Skip to main content

Advertisement

Springer Nature Link
Log in

Suicide Risk Monitoring: the Missing Piece in Suicide Risk Assessment

  • Tools for Practice
  • Published:
Contemporary School Psychology Aims and scope Submit manuscript

Abstract

Suicide is the second leading cause of death among youth aged 10–25 years and approximately 1-in-6 adolescents reported serious suicidal ideation in the past year. Schools are a unique environment in which to identify and respond to youth suicide risk. Although there are screening tools for identifying which youth are at risk and assessment measures for establishing the severity of suicide risk, an essential aspect of risk management is excluded: monitoring youth suicide risk. It is likely that this gap exists because most of the development and research on screening and assessment is in settings such as outpatient mental health clinics or hospitals where routine monitoring is difficult. The Suicide Risk Monitoring Tool (SMT) was developed so that school mental health professionals could quickly track changes in youth already identified at-risk for suicide, including youth who are assessed but remain in school, or those who are re-entering school after a hospitalization. The SMT includes factors known to correlate with youth suicide risk. This paper will review the research on suicide screening and risk assessment, identify and describe the empirical and theoretical basis for the SMT, relate monitoring to the comprehensive risk assessment within a school’s overall framework for suicide risk assessment procedures, and provide a detailed case study that demonstrates how the SMT can be used with students in a school setting. Implications for research and practice are included.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
€32.70 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Finland)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington: American Psychiatric Association.

    Book  Google Scholar 

  • Barrett, J. R., Shetty, H., Broadbent, M., Cross, S., Hotopf, M., Stewart, R., & Lee, W. (2016). “He left me a message on Facebook”: comparing the risk profiles of self-harming patients who leave paper suicide notes with those who leave messages on new media. BJ Psych Open, 2(3), 217–220. https://doi.org/10.1192/bjpo.bp.116.002832.

    Article  Google Scholar 

  • Barrio, C. A. (2007). Assessing suicide risk in children: guidelines for developmentally appropriate interviewing. Journal of Mental Health Counseling, 29(1), 50–66.

    Article  Google Scholar 

  • Brent, D. A., Perper, J. A., Moritz, G., Baugher, M., Schweers, J., & Roth, C. (1993). Firearms and adolescent suicide: a community case-control study. American Journal of Diseases of Children, 147(10), 1066–1071. https://doi.org/10.1001/archpedi.1993.02160340052013.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2017). Web-based Injury Statistics Query and Reporting System (WISQARS) (Fatal Injury Reports, 1999–2015, for National, Regional, and States [RESTRICTED]). National Center for Injury Prevention and Control. Retrieved from http://webappa.cdc.gov/cgi-bin/broker.exe

  • Chhabra, N., & Bryant, S. M. (2016). Snapchat toxicology: social media and suicide. Annals of Emergency Medicine, 68(4), 527. https://doi.org/10.1016/j.annemergmed.2016.05.031.

    Article  PubMed  Google Scholar 

  • Chu, C., Klein, K. M., Buchman-Schmitt, J. M., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2015). Routinized assessment of suicide risk in clinical practice: an empirically informed update. Journal of Clinical Psychology, 71(12), 1186–1200. https://doi.org/10.1002/jclp.22210.

    Article  PubMed  Google Scholar 

  • Condron, D. S., Garraza, L. G., Walrath, C. M., McKeon, R., Goldston, D. B., & Heilbron, N. S. (2015). Identifying and referring youths at risk for suicide following participation in school-based gatekeeper training. Suicide & Life-Threatening Behavior, 45(4), 461–476. https://doi.org/10.1111/sltb.12142.

    Article  Google Scholar 

  • Eack, S. M., Singer, J. B., & Greeno, C. G. (2008). Screening for anxiety and depression in community mental health: the Beck Anxiety and Depression Inventories. Community Mental Health Journal, 44(6), 465–474. https://doi.org/10.1007/s10597-008-9150-y.

    Article  PubMed  Google Scholar 

  • Erbacher, T. A., Singer, J. B., & Poland, S. (2015). Suicide in schools: a practitioner’s guide to multi-level prevention, assessment, intervention, and postvention. New York: Routledge.

    Google Scholar 

  • Freuchen, A., & Grøholt, B. (2015). Characteristics of suicide notes of children and young adolescents: an examination of the notes from suicide victims 15 years and younger. Clinical Child Psychology and Psychiatry, 20(2), 194–206. https://doi.org/10.1177/1359104513504312.

    Article  PubMed  Google Scholar 

  • Garraza, L., Walrath, C., Goldston, D. B., Reid, H., & McKeon, R. (2015). Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on suicide attempts among youths. JAMA Psychiatry, 72(11), 1143–1149. https://doi.org/10.1001/jamapsychiatry.2015.1933.

    Article  Google Scholar 

  • Gould, M. S., Marrocco, F. A., Kleinman, M., Thomas, J. G., Mostkoff, K., Cote, J., & Davies, M. (2005). Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA: The Journal of the American Medical Association, 293(13), 1635–1643. https://doi.org/10.1001/jama.293.13.1635.

    Article  PubMed  Google Scholar 

  • Hom, M. A., Joiner, T. E., & Bernert, R. A. (2016). Limitations of a single-item assessment of suicide attempt history: implications for standardized suicide risk assessment. Psychological Assessment, 28(8), 1026–1030. https://doi.org/10.1037/pas0000241.

    Article  PubMed  Google Scholar 

  • Horowitz, L. M., Ballard, E. D., & Pao, M. (2009). Suicide screening in schools, primary care and emergency departments. Current Opinion in Pediatrics, 21(5), 620–627. https://doi.org/10.1097/MOP.0b013e3283307a89.

    Article  PubMed  PubMed Central  Google Scholar 

  • Joiner, T. E. (2007). Why people die by suicide. Cambridge: Harvard University Press.

    Google Scholar 

  • Joiner, T. E. (2011). Myths about suicide. Cambridge: Harvard University Press.

    Google Scholar 

  • Joiner, T. E., Steer, R. A., Brown, G., Beck, A. T., Pettit, J. W., & Rudd, M. D. (2003). Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide. Behaviour Research and Therapy, 41(12), 1469–1480.

    Article  PubMed  Google Scholar 

  • Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Hawkins, J., et al. (2016). Youth risk behavior surveillance—United States, 2015. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 65(6), 1–174. 10.15585/mmwr.ss6506a1.

    Google Scholar 

  • Kleiman, E. M., Turner, B. J., Fedor, S., Beale, E. E., Huffman, J. C., & Nock, M. K. (2017). Examination of real-time fluctuations in suicidal ideation and its risk factors: results from two ecological momentary assessment studies. Journal of Abnormal Psychology. https://doi.org/10.1037/abn0000273.

  • Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples. Journal of Abnormal Psychology, 122(1), 231–237.

    Article  PubMed  Google Scholar 

  • Lester, D., & Leenaars, A. (2016). A comparison of suicide notes written by men and women. Death Studies, 40(3), 201–203. https://doi.org/10.1080/07481187.2015.1086449.

    Article  PubMed  Google Scholar 

  • Miller, A. L., Rathus, J. H., & Linehan, M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.

    Google Scholar 

  • Millner, A. J., Lee, M. D., & Nock, M. K. (2017). Describing and measuring the pathway to suicide attempts: a preliminary study. Suicide & Life-Threatening Behavior, 47(3), 353–369. https://doi.org/10.1111/sltb.12284.

    Article  Google Scholar 

  • Mills, C., Stephan, S. H., Moore, E., Weist, M. D., Daly, B. P., & Edwards, M. (2006). The President’s New Freedom Commission: capitalizing on opportunities to advance school-based mental health services. Clinical Child and Family Psychology Review, 9(3–4), 149–161. https://doi.org/10.1007/s10567-006-0003-3.

    Article  PubMed  Google Scholar 

  • Pisani, A. R., Murrie, D. C., & Silverman, M. M. (2016). Reformulating suicide risk formulation: from prediction to prevention. Academic Psychiatry, 40, 623–629. https://doi.org/10.1007/s40596-015-0434-6.

    Article  PubMed  Google Scholar 

  • Ribeiro, J. D., Bodell, L. P., Hames, J. L., Hagan, C. R., & Joiner, T. E. (2013). An empirically based approach to the assessment and management of suicidal behavior. Journal of Psychotherapy Integration, 23(3), 207–221. https://doi.org/10.1037/a0031416.

    Article  Google Scholar 

  • Scott, M., Wilcox, H., Huo, Y., Turner, J. B., Fisher, P., & Shaffer, D. (2010). School-based screening for suicide risk: balancing costs and benefits. American Journal of Public Health, 100(9), 1648–1652. https://doi.org/10.2105/AJPH.2009.175224.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shea, S. C. (2002). The practical art of suicide assessment: a guide for mental health professionals and substance abuse counselors. Lexington: Mental Health Presses.

    Google Scholar 

  • Shea, S. C. (2017). Uncovering a patient’s hidden method of choice for suicide: insights from the Chronological Assessment of Suicide Events (CASE approach). Psychiatric Annals, 47(8), 421–427. https://doi.org/10.3928/00485713-20170708-01.

    Article  Google Scholar 

  • Smith, A. R., Witte, T. K., Teale, N. E., King, S. L., Bender, T. W., & Joiner, T. E. (2008). Revisiting impulsivity in suicide: implications for civil liability of third parties. Behavioral Sciences & the Law, 26(6), 779–797. https://doi.org/10.1002/bsl.848.

    Article  Google Scholar 

  • Stack, S., & Rockett, I. R. H. (2016). Are suicide note writers representative of all suicides? Analysis of the National Violent Death Reporting System. Suicide & Life-Threatening Behavior. https://doi.org/10.1111/sltb.12320.

  • Stanley, B., & Brown, G. K. (2012). Safety planning intervention: a brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001.

    Article  Google Scholar 

  • Stiffman, A. R., Pescosolido, B., & Cabassa, L. J. (2004). Building a model to understand youth service access: the Gateway Provider Model. Mental Health Services Research, 6(4), 189–198.

    Article  PubMed  PubMed Central  Google Scholar 

  • Walrath, C., Garraza, L. G., Reid, H., Goldston, D. B., & McKeon, R. (2015). Impact of the Garrett Lee Smith Youth Suicide Prevention Program on suicide mortality. American Journal of Public Health, 105(5), 986–993. https://doi.org/10.2105/AJPH.2014.302496.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wintersteen, M. B. (2010). Standardized screening for suicidal adolescents in primary care. Pediatrics, 125(5), 938–944. https://doi.org/10.1542/peds.2009-2458.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Philadelphia College of Osteopathic Medicine, School Psychology Department, 4170 City Avenue, Philadelphia, PA, 19131, USA

    Terri A. Erbacher

  2. Loyola University Chicago, Chicago, IL, USA

    Jonathan B. Singer

Authors
  1. Terri A. Erbacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan B. Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Terri A. Erbacher.

Ethics declarations

This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent is therefore not applicable.

Conflict of Interest

Both authors of this manuscript receive royalties from the sale of their 2015 text, Suicide in schools: A practitioner’s guide to multi-level prevention, assessment, intervention, and postvention, through which the suicide monitoring tool noted in this article is made available.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Erbacher, T.A., Singer, J.B. Suicide Risk Monitoring: the Missing Piece in Suicide Risk Assessment. Contemp School Psychol 22, 186–194 (2018). https://doi.org/10.1007/s40688-017-0164-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40688-017-0164-8

Keywords

Search

Navigation