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Self-Destructive Behaviors: Definitions & Rates

_______________. Self-Destructive Behaviors: Definitions & Rates. _______________. Prof. Matthew K. Nock. Why Study Self-Injurious Behaviors?. _______________.

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Self-Destructive Behaviors: Definitions & Rates

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  1. _______________ Self-Destructive Behaviors:Definitions & Rates _______________ Prof. Matthew K. Nock

  2. Why Study Self-Injurious Behaviors? _______________ “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest– whether or not the world has three dimensions, whether the mind has nine or twelve categories– comes afterwards. These are games; one must first answer.” --Albert Camus, The Myth of Sisyphus

  3. Why Study Self-Injurious Behaviors? _______________ • ~1 million suicide deaths annually; 1 every 40 seconds • ~30,000 deaths each year in US • Twice as many suicides as HIV/AIDS deaths, >homicides • 11th leading cause of death, 3rd among adolescents • 15% of high school students “seriously consider” suicide, and 7% make a suicide attempt (YRBS, 2007) • 97% of clinical psychology students see ≥ 1 suicidal patient; 25% of psychologists and 50% of psychiatrists lose patient to suicide(Kleespies & Dettmer, 2000)

  4. Public Health Context _______________

  5. Suicide Rates (per 100,000) by Country: WHO 2005

  6. Suicide Rates (per 100,000) by Country: WHO 2005

  7. U.S. Suicide Rate by Age, Gender & Race _______________

  8. U.S. Suicide Rate by Age, Gender & Race _______________

  9. U.S. Suicide Rate by Age & Sex Over Time _______________

  10. U.S. Suicide Rate by Region _______________

  11. U.S. Suicide Rate by Age, Gender & Race _______________

  12. U.S. Suicide Rate by Age, Gender & Race _______________

  13. U.S. Suicide Rate by Age, Gender & Race _______________

  14. U.S. Suicide Rate by Age, Gender & Race _______________

  15. U.S. Suicide Rate by Method & Gender _______________

  16. Death Rates of U.S. Youth _______________

  17. Suicide Rates by Month _______________

  18. Current Context _______________ • Suicide & NSSI are very difficult to predict & prevent

  19. Classifying Self-Injurious Thoughts and Behaviors _______________ • Common terms: “suicidality” …“deliberate self-harm”… “parasuicide”… • More specific terms and definitions: • Suicide ideation: thoughts of intentionally ending one’s own life • Suicide plan: selection of method with some intent to act in the future • Suicide attempt: self-injurious behavior with intent to die • Non-suicidal self-injury (NSSI): self-injury with no intent to die Nock & Kessler (2006) J Abnormal Psychology Nock & Kazdin (2002) J Clinical Child & Adolescent Psychology

  20. Epidemiology of Suicidal Outcomes _______________ • What is the prevalence of suicide ideation, plans, and attempts? • What are the onset, course, and risk factors?

  21. Epidemiology of Suicidal Outcomes _______________ * * * * * * * * * * * * * * * * * * * * * * * * * *

  22. Epidemiology of Suicidal Outcomes _______________ • What is the prevalence of suicide ideation, plans, and attempts? • What are the onset, course, and risk factors? • WHO World Mental Health Survey Initiative (Kessler et al): nationally representative survey in 28 countries (N ~ 250,000) • Prevalence • Estimate Range • Suicide Ideation 9.2% (3.1China - 15.9New Zealand) • Suicide Plan 3.1% (0.7Italy - 5.6New Zealand) • Suicide Attempt 2.7% (0.9Italy - 5.0USA) N = 84,850; 17 Countries Nock et al. (2008). British Journal of Psychiatry

  23. Epidemiology of Suicidal Outcomes _______________ • Although variability in prevalence of suicidal outcomes, there is consistency in: • Age-of-onset (AOO) of suicidal outcomes Nock et al. (2008). British Journal of Psychiatry

  24. Epidemiology of Suicidal Outcomes _______________ Nock et al. (2008). British Journal of Psychiatry

  25. Epidemiology of Suicidal Outcomes _______________ • Although variability in prevalence of suicidal outcomes, there is consistency in: • Age-of-onset (AOO) of suicidal outcomes • Conditional probabilities of transition from ideation to plans (33.6%) and attempts (29.0%) • Speed of transition from ideation to plans and attempts Nock et al. (2008). British Journal of Psychiatry

  26. Epidemiology of Suicidal Outcomes _______________ Nock et al. (2008). British Journal of Psychiatry

  27. Epidemiology of Suicidal Outcomes _______________ • Although variability in prevalence of suicidal outcomes, there is consistency in: • Age-of-onset (AOO) of suicidal outcomes • Conditional probabilities of transition from ideation to plans (33.6%) and attempts (29.0%) • Speed of transition from ideation to plans and attempts • Risk factors for suicide ideation, plans, and attempts • Female, younger age, unmarried • Presence of mental disorders Nock et al. (2008). British Journal of Psychiatry

  28. Epidemiology of Suicidal Outcomes _______________ Nock et al. (2008). British Journal of Psychiatry

  29. Predictors of Transition from Suicide Ideation to Attempt _______________ Prediction of first onset of suicide ideation and attempts in the NCS-R Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here. Nock et al. (2010). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally)

  30. Predictors of Transition from Suicide Ideation to Attempt _______________ Prediction of first onset of suicide ideation and attempts in the NCS-R Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here. Nock et al. (2010). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally)

  31. Predictors of Transition from Suicide Ideation to Attempt _______________ Prediction of first onset of suicide ideation and attempts in the NCS-R Values are ORs from multivariate survival models predicting ideation in the total sample (column 1), and unplanned attempts among ideators (column 2) in the NCS-R. Models included 16 disorders– only 4 shown here. Nock et al. (2010). Molecular Psychiatry (US) Nock et al. (2009). PLoS Medicine (Cross-nationally)

  32. Self-Injury Rate by Sex _______________

  33. Self-Injury Rate Over Time _______________

  34. Rate of NSSI among U.S. Youth _______________ (Hilt, Nock, Lloyd-Richardson & Prinstein, 2008)

  35. _______________ Self-Destructive Behaviors:Definitions & Rates _______________ Prof. Matthew K. Nock

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