229
CHAPTER 11 ■ Suicide Prevention
Individuals may provide both behavioral and ver- bal clues about their intentions to act. Examples of behavioral clues that may indicate a decision to carry out suicidal intent include giving away prized posses- sions, getting financial affairs in order, writing sui- cide notes, and a sudden shift in mood. Verbal clues may be both direct and indirect. Examples of direct statements include “I want to die” and “I’m going to kill myself.” Examples of indirect statements include “This is the last time you’ll see me,” “I won’t be around much longer for the doctor to have to worry about,” and “I don’t have anything worth living for anymore.” Recent research (Rogers & Joiner, 2017) provides evidence that suicide-specific rumination, that is, fix- ation on one’s thoughts, intentions, and plans, may be an important predictor of suicidal behavior. Ask- ing how frequently the patient is thinking about sui- cide ideas, intentions, and plans helps to discern this level of risk. The lethality of the method identified by an individual with suicide ideation or by one who has already made an attempt provides meaningful infor- mation about the patient’s intent to die. Use of fire- arms, hanging, and suffocation, for example, are considered highly lethal methods. Other assessments include determining whether individuals have a plan, and if so, whether they have the means to carry out that plan. If the person states the suicide will be carried out with a gun, does the person have access to a gun? Bullets? If pills are planned, what kind of pills? Are they accessible? Asking the patient, “How likely are you to carry out this plan?” may provide verbal confirmation of their level of intent. Interpersonal Support System Does the individual have support persons on whom to rely during a crisis situation? Lack of a meaning- ful network of satisfactory relationships may indicate an individual has a higher risk for suicide during an emotional crisis. Analysis of the Suicidal Crisis Three aspects of assessment that enhance under- standing of the patient’s current suicidal crisis include an evaluation of the patient’s precipitating stressors, relevant history, and life-stage issues. ■■ The precipitating stressor: Adverse life events in combination with other risk factors, such as depres- sion, may lead to suicide. Life stresses accompa- nied by an increase in emotional disturbance
include the loss of a loved person either by death or by divorce, problems in major relationships, changes in roles, or serious physical illness. ■■ Relevant history: Has the individual experienced multiple failures or rejections that might increase their vulnerability for a dysfunctional response to the current situation? ■■ Life-stage issues: The ability to tolerate losses and disappointments is often compromised if the indi- vidual is also struggling with the developmental tasks associated with different life stages (e.g., ado- lescence, midlife, old age). Psychiatric, Medical, and Family History The individual should be assessed for previous psy- chiatric treatment for depression or other mental disorders, substance use disorders, or previous sui- cide attempts. Medical history should be obtained to determine the presence of chronic, debilitating, or terminal illness. Is there a history of depressive dis- order in the family, and has a close relative died by suicide in the past? Coping Strategies How has the individual handled previous crisis situ- ations? How does this situation differ from previous ones? Presenting Symptoms Several acronyms have been developed as mnemonic devices to summarize important factors that may increase a person’s risk for suicidal behavior. One of these is the acronym IS PATH WARM? (Ameri- can Association of Suicidology, 2020; Juhnke et al., 2007). The assessment items and descriptors for each letter are as follows: I deation: Has suicide ideas that are current and active, especially with an identified plan S ubstance abuse: Has current and/or excessive use of alcohol or other mood-altering drugs ——— P urposelessness: Expresses thoughts that there is no reason to continue living A nger: Expresses uncontrolled anger or feelings of rage T rapped: Expresses the belief that there is no way out of the current situation H opelessness: Expresses lack of hope and perceives little chance of positive change ———
Powered by FlippingBook