Conversations About Suicide: Strategies for Detecting and Assessing Suicide Risk

John Sommers-Flanagan, PhD

Citation

Sommers-Flanagan, J. (2018). Conversations about suicide: Strategies for detecting and assessing suicide risk. Journal of Health Service Psychology, 44, 33–45.

Abstract

When patients disclose suicidal thoughts, clinicians often feel their anxiety rise. The best remedies for clinician anxiety include an understanding of suicide dynamics and a thoughtful and empathic engagement with patients. Engagement with patients typically includes collaborative exploration of eight psychological, interpersonal, and situational dimensions related to suicidality. These dimensions are rooted in suicide theories and empirical research. In this article, specific strategies are described and illustrated, including strategies for initiating conversations about suicide, exploring different dimensions of suicide, and engaging patients in steps to increase their safety.

Registrants can read the full article on CE.NationalRegister.org.

References

Anestis, M. D., & Houtsma, C. (2017). The association between gun ownership and statewide overall suicide rates. Suicide and Life-Threatening Behavior, epub, no volume or pagination yet** doi: 10.1111/sltb.12346

Bolton, J. M., Spiwak, R., & Sareen, J. (2012). Predicting suicide attempts with the SAD PERSONS scale: A longitudinal analysis.Journal of Clinical Psychiatry, 73(6), e735-e741. doi:10.4088/JCP.11m07362

de Shazer, S., Dolan, Y., Korman, H., McCollum, E., Trepper, T., & Berg, I. K. (2007). More than miracles: The state of the art of solution-focused brief therapy. New York, NY: Haworth Press.

Fowler, J. C. (2012). Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments. Psychotherapy, 49(1), 81-90. doi: http://dx.doi.org/10.1037/a0026148

Ganzini, L., Denneson, L. M., Press, N., Bair, M. J., Helmer, D. A., Poat, J., & Dobscha, S. K. (2013). Trust is the basis for effective suicide risk screening and assessment in veterans. Journal of General Internal Medicine, 28(9), 1215-1221. doi:10.1007/s11606-013-2412-6

Ghahramanlou-Holloway, M., Bhar, S. S., Brown, G. K., Olsen, C., & Beck, A. T. (2012). Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. Psychological Medicine, 42(6), 1185-1193. doi:10.1017/S0033291711002169

Hagan, C. R., Podlogar, M. C., Chu, C., & Joiner, T. E. (2015). Testing the interpersonal theory of suicide: The moderating role of hopelessness. International Journal of Cognitive Therapy, 8(2), 99-113. doi:10.1521/ijct.2015.8.2.99

Healy, D. (2009). Are selective serotonin reuptake inhibitors a risk factor for adolescent suicide? The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie, 54(2), 69-71.

Jobes, D. A. (2012). The collaborative assessment and management of suicidality (CAMS): An evolving evidence‐based clinical approach to suicidal risk. Suicide and Life-Threatening Behavior, 42(6), 640-653. doi:10.1111/j.1943-278X.2012.00119.x

Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach (2^nd ed.). New York, NY: Guilford Press.

Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

Kleespies, P. M., & Dettmer, E. L. (2000). The stress of patient emergencies for the clinician: incidence, impact, and means of coping. Journal of Clinical Psychology, 56(10), 1353-1369.

Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114-129.

Konrad, M., & Jobes, D. A. (Eds.). (2011). Building a therapeutic alliance with the suicidal patient. Washington, D.C.: American Psychological Association.

Large, M. M., & Ryan, C. J. (2014). Suicide risk categorisation of psychiatric inpatients: What it might mean and why it is of no use. Australasian Psychiatry, 22(4), 390-392. doi:10.1177/1039856214537128

Lau, M. A., Haigh, E. A. P., Christensen, B. K., Segal, Z. V., & Taube-Schiff, M. (2012). Evaluating the mood state dependence of automatic thoughts and dysfunctional attitudes in remitted versus never-depressed individuals. Journal of Cognitive Psychotherapy, 26(4), 381-389.

Lester, D., McSwain, S., & Gunn, J. F. (2011). A test of the validity of the IS PATH WARM warning signs for suicide. Psychological Reports, 108(2), 402–404. doi:10.2466/09.12.13.PR0.108.2.402-404

Linehan, M. (1993). Cognitive behavioral therapy of borderline personality disorder. New York, NY: Guilford Press.

Linehan, M. M., Comtois, K. A., & Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232. doi:10.1016/j.cbpra.2010.11.008

Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are thinking of killing yourself: The reasons for living inventory. Journal of Consulting and Clinical Psychology, 51(2), 276-286. doi:http://dx.doi.org/10.1037/0022-006X.51.2.276

Litman, R. E. (1995). Suicide prevention in a treatment setting.Suicide and Life-Threatening Behavior.Special Issue: Suicide Prevention: Toward the Year 2000, 25(1), 134–142.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Preparing people for change (3rd ed.). New York, NY: Guilford Press.

Nock, M. K., Kessler, R. C., & Franklin, J. C. (2016). Risk factors for suicide ideation differ from those for the transition to suicide attempt: The importance of creativity, rigor, and urgency in suicide research. Clinical Psychology: Science and Practice,doi:10.1111/cpsp.12133

Ribeiro, J. D., Silva, C., & Joiner, T. E. (2014). Overarousal interacts with a sense of fearlessness about death to predict suicide risk in a sample of clinical outpatients. Psychiatry Research, 218(1-2), 106-112. doi:10.1016/j.psychres.2014.03.036

Rosenberg, J. I. (1999). Suicide prevention: An integrated training model using affective and action-based interventions. Professional Psychology: Research and Practice, 30, 83-87.

Safran, J. D., Muran, J. C., & Eubanks-Carter, C. (2011). Repairing alliance ruptures. In J. C. Norcross (Ed.). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.) (pp. 224–238). New York, NY: Oxford University Press.

Schmitz, W. M., Jr., Allen, M. H., Feldman, B. N., Gutin, N. J., Jahn, D. R., Kleespies, P. M., . . . Simpson, S. (2012). Preventing suicide through improved training in suicide risk assessment and care: An American Association of Suicidology task force report addressing serious gaps in U. S. mental health training. Suicide and Life-Threatening Behavior, 42(3), 292-304. doi:10.1111/j.1943-278X.2012.00090.x

Shea, S. C., & Barney, C. (2015). Teaching clinical interviewing skills using role-playing: Conveying empathy to performing a suicide assessment: A primer for individual role-playing and scripted group role-playing. Psychiatric Clinics of North America, 38(1), 147-183. doi:10.1016/j.psc.2014.10.001

Shneidman, E. S. (1984). Aphorisms of suicide and some implications for psychotherapy. American Journal of Psychotherapy, 38(3), 319-328.

Shneidman, E. (1985). The definition of suicide. New York, NY: Wiley-Interscience.

Sommers-Flanagan, J., & Shaw, S. L. (2017). Suicide risk assessment: What psychologists should know. Professional Psychology: Research and Practice, 48, 98-106.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2017). Clinical interviewing (6^th ed.). Hoboken, NJ: John Wiley and Sons.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (1995). Intake interviewing with suicidal patients: A systematic approach. Professional Psychology: Research and Practice, 26(1), 41-47. doi:10.1037/0735-7028.26.1.41

Stanley, B. & Brown, G. K (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264.

Stanley, I. H., Hom, M. A., Rogers, M. L., Anestis, M. D., & Joiner, T. E. (2017) Discussing firearm ownership and access as part of suicide risk assessment and prevention: “Means safety” versus “means restriction.” Archives of Suicide Research, 21(2), 237-253. doi: 10.1080/13811118.2016.1175395

Strosahl, K., Chiles, J. A., & Linehan, M. (1992). Prediction of suicide intent in hospitalized parasuicides: Reasons for living, hopelessness, and depression. Comprehensive Psychiatry, 33(6), 366-373.

Swanson, J.W., Bonnie, R.J., & Appelbaum, P. S. (2015). Getting serious about reducing suicide: More “how” and less “why.” Journal of the American Medical Association,  314(21), 2229-2230. doi:10.1001/jama.2015.15566.

Tucker, R. P., Crowley, K. J., Davidson, C. L., & Gutierrez, P. M. (2015). Risk factors, warning signs, and drivers of suicide: What are they, how do they differ, and why does it matter? Suicide and Life-Threatening Behavior, doi:10.1111/sltb.12161

Wenzel, A., Brown, G. K., & Beck, A. T. (2009). Cognitive therapy for suicidal patients: Scientific and clinical applications. Washington, D.C.: American Psychological Association.

Wollersheim, J. P. (1974). The assessment of suicide potential via interview methods. Psychotherapy: Theory, Research & Practice, 11(3), 222-225. doi:10.1037/h0086344

Zahl, D. L., & Hawton, K. (2004). Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11,583 patients. British Journal of Psychiatry, 185(1), 70–75. doi: 10.1192/bjp.185.1.70