TRAUMA AND SUICIDE AMONG CHILDREN AND ADOLESCENTS

Tehmina Shakir, MD, CCP, DAAETS, CCTSS, CCTP, CSOTP, CFRC, CCFP�Child and Adolescent Psychiatrist�Assistant Clinical Professor, Wayne State University�Department of Psychiatry and Behavioral Neurosciences�Director of Psychiatric Services, Vista Maria�Medical Director, Cruz Clinic�Board member MI-ATSA�Board member Farmington SAFE

Trauma

After a child is traumatized multiple times, the imprint of the trauma becomes lodged in many aspects of his or her makeup.

Traumatic Stress

Children who suffer from traumatic stress:

• have been exposed to one or more traumatic events over the course of their lives
• Develop reactions that persist and affect their daily lives after the events have ended.
• Have various degree of trauma responses when reminded in some way of the traumatic event
• Without treatment, repeated childhood exposure to traumatic events can affect the brain and nervous system and increase health-risk behaviors (e.g., smoking, eating disorders, substance use, and high-risk activities).
• Childhood trauma survivors are at increased risk of developing long-term health problems (e.g., diabetes, asthma, COPD, autoimmune illnesses and heart disease) or to die at an earlier age.
• Traumatic stress can also lead to increased involvement with the child welfare and juvenile justice systems.
• Adult survivors of traumatic events may also have difficulty in establishing fulfilling relationships and maintaining employment.

ntcsn.org (The National Child Traumatic Stress Network)

Effects of traumatic stress/injuries

• Traumatic injuries and abuse are important risk factors for suicide due to alterations in mood and cognition that are part of PTSD symptomology:
• persistent exaggerated negative beliefs about oneself,
• blaming oneself for the traumatic event,
• persistent negative emotional state,
• loss of interest in activities, and
• persistent inability to experience positive emotions such as happiness, satisfaction, or loving feelings.
• Feelings of guilt and Shame

Hink, A.B., Killings, X., Bhatt, A. et al. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. Curr Trauma Rep 8, 41–53 (2022). https://doi.org/10.1007/s40719-022-00223-7

Traumatic events in childhood

Traumatic/Adverse Experiences During Childhood

• The childhood years, from the prenatal period to late adolescence, are the “building block” years that help set the stage for adult relationships, behaviors, health, and social outcomes.
• Adeverse Childhood Experiences (ACEs):
• Living in under-resourced or racially segregated neighborhoods,
• Frequently moving,
• Experiencing food insecurity,
• Poverty
• Childhood abuse and neglect
• Domestic, community and school violence
• War, terrorism, refugee trauma
• Parental substance use

Leading causes of deaths among adolescents aged 15–24 years:�www.aacap.org�

NCANDS: Child Maltreatment 2021

National Child Abuse and Neglect Data System (NCANDS) of the U.S. Department of Health and Human Services was established as part of the Child Abuse Prevention and Treatment Act as amended in 1988

Child Maltreatment 2021 is the latest edition of the annual Child Maltreatment report series.

For FFY 2021, 51 states submitted both a Child File and an Agency File.

Key findings of the Federal fiscal year (FFY) 2021 report include:

• Nationally estimated 3,016,000 children received either an investigative or alternative response at a rate of 40.7 children per 1,000 in the population.
• 51 states reported 588,229 victims of child abuse and neglect. This equates to a national rate of 8.1 victims per 1,000 children in the population. Estimating for missing data, there are 600,000 victims of maltreatment for FFY 2021.
• Three-quarters (76.0%) of victims are neglected, 16.0 percent are physically abused, 10.1 percent are sexually abused, and 0.2 percent are sex trafficked.
• A nationally estimated 1,820 children died from abuse and neglect at a rate of 2.46 per 100,000 children in the population.

https://www.acf.hhs.gov/cb/data-research/child-maltreatment.

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Hink, A.B., Killings, X., Bhatt, A. et al. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. Curr Trauma Rep 8, 41–53 (2022). https://doi.org/10.1007/s40719-022-00223-7

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The incidence of adolescent suicide has increased from 4.57 per 100,000 in 2001 to 6.5 per 100,000 in 2019.

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• Older adolescents are more likely to die by suicide
• incidence is 4 times higher among the ages of 15–19 compared to 10–14.
• Over the past 20 years, the incidence of suicide has increased for all races, with the most drastic increases in American Indian youth.
• Males have a significantly higher rate of deaths;
• Female suicide rates have doubled since 2001, from 1.64 per 100,000 in 2001 to 3.48 per 100,000 in 2019.
• Females have significantly more suicide attempts than males,
• Males have higher fatalities, likely due to use of more lethal means in the form of firearms
• There are notable geographic differences in the incidence of adolescent suicide

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Hink, A.B., Killings, X., Bhatt, A. et al. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. Curr Trauma Rep 8, 41–53 (2022). https://doi.org/10.1007/s40719-022-00223-7

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Hink, A.B., Killings, X., Bhatt, A. et al. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. Curr Trauma Rep 8, 41–53 (2022). https://doi.org/10.1007/s40719-022-00223-7

Suicide Among Children And Adolescents

• Among younger children, suicide attempts are often impulsive. They may be associated with feelings of sadness, confusion, anger, or problems with attention and hyperactivity.
• Among teenagers, suicide attempts may be associated with feelings of stress, self-doubt, pressure to succeed, financial uncertainty, disappointment, and loss. For some teens, suicide may appear to be a solution to their problems.
• www.aacap.org

CDC releases 2021 Youth Risk Behavior Survey (YRBS)Results �https://www.cdc.gov/healthyyouth/data/yrbs��

• CDC’s Youth Risk Behavior Surveillance System (YRBSS) monitors priority health risks and experiences among U.S. high school students across the country. Youth Risk Behavior Survey (YRBS) results help us understand what contributes to the leading causes of death and disability among youth.
• 2021 YRBS results showed over 40 percent (42%) of high school students struggle with persistent feelings of sadness or hopelessness and nearly 30 percent (29%) experienced poor mental health.
• Female students and those who identify as lesbian, gay, bisexual, other or questioning (LGBTQ+) are experiencing disproportionate levels of poor mental health and suicide-related behaviors as compared to their peers.
• More than 2 in 10 LGBQ+ students did not go to school because of safety concerns; nearly 1 in 4 experienced sexual violence, and nearly 1 in 4 were bullied at school during the past year.
• LGBQ+ students were nearly 4 times as likely as their heterosexual peers to attempt suicide during the past year, with more than 2 in 10 reporting this experience.

CDC releases 2021 Youth Risk Behavior Survey (YRBS)Results �https://www.cdc.gov/healthyyouth/data/yrbs�

• 14% of female students experienced forced sex
• Female students were nearly twice as likely to experience persistent feelings of sadness or hopelessness and nearly twice as likely to attempt suicide during the past year compared to their male peers; with nearly 6 in 10 feeling persistently sad or hopeless and more than 1 in 10 attempting suicide.
• Feelings of connectedness were lower among students who were female, American Indian/Alaska Native, Black, or lesbian, gay, bisexual, and queer/questioning (LGBQ).
• Nearly 3% of high school students experienced unstable housing.�Rates of unstable housing are higher among youth of color and LGBQ+ youth.
• Youth who experience unstable housing face higher risks for poor physical and mental health outcomes—including increased risk for suicide.

Warning Signs

• Children and adolescents thinking about suicide may make openly suicidal statements or comments such as, "I wish I was dead," or "I won't be a problem for you much longer."
• Changes in eating or sleeping habits
• Frequent or pervasive sadness
• Withdrawal from friends, family, and regular activities
• Frequent complaints about physical symptoms often related to emotions, such as stomachaches, headaches, fatigue, etc.
• Frequent thoughts of death and dying
• Inability to plan for the future
• Losing interest in things/activities that the child otherwise enjoys or inability to feel happy
• Self-injurious behaviors�

CDC releases 2021 Youth Risk Behavior Survey (YRBS)Results �https://www.cdc.gov/healthyyouth/data/yrbs� ��

What can help our youth:

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• Increase feelings of school connectedness.
• Engage in more parental monitoring.
• Provide care and services to youth who are unstably housed.
• Support more schools across the country.

Trauma Informed Care

Being Trauma-Informed Means:

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• UNDERSTANDING the prevalence of trauma and its impact;
• RECOGNIZING the signs and symptoms of traumatization;
• CREATING an emotionally and physically safe space, and empowering the individual with an active voice in collaborative decision-making; and
• RESPECTING the person’s experience through active listening, being sensitive to the language used, being transparent, being trustworthy, and offering stability and consistency (Bath, 2008; Hodas, 2006; Rosenberg, 2011; SAMHSA, 2015; Huckshorn & LeBel, 2013).

WHAT CAN PARENTS AND CAREGIVERS DO TO HELP

Getting Professional Help

COMMUNICATE WITH THE TREATMENT PROVIDERS

�Recognizing Your Child’s Strengths And Helping The Child Become Aware Of Them�

TRY TO HELP THE CHILD UNDERSTAND THE TRAUMA

Keep the Doors of Communication open

Open, Honest and Age-Appropriate Communication

PAY ATTENTION TO THE CHILD’S CUES

�THANKYOU�