Abstract:
A high percentage of individuals who die by suicide are in treatment at the time of their death. This speaks to the importance of ensuring adequate training for mental health providers in the assessment and treatment of suicidal behavior. This chapter provides information on areas of competence that are essential for clinicians working with patients at risk for suicide. Specifically, this chapter provides guidelines for assessing suicide risk and ensuring patient safety, as well as data on factors that maintain suicidal behavior. An overview of the literature on empirically-based treatment of suicidal behavior is provided, as well as data on the mechanisms of action for these treatments. Importantly, this chapter provides an overview of the basic competencies of clinicians working with patients at risk for suicide and the steps necessary to move from basic competence to expert competence.
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References
Appleby, L., Shaw, J., Amos, T., McDonnell, R., Harris, C., McCann, K., et al. (1999). Suicide within 12 months of contact with mental health services: national clinical survey. British Medical Journal, 318, 1235–1239.
Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97, 90–113.
Beck, A. T. (1996). Beyond belief: A theory of modes, personality, and psychopathology. In Salkovksis, P. M. (Ed.), Frontiers of cognitive therapy. New York: Guilford.
Beck, A. T., Brown, G., & Steer, R. A. (1989). Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness. Journal of Consulting and Clinical Psychology, 57, 309–310.
Beck, A. T., Steer, R. A., Beck, J. S., & Newman, C. F. (1993). Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide and Life-Threatening Behavior, 23, 139–145.
Birtchnell, J. (1983). Psychotherapeutic considerations in the management of the suicidal patient. American Journal of Psychotherapy, 37, 24–36.
Black, H. C. (1996). Black’s law dictionary. St. Paul, MN: West.
Boardman, A. P., Grimbaldeston, A. H., Handley, C., Jones, P. W., & Willmott, S. (1999). The new staffordshire suicide study: A case-control study of suicide in one health district. Psychological Medicine, 29, 27–33.
Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.
Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68, 371–377.
Brown, G. K., Jeglic, E., Henriques, G. R., & Beck, A. T. (2006). Cognitive therapy, cognition, and suicidal behavior. In Ellis, T. E. (Ed.), Cognition and suicide: Theory, research, and therapy. Washington, DC: American Psychological Association.
Brown, G. K., TenHave, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294, 563–570.
Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111, 198–202.
Bryan, C. & Rudd, M. D. (2006). Advances in the assessment of suicide risk. Journal of Clinical Psychology, 62, 185–200.
Callahan, C. M., Hendrie, H. C., & Tierney, W. M. (1996). The recognition and treatment of late-life depression: a view from primary care. International Journal of Psychiatry in Medicine, 26, 155–171.
Center for Disease Control and Prevention. (2004). WISQARS (web-based injury statistics query and reporting system). Retrieved June 30, 2007 from http://www.cdc.gov/ncipc/wisqars/default.html
Chance, S. E., Kaslow, N. J., & Baldwin, K. (1994). Anxiety and other predictors of severity of suicidal intent in urban psychiatric inpatients. Violent Behavior and Mental Illness, 45, 716–718.
Chapman, A. L., Specht, M. W., & Celluci, T. (2005). Borderline personality disorder and deliberate self-harm: Does experiential avoidance play a role? Suicide and Life-Threatening Behavior, 35, 388–399.
Conner, K. R., Duberstein, P. R., & Conwell, Y. (1999). Age-related patterns of factors associated with completed suicide in men with alcohol dependence. The American Journal on Addictions, 8, 312–318.
Conwell, Y. (1994). Suicide in elderly patients. In: Diagnosis and treatment of depression in late life: Results of the NIH consensus development conference. Washington, DC: American Psychiatric Press.
Cukrowicz, K. C., Wingate, L. R., Driscoll, K. A., & Joiner, T. E. (2004). A standard of care for the assessment of suicide risk and associated treatment: The Florida State University Psychology Clinic as an example. Journal of Contemporary Psychotherapy, 34, 87–100.
De Catanzaro, D. (1995). Reproductive status, family interactions, and suicidal ideation: Surveys of the general public and high-risk groups. Ethology and Sociobiology, 16, 385–394.
Durkheim, E. (1951). Suicide (G. Simpson, Trans.). New York: Free Press (Original work published 1897).
Ericsson, K. A., Krampe, R. T., & Tesch-Romer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100, 363–406.
Ericsson, K. A., Roring, R. W., & Nandagopal, K. (2007). Giftedness and evidence for reproducibly superior performance: An account based on the expert performance framework. High Ability Studies, 18, 3–56.
Fawcett, J. (1999). Profiles of completed suicides. In Jacobs, D. (Ed.), The harvard medical school guide to suicide assessment and intervention. San Francisco, CA: Jossey-Bass.
Foster, T. (2003). Suicide note themes and suicide prevention. International Journal of Psychiatry in Medicine, 33, 323–331.
Goldberg, R. (1987). The assessment of suicide risk in the general hospital. General Hospital Psychiatry, 9, 446–452.
Granboulan, V., Roudot-Thoraval, F., Lemerle, S., & Alvin, P. (2001). Predictive factors of post-discharge follow-up care among adolescent suicide attempters. Acta Psychiatr Scand, 104, 31–36.
Gratz, K. L. & Chapman, A. L. (2007). The role of emotional responding and childhood maltreatment in the development and maintenance of deliberate self-harm among male undergraduates. Psychology of Men and Masculinity, 8, 1–14.
Gratz, K. L. & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.
Guthrie, E., Kapur, N., Mackway-Jones, K., Chew-Graham, C., Moorey, J., Mendel, E., et al. (2001). Randomised controlled trial of brief psychological intervention after deliberate self poisoning. British Medical Journal, 323, 135.
Hayes, S., Barlow, D., & Nelson-Gray, R. (1999). The scientist practitioner: Research and accountability in the age of managed care (2nd ed.). Needham Heights, MA: Allyn & Bacon.
Hendin, H., Lipschitz, A., Maltsberger, J., Haas, A., & Wynecoop, S. (2000). Therapists’ reactions to patients’ suicides. American Journal of Psychiatry, 157, 2022–2027.
Huey, S., Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C. A., Cunningham, P., Pickrel, S. G., et al. (2004). Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 183–190.
Jacobs, D. & Brewer, M. (2004). American Psychiatric Association practice guidelines provides recommendations for assessing and treating patients with suicidal behaviors. Psychiatric Annals, 34, 373–380.
Jacobs, D. G., Baldessarini, R. J., Conwell, Y., Fawcett, J. A., Horton, L., Meltzer, H., et al. (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. Arlington, VA: American Psychiatric Association.
Jobes, D. A. & Berman, A. L. (1993). Suicide and malpractice liability: Assessing and revising policies, procedures, and practice in an outpatient setting. Professional Psychology: Research and Practice, 24, 91–99.
Joiner, T. E., Jr. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
Joiner, T. E., Conwell, Y., Fitzpatrick, K., Witte, T., Schmidt, N., Berlim, M., et al. (2005). Four studies on how past and current suicidality relate even when ‘Everything But the Kitchen Sink’ is covaried. Journal of Abnormal Psychology, 114, 291–303.
Joiner, T. E., Hollar, D., & Van Orden, K. A. (2006). On buckeyes, gators, super bowl Sunday, and the miracle on ice: “Pulling together” is associated with lower suicides. Journal of Social and Clinical Psychology, 25, 179–195.
Joiner, T. E., Pettit, J. W., Walker, R. L., Voelz, Z. R., & Cruz, J. (2002). Perceived burdensomeness and suicidality: Two studies on the suicide notes of those attempting and those completing suicide. Journal of Social and Clinical Psychology, 21, 531–545.
Joiner, T. E., Rudd, M. D., & Rajab, M. H. (1997). The modified scale for suicidal ideation: Factors of suicidality and their relation to clinical and diagnostic variables. Journal of Abnormal Psychology, 106, 260–265.
Joiner, T. E., Walker, R. L., Rudd, M. D., & Jobes, D. A. (1999). Scientizing and routinizing the assessment of suicidality in outpatient practice. Professional Psychology: Research and Practice, 30, 447–453.
Kessler, R., Borges, G., & Walters, E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617–626.
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226–239.
Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., et al. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.
Larsen, R. J. (1984). Theory and measurement of affect intensity as an individual difference characteristic. Dissertation Abstracts International, 85, 2297B.
Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guildford.
Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.
Linehan, M. M., Comtois, K. A., & Korslund, K. E. (2004). Dialectical behavior therapy versus nonbehavioral treatment-by-experts in the community: Clinical outcomes. In Kuom, J. R. & Lindenboim, N. (Chairs), Symposium conducted at the 112th Convention of the American Psychological Association, Honolulu.
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallup, R. J., Heard, H. L., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy for experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.
Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., Heagerty, P., et al. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.
Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. The American Journal on Addictions, 8, 279–292.
Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M. M. (2006). Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations. Journal of Clinical Psychology, 62, 459–480.
Lynch, T. R., Cheavens, J. S., Cukrowicz, K. C., Thorp, S. R., Bronner, L., & Beyer, J. (2007). Treatment of older adults with co-morbid personality disorder and depression: A dialectical behavior therapy approach. International Journal of Geriatric Psychiatry, 22, 131–143.
Magne-Ingvar, U. & Oejehagen, A. (1999). Significant others of suicide attempters: Their views at the time of the acute psychiatric consultation. Social Psychiatry and Psychiatric Epimemiology, 34, 73–79.
Mandrusiak, M., Rudd, M. D., Joiner, T. E., Jr., Berman, A. L., Van Orden, K. A., & Witte, T. (2006). Warning signs for suicide on the internet: A descriptive study. Suicide and Life-Threatening Behavior, 36, 263–271.
McMillan, D., Gilbody, S., Beresford, E., & Neilly, L. (2007). Can we predict suicide and non-fatal self-harm with the Beck Hopelessness Scale? A meta-analysis. Psychological Medicine, 37, 769–778.
Menninger, W. (1991). Patient suicide and its impact on the psychotherapist. Bulletin of the Menninger Clinic, 55, 216–227.
Motto, J. A. & Bostrom, A. G. (1990). Empirical indicators of near-term suicide risk. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 11, 52–59.
Motto, J. A. & Bostrom, A. G. (2001). A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 52, 828–833.
Nock, M. K. & Prinstein, M. J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114, 140–146.
O’Carroll, P. W., Berman, A. L., Maris, R. W., & Moscicki, E. K. (1996). Beyond the tower of Babel: A nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26, 237–252.
Packman, W. L., O’Connor Pennuto, T., Bongar, B., & Orthwein, J. (2004). Legal issues of professional negligence in suicide cases. Behavioral Sciences & the Law, 22, 697–713.
Piacentini, J., Rotheram-Borus, M. J., Gillis, J. R., Graae, F., Trautman, P., Cantwell, C., et al. (1995). Demo-graphic predictors of treatment attendance among adolescent suicide attempters. Journal of Consulting and Clinical Psychology, 63, 469–473.
Pettit, J. W., Lam, A. G., Voelz, Z. R., Walker, R. L., Perez, M., Joiner, T. E., Jr., et al. (2002). Perceived burdensomeness and lethality of suicide method among suicide completers in the people’s republic of China. Omega, 45, 57–67.
Roberts, A. R. (2002). Assessment, crisis intervention, and trauma treatment: The integrative ACT intervention model. Brief Treatment and Crisis Intervention, 2, 1–21.
Rudd, M. D. (2000). The suicidal mode: A cognitive-behavioral model of suicidality. Suicide and Life-Threatening Behavior, 30, 18–33.
Rudd, M. D., Berman, A. L., Joiner, T. E., Jr., Nock, M. K., Silverman, M. M., Mandrusiak, M., et al. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36, 255–262.
Rudd, M. D., Cukrowicz, K. C., & Bryan, C. J. (2008). Core competencies in suicide risk assessment and management: Implication for supervision of those in training. Training and Education in Professional Psychology, 2, 219–228.
Rudd, M. D., Joiner, T. E., & Rajab, M. H. (1996). Relationships among suicide ideators, attempters, and multiple attempters in a young-adult sample. Journal of Abnormal Psychology, 105, 541–550.
Rudd, M. D., Joiner, T. E., Jr., & Rajab, M. H. (2001). Treating suicidal behavior: An effective, time-limited approach. New York: Guilford.
Rudd, M. D., Mandrusiak, M., Joiner, T. E., Berman, A. L., Van Orden, K. A., & Hollar, D. (2006). The emotional impact and ease of recall of warning signs for suicide: A controlled study. Suicide and Life-Threatening Behavior, 36, 288–295.
Rudd, M. D., Rajab, M. H., Orman, D. T., Stulman, D. A., Joiner, T., & Dixon, W. (1996). Effectiveness of an outpatient intervention targeting suicidal young adults: Preliminary results. Journal of Consulting and Clinical Psychology, 64, 179–190.
Salkovskiss, P. M., Atha, C., & Storer, D. (1990). Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide: A controlled trial. British Journal of Psychiatry, 157, 871–876.
Satcher, D. (2001). National strategy for suicide prevention: Goals and objectives for action. Rockville, MD: U.S. Department of Health and Human Services PHS, editor.
Schneidman, E. (1996). Suicide as psychache. Essential papers on suicide. New York: New York University Press.
Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007). Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicide behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide and Life-Threatening Behavior, 37, 264–277.
Simon, R. I. (2007). Gun safety management with patients at risk for suicide. Suicide and Life-Threatening Behavior, 37, 518–526.
Spirito, A., Boergers, J., Donaldson, D., Bishop, D., & Lewander, W. (2002). An intervention trial to improve adherence to community treatment by adolescents after a suicide attempt. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 435–442.
Spirito, A., Brown, L., Overholser, J., & Fritz, G. (1989). Attempted suicide in adolescence: A review and critique of the literature. Clinical Psychology Review, 9, 335–363.
Stellrecht, N. E., Gordon, K. H., Van Orden, K. A., Witte, T. K., Wingate, L. R., Cukrowicz, K. C., et al. (2006). Clinical applications of the interpersonal-psychological theory of attempted and completed suicide. Journal of Clinical Psychology, 62, 211–222.
Suicide Prevention Resource Center. (2006). Core competencies in the assessment and management of suicidality. Newton, MA: SPRC.
Turner, R. M. (2000). Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice, 7, 413–419.
Vaiva, G., Ducrocq, F., Meyer, P., Mathieu, D., Philippe, A., Libersa, C., et al. (2006). Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: Randomised controlled study. British Medical Journal, 332, 1241–1245.
Van Heeringen, C., Jannes, S., Buylaert, W., Henderick, H., De Bacquer, D., & Van Remoortel, J. (1995). The management of non-compliance with referral to out-Patient after-care among attempted suicide patients: A controlled intervention Study. Psychological Medicine, 25, 963–970.
Van Orden, K. A., Joiner, T. E., Jr., Hollar, D., Rudd, M. D., Mandrusiak, M., & Silverman, M. M. (2006). A test of the effectiveness of a list of suicide warning signs for the public. Suicide and Life-Threatening Behavior, 36, 272–287.
Van Orden, K. A., Lynam, M. E., Hollar, D., & Joiner, T. E. (2006). Perceived burdensomeness as an indicator of suicidal symptoms. Cognitive Therapy and Research, 30, 457–467.
Van Orden, K. A., Merrill, K. A., & Joiner, T. E. (2005). Interpersonal-psychological precursors to suicidal behavior: A theory of attempted and completed suicide. Current Psychiatry Reviews, 1, 187–196.
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicide desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72–83.
Verheul, R., van den Bosch, L. M. C., Koeter, M. W. J., de Ridder, M. A. J., Stijen, T., & van den Brink, W. (2003). Dialectical behavior therapy for women with borderline personality disorder: 12-month, randomized clinical trial in the Netherlands. British Journal of Psychiatry, 182, 135–140.
Wagner, K. D., Rouleau, M., & Joiner, T. E., Jr. (2000). Cognitive factors related to suicidal ideation and resolution in psychiatrically hospitalized children and adolescents. American Journal of Psychiatry, 157, 2017–2021.
Welu, T. C. (1977). A follow-up program for suicide attempters: Evaluation of effectiveness. Suicide and Life-Threatening Behavior, 7, 17–30.
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Cukrowicz, K.C., Smith, P.N., Schlegel, E.F. (2010). Managing Suicidality. In: Thomas, J.C., Hersen, M. (eds) Handbook of Clinical Psychology Competencies. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09757-2_41
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