical companies in the 1980s attempted to apply chemical blockers to these receptors as a means to prevent stroke. But blocking these receptors led to the opposite effect—--the rise of cardiovascular disease. Research in the field dampened until a glutamate receptor antagonist already approved for anesthesia, and known on the streets as “Special K”, ketamine, made headlines in the early 2000s. Human clinical studies demonstrated that ketamine can ward off major and bipolar depressive symptoms within 2 hours of administration and last for several days. Ketamine is fraught with serious side effects including excessive sleepiness, hallucinations, and substance abuse behavior. “Ketamine lit the field back up,“ said Joseph Moskal, Ph.D., a molecular neurobiologist at Northwestern University and senior study author. “Our drug, GLYX-13, is very different. It does not block the receptor ion channel, which may account for why it doesn’t have the same side effects.” Moskal’s journey with GLYX-13 came about from his earlier days as a Senior Staff Fellow in NIMH’s Intramural Research Program. While at NIMH, he created specific molecules, monoclonal antibodies, to use as new probes to understand pathways of learning and memory. Some of the antibodies he created were for NMDA receptors. When he moved to Northwestern University, Moskal converted the antibodies to small protein molecules. Comprised of only four amino acids, GLYX-13 is one of these molecules. Previous electrophysiological and conditioning studies had suggested that GLYX-13, unlike ketamine, enhanced memory and learning in rats, particularly in the brain’s memory hub or hippocampus. GLYX-13 also produced analgesic effects. Using several rat behavioral and molecular experiments, Moskal’s research team tested four compounds: GLYX-13, an inactive, “scrambled” version of GLYX-13 that had its amino acids rearranged, ketamine, and the SSRI fluoxetine. Results of the Study GLYX-13 and ketamine produced rapid acting (1 hour) and long-lasting (24 hour) antidepressant-like effects in the rats. Fluoxetine, an SSRI that typically takes from 2–4 weeks to show efficacy in humans, did not produce a rapid antidepressant effect in this study. As expected, the scrambled GLYX-13 showed no antidepressant-like effects at all. The researchers observed none of the aforementioned side effects of ketamine in the GLYX-13–treated rats. Protein studies indicated an increase in the hippocampus of the NMDA receptor NR2B and a receptor for the chemical messenger glutamate called AMPA. Electrophysiology studies in this brain region showed that GLYX-13 and ketamine promoted long-lasting signal transmission in neurons, known as long-term potentiation/synaptic plasticity. This phenomenon is essential in learning and memory. The researchers propose how GLYX-13 works: GLYX-13 triggers NR2B receptor activation that leads to intracellular calcium influx and the expression of AMPA, which then is responsible for increased communication between neurons. These results are consistent with data from a recent Phase 2 clinical trial, in which a single administration of GLYX-13 produced statistically significant reductions in depression scores in patients who had failed treatment with current antidepressants. The reductions were evident within 24 hours and persisted for an average of 7 days. After a single dose of GLYX-13, the drug’s antidepressant efficacy nearly doubled that seen with most conventional antidepressants after 4–6 weeks of dosing. GLYX-13 was well tolerated and it did not produce any of the schizophrenia-like effects associated with other NMDA receptor modulating agents. Significance NMDA receptors need a molecule each of the amino acid chemical messengers glutamate and glycine to become activated. Moskal speculates that GLYX-13 either directly binds to the glycine site on the NMDA receptor or indirectly modulates how glycine works with the receptor. Resulting activation of more NMDA and AMPA receptors leads to an increase in memory, learning—and antidepressant effects. By contrast, ketamine only blocks the NMDA receptor, but also increases the activity of the AMPA receptor. Knowledge of these mechanisms could lead to the development of more effective antidepressants. What’s Next GLYX-13 is now being tested in a Phase 2 repeated dose antidepressant trial, where Moskal and his colleagues at Naurex, Inc., a biotechnology company he founded, hope to find in humans the optimal dosing for the drug. They also want to see if this molecule, and others like it, regulate other NMDA receptor subtypes—there are over 20 of them—and whether it will work on other disorders, such as schizophrenia, attention-deficit hyperactivity disorder, and autism. “One could call NMDA modulators such as GLYX-13 ‘comeback kids,’” said Moskal. “A toolkit that I developed in 1983 is now setting the stage in 2013 for the development of possible new therapeutics that may provide individuals suffering from depression with a valuable new treatment option.” Alcoholism and Drug Abuse Counselors Continuing Education Reference Burgdorf J, Zhang X-l, Nicholson KL, Balster RL, Leander JD, Stanton PK, Gross AL, Kroes RA, Moskal JR. GLYX-13, a NMDA Receptor Glycine-Site Functional Partial Agonist, Induces Antidepressant-Like Effects Without Ketamine-Like Side Effects. Neuropsychopharmacology, April 2013. 38:729–742.

Nearly 20 percent of suicidal youths have guns in their home

Researchers say emergency department doctors should screen all pediatric patients for suicide risk WASHINGTON, DC – Nearly one in five children and teens found to be at risk for suicide report that there are guns in their homes, and 15 percent of those at risk for suicide with guns in the home know how to access both the guns and the bullets, according to a study to be presented Monday, May 6, at the Pediatric Academic Societies (PAS) annual meeting in Washington, DC. Suicide is the second leading cause of death among young people ages 10 to 24 years in the United States, according to Centers for Disease Control and Prevention data. Nearly half of youths who die by suicide use a firearm. Researchers conducted a study to create a suicide risk screening tool that health care professionals in emergency departments (EDs) could use to figure out which youths need further mental health evaluation to keep them from harming themselves. As part of that study, researchers asked youths about access to guns in or around their home and about gun/bullet storage. "For more than 1.5 million adolescents, the ED is their primary point of contact with the health care system, which makes the ED an important place for identifying youth at risk for suicide," said Stephen J. Teach, MD, MPH, FAAP, associate chief in the Division of Emergency Medicine at Children's National Medical Center in Washington, DC, and co-author who will be presenting the study at the PAS meeting. Many clinicians and parents do not know how to ask youth about suicide, so they require screening tools to assist in detection, added study senior author Lisa M. Horowitz, PhD, MPH, staff scientist/pediatric psychologist at the National Institute of Mental Health, National Institutes of Health, Bethesda, Md. "According to our data, when asked their opinion, nearly all of the kids in our study were in favor of suicide screening in the ED. Our study shows that if you ask kids directly about suicide, they will tell you what they are thinking." Study participants included 524 patients ages 10 to 21 who were seen for medical/surgical or psychiatric complaints at one of three pediatric EDs. They were asked to fill out a 17-item questionnaire that the researchers used to develop the Ask Suicide-Screening Questions (ASQ), a four-question screening tool that can be used for all pediatric patients visiting the ED. The ASQ has been validated against a longer more in-depth suicide assessment tool. "While many youths who kill themselves have mental health disorders, up to 40 percent of youths who kill themselves have no known mental illness," said co-author and youth suicide expert Jeffrey A. Bridge, PhD, principal investigator at The Research Institute at Nationwide Children's Hospital and associate professor of pediatrics at The Ohio State University. "Therefore, it is important to screen all children and adolescents for suicide, regardless of the reason they are visiting the ED." Of the patients who completed the screening tools, 151 (29 percent) were found to be at risk for suicide, and 17 percent of them reported guns in or around the home. Of those at risk for suicide and reporting guns in the home, 31 percent knew how to access the guns, 31 percent knew how to access the bullets, and 15 percent knew how to access both the guns and the bullets. "This study highlights the importance of parents understanding the risks of having guns in their homes," said Dr. Bridge. "Being at risk for suicide and having access to firearms is a volatile mix. These conversations need to take place in the ED with families of children at risk for suicide." Suicide Prevention CE Course ### To view the abstract, "Access to Firearms among Patients Screening Positive for Suicide Risk in Pediatric Emergency Departments," go to http://www.pas-meeting.org/2013DC/Abstracts/LB%20Pub%20All%202013.pdf The research was supported by the Intramural Research Program of the National Institute of Mental Health, the National Institutes of Health (Drs. Horowitz & Pao); institutional research funds from the Research Institute at Nationwide Children's Hospital and grant K01 MH-69948 from the National Institute of Mental Health (Dr. Bridge); institutional research funds from the Program for Patient Safety and Quality at Boston Children's Hospital Boston (Dr. Wharff). The Pediatric Academic Societies (PAS) are four individual pediatric organizations that co-sponsor the PAS Annual Meeting – the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics. Members of these organizations are pediatricians and other health care providers who are practicing in the research, academic and clinical arenas. The four sponsoring organizations are leaders in the advancement of pediatric research and child advocacy within pediatrics, and all share a common mission of fostering the health and well-being of children worldwide. For more information, visit http://www.pas-meeting.org. Follow news of the PAS meeting on Twitter at http://twitter.com/PedAcadSoc.

Emergency Department Suicide Screening Tool Accurately Predicts At Risk Youth

A set of four questions that takes emergency department nurses or physicians less than 2 minutes to administer can successfully identify youth at risk for attempting suicide, reported a study by National Institute of Mental Health (NIMH) researchers that was published in the December 2012 issue of the Archives of Pediatrics and Adolescent Medicine Aspira Continuing Education Online Courses Background Each year as many as 5 to 8 percent of U.S. children and young adults attempt suicide, according to the U.S. Centers for Disease Control and Prevention. In 2010, 4867 youths between ages 10 and 24 died by suicide, making it the second leading cause of death for people in this age group. Most individuals who die by suicide have visited a health care provider 3 months to 1 year before their death. Typically these patients saw an emergency department (ED) nurse and physician for some other health concern such as abdominal pain or headaches. These at-risk individuals often go unrecognized by ED staff who either lack the time or training to properly screen patients. The Joint Commission, a leading U.S.-based nonprofit healthcare accreditation organization, and the American Academy of Pediatrics have previously recommended the creation and use of suicide screening tools for adult and pediatric patient populations. To date there are no screening instruments to assess suicide risk in children and adolescents who visit EDs for medical or surgical reasons. “Many families use the emergency department as their sole contact in the healthcare system,” said Lisa M. Horowitz, Ph.D., M.P.H., lead author of the study. “Most people don’t show up to the emergency department and say ‘I want to kill myself.’ Rather they show up with physical complaints and do not discuss their suicidal thoughts. But studies have shown that if you ask directly, the majority will tell you. Nurses and physicians need to know what questions to ask.” Horowitz, a clinician and researcher with NIMH, and her colleagues developed a quick questionnaire that ED nurses and physicians could use to assess suicide risk among youth. Their study tested 17 candidate questions in 524 patients ages 10 to 21 years who visited one of three academically-affiliated pediatric EDs and had either psychiatric problems—suicidal ideation, intense anxiety, post-traumatic stress disorder—or medical/surgical concerns—gastrointestinal diseases, sickle cell anemia, cystic fibrosis. The questions—focusing on suicidal thoughts and behavior—were reviewed and revised by a panel of mental health clinicians, health services researchers, and survey specialists. The patients also completed one of two versions of the Suicidal Ideation Questionnaire (SIQ), the “gold standard,” 30-question suicide-screening tool that is used by pediatric and adolescent psychiatrists, but which is too long for ED visits and requires additional training. As part of the study’s safety plan, individuals whose responses indicated that they were at risk for attempting suicide were referred to mental health professionals—social workers, psychiatrists, psychologists—for further evaluation Suicide Prevention CE Course Results of the Study Of the 17 candidate questions, four (used as a set) stood out as having the most accuracy for predicting suicide attempts: current thoughts of being better off dead, current wish to die, current suicidal ideation, and history of suicide attempt. Positive responses to 1 or more of these 4 questions identified 97% of the youth at risk for suicide, regardless of whether these patients came in for psychiatric or general medical concerns. Based on results from the new questionnaire, 18.7% of the ED patients (98 of the 524) screened positive for suicide risk; most of whom had come to the ED with psychiatric concerns (84 of the 524). Elevated suicide risk was detected in 4.1% of the ED patients (14 of the 344) with medical/surgical concerns. Had it not been for the new screening tool, the suicide risk in these 14 patients most likely would have gone undetected. Significance The instrument based on these 4 questions, called the Ask Suicide-Screening Questions (ASQ), is the first time such a screen has been validated for pediatric and young adult patients evaluated in EDs for medical/surgical reasons. Although the number of these patients identified as high risk for suicide is small, the screen takes less than 2 minutes to administer. The tool is freely available and accessible online (pdf). What’s Next Additional research assessing the impact of suicidal screening in pediatric EDs on referral rates to mental health services and future suicidal behavior are needed. The accuracy of the ASQ among diverse demographic populations also needs examination. Additionally, a cost-benefit analysis for the screening tool is needed, as is research studying its use in other healthcare settings such as in-patient and out-patient care. Reference Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask Suicide-Screening Questions (ASQ). A Brief Instrument for the Pediatric Emergency Department. Archives of Pediatrics and Adolescent Medicine. December 2012. 166(12):1170–1176.

Suicide Now Kills More Americans Than Car Crashes: Study

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Suicide Now Kills More Americans Than Car Crashes: Prevention efforts lowered traffic fatalities, more attention needed for suicide, experts say ***************************************************** Suicide Prevention CE Course (7 hours) Description $ - For course pricing details, see our Pricing page by clicking on the "Pricing" tab This course is designed to help you: Increase awareness of suicide prevention methods Increase familiarity with broad based support systems Become familiar with strategies to reduce stigma Learn how to promote efforts to reduce efforts to lethal means of self harm. Identify at risk behavior Implement appropriate treatment and resources Develop and Promote Effective Clinical and Professional Practices CEU LPC, ceus mft, ceu’s for social workers, BBS approved, NBCC provider, nursing ceus, online ceus, ceus for MFTs, ce courses for counselors, Social Worker ceus, continuing education units for LPCs, MHC ceus, LCSW, ASW and MFT Intern ceus, Board approved ceus in many states, national board approval ceus, alcohol and drug abuse counselor ceus. See chart below for your state and license.

New national strategy paves way for reducing suicide deaths

Today on World Suicide Prevention Day, the National Action Alliance for Suicide Prevention (Action Alliance) released an ambitious national strategy to reduce the number of deaths by suicide. The strategy was called for by Health and Human Services (HHS) Secretary Kathleen Sebelius and former Department of Defense Secretary Robert Gates when they launched the Action Alliance on Sept. 10, 2010. The 2012 National Strategy for Suicide Prevention, a report from the U.S. Surgeon General and the Action Alliance, details 13 goals and 60 objectives for reducing suicides over the next 10 years. The Action Alliance, co-chaired by Gordon Smith, chief executive of the National Association of Broadcasters, and Army Secretary John McHugh, highlights four immediate priorities to reduce the number of suicides: integrating suicide prevention into health care policies; encouraging the transformation of health care systems to prevent suicide; changing the way the public talks about suicide and suicide prevention; and improving the quality of data on suicidal behaviors to develop increasingly effective prevention efforts. The Obama Administration also announced a series of activities that will help prevent suicide: •Secretary Sebelius announced $55.6 million in new grants for national, state, tribal, campus and community suicide prevention programs made possible under the Garrett Lee Smith Memorial Act and partially funded by the Prevention and Public Health Fund under the Affordable Care Act, the health care law enacted in 2010. •The Department of Veterans Affairs (VA) launched, Stand by Them: Help a Veteran, a joint VA-Department of Defense (DoD) outreach campaign that includes a new public service announcement, Side by Side, designed to help prevent suicide among veterans and servicemembers and focuses on the important role family and community play in supporting Veterans in crisis. Throughout September and beyond, VA and DoD are urging community-based organizations, Veterans Service Organizations, health care providers, private companies and other government agencies to connect Veterans and Service members in need of assistance to the Veterans Crisis Line ( 1-800-273-8255 , press 1). Additionally, as directed by President Obama’s Mental Health Executive Order issued August 31st, VA is also increasing the workforce of the Crisis Line by 50% and hiring 1,600 new mental health professionals. “Our message today is one of hope,” Secretary Sebelius said. “The national strategy will bring together the nation’s resources, both public and private, in an organized effort to provide life saving services and improve the ability of individuals, friends and family members to recognize the warning signs of despair and take action to save lives.” “By implementing this plan, we will engage diverse sectors of our communities, from health care systems and policy-makers to the media and public,” said Gordon Smith, a former U.S. senator from Oregon. “It will take all of our efforts to win this fight against suicide that touches so many American lives.” VA Deputy Secretary W. Scott Gould said, “All of us working together - friends, family, neighbors, the public and the private sector - can make a difference for Service members and Veterans transitioning back into their communities. Recognizing the warning signs of suicide and knowing where to turn for help will save lives.” Army Secretary McHugh commented on the impact of suicide on the military community in particular. “Suicide is one of the most challenging issues we face,” he said. “In the Army, suicide prevention requires soldiers to look out for fellow soldiers. We must foster an environment that encourages people in need to seek help and be supported.” Suicide is a public health issue that results in an average of 100 American deaths each day, more than double the average number of homicides. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more that 8 million adults in the United States had serious thoughts of suicide within the past 12 months. The first National Strategy for Suicide Prevention was launched in 2001 by then-Surgeon General David Satcher. The progress achieved over the years, the significant advances in knowledge, research and practice of preventing suicide, and public comment informed the development of the new Strategy by the Action Alliance. Since the development of the first strategy, more than 100 best practices in suicide prevention are now documented and form the foundation of the new strategy. “The latest research shows that suicide is preventable, suicidal behaviors are treatable, and the support of families, friends, and colleagues are critical protective factors. Suicide prevention needs to be addressed in the comprehensive, coordinated way outlined in the national strategy,” said Surgeon General Regina M. Benjamin. Dr. Benjamin also released a new public service announcement promoting the national suicide prevention line –1-800-273-TALK(8255). The Action Alliance is composed of approximately 200 public- and private- sector organizations united by a common vision of a nation free from the tragic experience of suicide. One of the private sector partners, Facebook is supporting the strategy by harnessing the power of social networking and crisis support to help prevent suicides across the nation. "All too often, people in crisis do not know how—or who—to ask for help,” said Facebook’s Global VP for Public Policy, Marne Levine. “At Facebook, we have a unique opportunity to provide the right resources to our users in distress, when and where they need them most. By enabling connection to trained and caring professionals around the world, we can do our part to let users know help is available. Through a concerted and coordinated effort on the part of private industry, government, and concerned family and friends, we can make a real difference in preventing suicide and saving lives." A new service offered by Facebook enables users to report a suicidal comment they see posted by a friend to Facebook using either the Report Suicidal Content link or the report links found throughout the site. The person who posted the suicidal comment will then immediately receive an email from Facebook encouraging him or her to call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or to click on a link to begin a confidential chat session with a crisis worker. Additionally, •If you are concerned about yourself or someone you care about, call the National Suicide Prevention Lifeline 24/7 for free, confidential help ( 1-800-273-8255 ). •To view or order printed copies of the National Strategy for Suicide Prevention and other materials, visit www.samhsa.gov/NSSP. •To learn more about suicide prevention, visit www.sprc.org. •To view the U.S. Surgeon General’s new “Everyone Plays A Role” PSA, visit http://www.surgeongeneral.gov/ •To view the Department of Veterans Affairs new “Side by Side” PSA, visit http://www.veteranscrisisline.net/materials/spmsupport/files/side-by-side-SD-eng-60-cc.wmv -------------------------------------------------------------------------------- SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Girls with ADHD more prone to self-injury, suicide as they enter adulthood

Visible symptoms can go undercover, UC Berkeley psychologists find Girls with Attention Deficit Hyperactivity Disorder (ADHD) – and their families – often look forward to the likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women. However, new findings from UC Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure – a development that can manifest itself in self-injury and even attempted suicide LPC continuing education "Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood," said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood. "Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD females are profound," he added. The study is published today (Tuesday, August 14) in the Journal of Consulting and Clinical Psychology. Its results are consistent with earlier findings by the UC Berkeley team that, as girls with ADHD grow older, they show fewer visible symptoms of the disorder, but continue to suffer in hidden ways. The findings challenge assumptions that girls can "outgrow" ADHD, and underscore the need for long-term monitoring and treatment of the disorder, Hinshaw said. The longitudinal study, which began when the girls were ages 6 to 12, is funded by grants from the National Institute of Mental Health. Since 1997, Hinshaw and his team have tracked a racially and socio-economically diverse group of girls with ADHD in the San Francisco Bay Area through early childhood summer camps, adolescence and now early adulthood. In addition to this new study, many others have been published by the team about the girls every five years. In the United States, more than 5 million children ages 3-17 – approximately one in 11 – have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. ADHD is characterized by poor concentration, distractibility, hyperactivity, impulsiveness and other symptoms that are inappropriate for the child's age. Evidence-based treatment includes stimulant medications and various forms of behavior therapy. The new UC Berkeley study, assessing the girls 10 years after it began, examined 140 of them, ages 17-24, comparing their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD. It also gauged the symptoms of two major ADHD subtypes: Those who entered the study with poor attention alone versus those who had a combination of inattention plus high rates of hyperactivity and impulsivity. The study's major finding was that the group with combined inattention and hyperactivity-impulsivity during childhood was by far the most likely to manifest self-injury and suicide attempts in early adulthood. In fact, the study pointed out, more than half of the members of this subgroup were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said. "A key question is why, by young adulthood, young women with ADHD would show a markedly high risk for self-harm … Impulse control problems appear to be a central factor," the study said. In the first study on this group, published in 2002, the 6- to- 12-year old girls attended five-week camps where they were closely monitored as they partook in art and drama classes and outdoor activities. Those taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all the participants did not know which of them had been diagnosed with ADHD. That study found that girls with ADHD were more likely to struggle academically and to be rejected by their peers, compared to the comparison peer group. The five-year follow-up study, when the girls were 12 to 17 and experiencing early to mid-adolescence, found that the fidgety and impulsive symptoms tended to subside in the early teen years, but that the learning gap between girls with ADHD and their non-ADHD peers had widened, and eating disorders and substance abuse had surfaced. For the latest study, in which 95 percent of the original sample of girls participated, the researchers conducted intensive interviews with the subjects and their families. Those interviews include personal reports on behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior. Researchers also measured key cognitive functions such as executive planning skills, which include goal-setting and monitoring, planning and keeping on task despite distractions. While many girls in the study showed improvement in ADHD symptoms during the 10-year period, certain problems persisted and new ones emerged, suggesting that careful monitoring and treatment are essential, Hinshaw said. "The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood," the study concluded. "Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition on girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm in young adulthood." That said, Hinshaw added, "ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years." ### In addition to Hinshaw, authors and researchers of the study are Elizabeth Owens, Christine Zalecki, Emily Schrodek and Erika Swanson at UC Berkeley; Suzanne Perrigue Huggins at the University of Maryland and Adriana Montenegro-Nevado at Palo Alto University

Antidepressant-suicide link in youths absent in new analysis

Drugs also found effective in reducing suicidal behavior in adults, elderly

In 2004, concerns about antidepressant drugs increasing suicidal thoughts and behaviors in young patients prompted the FDA to issue a rare "black box warning." Now, a new analysis of clinical trial data finds that treatment with the antidepressant fluoxetine did not increase — or decrease — suicidality in children compared to placebo treatment.

An analysis built on data from 41 trials and more than 9,000 patients also found that two different popular antidepressant drugs were effective at reducing suicidal behavior and depressive symptoms in adult and geriatric patients. The findings are published online Feb. 6 in the journal Archives of General Psychiatry Alcoholism and Drug Abuse Counselors Continuing Education


The failure to replicate the link between antidepressants and suicide should reassure doctors about prescribing these drugs to depressed patients, said first author Robert Gibbons, PhD, professor of medicine, health studies, and psychiatry at the University of Chicago Medicine.

"The key finding here, when we re-analyze all the patient-level longitudinal records in these studies, is that antidepressants neither increase nor decrease suicidal thoughts or behavior in children," Gibbons said.

The FDA decision on the black box warning was based on retrospective data from 25 clinical trials of newer antidepressant medications, including the serotonin reuptake inhibitor drug fluoxetine, marketed as Prozac or Sarafem. A meta-analysis combining adverse event data (primarily based on self reports of suicidal thoughts) from the trials revealed a small, but significant, increase in suicidal thoughts and behavior in children and young adults up to the age of 25.

For the new analysis, Gibbons and colleagues from the University of Illinois at Chicago, the University of Miami and Columbia University obtained individual-level, longitudinal clinical trial data — some of it unpublished — from pharmaceutical producers and a large National Institute of Mental Health collaborative study of fluoxetine and venlafaxine. The data included weekly screening of each trial subject for depression and suicidal thoughts, allowing researchers to compare the effect of drug or placebo over time on these measures.

In the analysis of the adult and geriatric trials testing fluoxetine or venlafaxine, both antidepressants were found effective in reducing suicide risk and depression symptoms. These two effects were also found to be statistically associated, suggesting that the drugs reduced suicidality by alleviating depression. Therefore, Gibbons said, effective treatment of major depressive disorder is important for a patient's safety.

"Basically, the results say that the mechanism by which the antidepressants affect suicide rates is by decreasing depression," Gibbons said. "It follows that if a treatment is not working for an individual, the risk for suicidal behavior and perhaps worse remains high."

To analyze the effects of antidepressants in children, the researchers used four trials of fluoxetine, which until recently was the only antidepressant approved for pediatric use. Once again, a reduction in depressive symptoms was observed in the drug-treated population compared to placebo. However, no significant change in suicide risk was detected between the two patient groups.

"I think that this paper supports the general idea that the effects of antidepressants in kids and adults are not really the same, since we don't see anything but beneficial effects of antidepressants in adults and geriatrics," Gibbons said. "In kids, we don't see a harmful effect, but we do see a disassociation between the beneficial effects on depression and the potential beneficial effect on suicide."

"This raises continued questions about what's going on in children," he continued. "Maybe children think about suicide in part because of depression, but also maybe due to other reasons not related to depression that are not affected by antidepressants."

Gibbons, who sat on the Food and Drug Administration panel that considered placing the black box warning on antidepressants, said he hoped the new results would reassure clinicians about the safety of the drugs. Previous research by his group found that the addition of the warning significantly reduced antidepressant prescriptions to both children and adults and correlated with a spike in suicide rates.

"I hope that the warnings will not prevent depressed children and adults from getting treatment for depression," Gibbons said. "The greatest cause of suicide is untreated or undiagnosed depression. It's very important that this condition be recognized and appropriately treated and not discarded because doctors are afraid to be sued."


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The paper, "Suicidal Thoughts and Behavior with Antidepressant Treatment," will be published online February 6th by Archives of General Psychiatry. In addition to Gibbons, authors include C. Hendricks Brown of the University of Miami, Kwan Hur of the University of Chicago, John M. Davis of the University of Illinois at Chicago, and J. John Mann of Columbia University. Funding for the research was provided by the National Institute of Mental Health and the Agency for Healthcare Research and Quality.

For more news from the University of Chicago Medical Center, follow us on Twitter at @UChicagoMed, or visit our Facebook page at facebook.com/UChicagoMed, our research blog at sciencelife.uchospitals.edu, or our newsroom at uchospitals.edu/news.

Holiday Suicides: Fact or Myth?

The idea that suicides occur more frequently during the holiday season is a long perpetuated myth. The Annenberg Public Policy Center has been tracking media reports on suicide since 2000. A recent analysis found that 40% of articles written during the 2008 holiday season perpetuated the myth.1

CDC’s National Center for Health Statistics reports that the suicide rate is, in fact, the lowest in December.1 The rate peaks in the spring and the fall. This pattern has not changed in recent years. The holiday suicide myth supports misinformation about suicide that might ultimately hamper prevention efforts. MFT Continuing Education http://www.aspirace.com
Suicide remains a major public health problem, one that occurs throughout the year. It is the 11th leading cause of death for all Americans. Each year, more than 33,000 people take their own lives.2 In addition, more than 376,000 are treated in emergency departments for self-inflicted injuries.2

CDC works to prevent suicidal behavior before it initially occurs. Some of CDC’s activities include:

1.monitoring suicidal behavior;
2.conducting research to identify the factors that put people at risk or protect them from suicide; and
3.developing and evaluating prevention programs.

Dept of Consumer Affairs Offers Consumer Coping Strategies to Help Keep Holiday Rush from Becoming "Holiday Blues"

The holiday season can be stressful for many people. Often it's the stress of trying to live up to unrealistic expectations. Many factors can take their toll on emotional well being: rushing around; attending to extra social obligations; being alone; spending too much money; or overindulging in food and drink.

The California Department of Consumer Affairs has tips on dealing with the holiday blues, and advice for consumers who may need to seek professional help. The Department's Board of Psychology licenses psychologists, while the Board of Behavioral Sciences licenses clinical social workers, and marriage and family therapists.

Experts say coping with the holidays starts with simply being aware of your expectations, both for yourself and for friends and family.

"It's an illusion that everyone's holidays are perfect. You may not be able to relive past holidays or create the "perfect" holiday season," explains Jacqueline Horn, Ph.D., president of the California Board of Psychology. "But the holiday blues are usually short-lived and should pass. If you don't feel better soon after the holiday season is over, you may want to seek professional help."

Dr. Horn, a practicing clinical psychologist and lecturer for the UC Davis Department of Psychology, says even those who are isolated and have no support group can brighten their holidays by going out in public. They can go to the mall, attend no-cost or low-cost community events, or volunteer their time to help others during the holidays.

Since days are shorter and the hours of darkness longer, another way to keep the blues at bay is to simply get some sunlight with a daytime activity, experts say.

Following are some tips from psychologists on how to cope with holiday stress:

TIPS TO HELP YOU HANDLE THE HOLIDAYS

■Set realistic goals for yourself
■Find time for yourself.
■Volunteer to do something for others
■Let go of the past. Approach the holidays with a fresh outlook and try something new
■Don't over-indulge by drinking or eating too much
■Spend time with people who are supportive
■Get your sleep
■Get some exercise
■Connect with your community.


However, if your typical coping skills are ineffective and you become overwhelmed by stress, anxiety or depression, it may be a sign that you should consider seeking professional help. Other warning signs include:

■Weight loss or gain
■Thoughts of suicide
■Feelings of worthlessness
■Difficulty thinking or concentrating
■Difficulty sleeping or increased sleeping
■Depression symptoms lasting more than two weeks
If you think you need professional help, start by getting a referral for a qualified therapist from friends, family members, clergy or your physician. Consumers should confirm a therapist is licensed so they meet the professional standards set by the state. Also check that the license is in good standing.

The California Department of Consumer Affairs licenses thousands of professionals who can help. To check license status or get more information, visit the Psychology Board Web site at www.psychboard.ca.gov or the Board of Behavioral Sciences site at www.bbs.ca.gov. Psychiatrists are medical doctors licensed by the Medical Board of California, www.mbc.ca.gov. Licensed Professional Counselor LPC CEUs
For more tips on how to "Be a Safe and Smart Holiday Consumer," check the Department of Consumer Affairs' Web site. The California Department of Consumer Affairs promotes and protects consumer interests. Call(800) 952-5210 or visit the Department's Web site for information on a variety of helpful consumer topics.

Health Department Offers Holiday Mental Health Tips

The holiday season is here, and although this is usually a joyous time of year, it can be an especially stressful time for those who experienced loss because of the recent hurricanes in Louisiana. To help people cope, the Department of Health and Hospitals-Office of Mental Health is offering counseling services and stress-relief tips. LPC CEUs, LPC Continuing Education

“We know this holiday season will be a difficult one for many of our citizens,” said DHH Secretary Dr. Fred Cerise. “The holidays can intensify feelings of grief and loneliness. Also, the contrast to past holidays may aggravate the losses people have experienced in recent months, and the stress of preparing for holidays when money is short and family members are scattered can be overwhelming. We want to let people know that help is available during this time.”

To be able to enjoy the holidays despite these feelings, DHH mental health officials advise citizens to think ahead about ways to adapt traditions to meet the current circumstances. “Don’t put pressure on yourself to have the ‘perfect’ holiday. Planning celebrations that accommodate your feelings can reduce stress and make the holiday a day of healing,” said Dr. Cheryll Bowers-Stephens, DHH-OMH assistant secretary. “Have a holiday that fits how you feel.”

To turn Thanksgiving and other upcoming holidays into a time of healing, it is important for people to acknowledge that things have changed in the past year.

“Prior to the holiday, each person should consider the question, ‘How did I get to this day in this place?’ The answer will include the many traumas of upheaval, but it will also include moments of help, support, togetherness and kindness with loved ones,” Dr. Bowers-Stephens said. “Citizens also can come up with ways to honor those who lost their lives during the hurricanes as part of their activities, as this will help them celebrate their lives. The journey from disaster to recovery takes a long time, but being aware of even small kindnesses is empowering and will help everyone tackle the difficult rebuilding that lies ahead.”

Such observations of the holiday may not help everyone to manage their emotions. Anyone experiencing overwhelming feelings of sadness or loss is encouraged to call the statewide crisis hotline at 1-800-273-TALK (8255) to speak to a certified mental health counselor.