California Psychology Ebook Continuing Education-PYCA1423

women with a history of an abortion are also indicated to be at higher risk for suicide (Miranda-Mendizzbal et al., 2019), which may be connected to poor access to healthcare and broader support networks. Legal problems and incarceration Rates of suicide in jails are greater than in the overall population (46 deaths by suicide as opposed to13 per 100,000, Case study 3: Youth suicide risk factors Jimmy is a 16-year-old Caucasian male presenting with several vague physical symptoms including insomnia and low energy. He has visited his primary care doctor several times in the recent past with similar complaints, which ultimately led to the referral for psychotherapy. His mother reports he has been moody, “in a funk,” and unable to concentrate. He has not been hanging out with his friends lately and his grades have been dropping. His doctor notes that Jimmy has been having frequent headaches, has been unable to sleep, and has experienced a decrease in appetite; the doctor has ruled out mononucleosis or another viral infection. Upon further questioning, Jimmy also reveals that he has been drinking beer and using marijuana three to four times per week. He denies other drug use. Jimmy states that his mood has been down for about a month or so, though he attributes it to being a typical “moody” teenager. He is not hanging out with his peers as often as before since they are all dating, and he does not want to be the “third wheel.” Jimmy is the younger of two children. He reports that his sister tends to get all of the attention in the family because of her defiant behavior. At times, he feels that he is a burden on his parents and that they simply do not have enough time for him. Further, he indicates that he is unable to talk with anyone in his family about how he feels, although he does have a close female friend at school in whom he can confide. Jimmy states, however, LGBTQIA youth There are numerous risk factors contributing to more suicidal behavior among LGBTQIA youth. Psychiatric disorders comprise one of the main precipitants for suicide attempts in all adolescents (Bischoff & Lippman, 2018). Research involving youth in the LGBTQIA community indicates higher frequency of suicide attempts by those with depression, anxiety, substance abuse, and/or conduct disorder. They were also six-times more likely to experience several such problems. Even after adjusting for mental health conditions, suicide attempts in LGBTQIA populations are still two- to-three times more frequent than for heterosexual individuals. LGBTQIA adolescents exhibit elevated prevalence of injuries, violence, tobacco smoking, alcohol and/or other drug use, as well as sexually high-risk behaviors correlated with unintended pregnancy and/or sexually transmitted infections. Sexual minority youth may also be reluctant to disclose the experience of suicidal ideation to others (Chang et al., 2020). These behaviors contribute to increased mortality and morbidity. Prejudice, stigma, and discrimination are unique factors that precipitate increased suicidal feelings by LGBTQIA youth. These individuals often experience rejection, bullying, harassment, and/or violence; rejection by family is an especially troublesome event. Adolescents receiving negative reactions from family members in response to their coming out are eight-times more likely to attempt suicide, six-fold more affected by depression, and evidence three times as much drug abuse and engagement in unprotected sex than LGBTQIA adolescents who suffer less such rejection (Puckett et al., 2017). Adolescence can be a period of turbulence because of the major physical, psychological, and cognitive changes that occur. In addition to the developmental changes experienced by all adolescents, LGBTQIA youth are also at risk of discrimination and potential victimization because of their sexual identity. Higher prevalence of health risks including substance misuse,

respectively), but research findings suggest that the suicide rate is even higher in the year following release (Noonan, Rohloff, & Ginder, 2015). Legal problems and incarceration can also affect a number of other psychosocial risk factors, which makes suicide risk assessment for patients with these concerns paramount (Gould, McGeorge, & Slade, 2018). that she has been frustrated with him lately due to his numerous school absences. Jimmy reports that he does not feel that his situation will get any better. He denies having considered suicide in the past week, remarking, “No. Life sucks. But I’m not exactly going to die over it.” Jimmy reports that he could not commit suicide because of what it would do to his family. He finally acknowledges that it is possible that things could get better, though he is unsure how. Discussion In many ways, Jimmy appears like a stereotypical adolescent making poor choices and having some behavioral problems. It would be easy to ignore some of the other risk factors that could suggest a more complicated challenge, particularly since he denies suicidal ideation. It is important to remember here that some adolescents may deny suicidal ideation and still be at heightened risk for suicide when other warning signs are present. In Jimmy’s case, he is exhibiting the following warning signs for suicide: increased substance use (alcohol and marijuana), initial expression of purposelessness, feeling trapped and hopeless that his home situation will not get any better, withdrawal from peers, and mood changes.

KEY RISK FACTORS FOR AT-RISK GROUPS

violence victimization, suicidality, and mental health disorders have been found among sexual minority youth compared with their heterosexual counterparts. These disparities have been linked to several complex issues affecting the LGBTQIA population, including stigma, discrimination, victimization, and social exclusion. Previous studies have interpreted these disparities and have demonstrated that discrimination and other forms of social intolerance experienced by LGBTQIA youth may be associated with chronic stress and depression that may contribute to self-injurious behaviors, including suicidal ideation and suicide attempts. Compared with their heterosexual counterparts, these youth are at a disproportionately greater risk for suicidal ideation and suicide attempts, with some studies suggesting that the disparity may persist into adulthood. Sexual orientation comprises three dimensions: sexual identity, sexual behavior, and sexual attraction. Each dimension may assess a unique feature of sexual orientation and influence the reported disparity in health-risk behaviors and health outcomes. Discordance may occur for reasons such as homophobia, societal norms that endorse heterosexual relationships, a lack of opportunity to act on one’s sexual identity, or the fluidity of sexual identity, which describes changes sexual experience and desires over time. Discrimination, stigma, prejudice, rejection, and societal norms may put pressure on LGBTQIA youth to act in a manner or present as a sexual orientation inconsistent with their true identity. Similarly, anticipation of rejection by family and peers, or fear of others assuming they are just going through an experimental phase, may also contribute to some youth to presenting in a discordant manner. A study by Annor et al. (2017) examined the association between sexual orientation discordance and suicidal ideation/suicide attempts among a nationally representative sample of U.S. high school students. Sexual orientation discordance describes the

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