Skip to main content
SpringerLink
Log in

Differentiation of Suicidal Behavior in Clinical Practice

  • Reference work entry
  • First Online:
Suicide Risk Assessment and Prevention

  • 909 Accesses

Abstract

A clinical differentiation model of suicidal behaviors may improve clinical practice. It may be helpful to determine which type of treatment is most appropriate for subtypes of suicidal behaviors and may improve adherence to suicide prevention guidelines. Also, differentiation of suicidal behaviors may create clarity about the role of healthcare providers, patients, and social networks in the prevention of completed suicide. From clinical experience, we developed a new model to differentiate subtypes of suicidal behaviors, the hypothetic four-type model of entrapment (H4ME), distinguishing the origin of entrapment that may result in a suicidal state. The subtypes are (1) perceptual disintegration (PD), (2) primary depressive cognition (PDC), (3) psychosocial turmoil (PT), and (4) inadequate communication/coping (IC) (emphasizing emotional pain). The SUICIDI-questionnaire was designed to identify subtypes of entrapment. In this chapter, we briefly describe previous models of subtypes of suicide, the background of the H4ME development, and a study design to examine the proposed models’ validity.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 649.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 699.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ten Have M, De Graaf R, Van Dorsselaer S, Verdurmen J, Van’t Land H, Vollebergh W. Suïcidaliteit in de algemene bevolking. Resultaten van de Netherlands Mental Health Survey and Incidence Study (NEMESIS) Suicidality in the general population. Results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Utrecht; 2006.

    Google Scholar 

  2. Sotiriou C, Neo S, McShane L, Korn E, Long P, Jazaeri A, et al. Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci U S A. 2003;100(18):10393–8.

    Article  CAS  Google Scholar 

  3. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28:37–42.

    Article  Google Scholar 

  4. Joosten-Weyn Banningh L, Vernooij-Dassen M, Rikkert MO, Teunisse J-P. Mild cognitive impairment: coping with an uncertain label. Int J Geriatr Psychiatry. 2008;23(2):148–54.

    Article  Google Scholar 

  5. Bernanke J, Galfalvy H, Mortali M, Hoffman L, Moutier C, Nemeroff C, et al. Suicidal ideation and behavior in institutions of higher learning: a latent class analysis. J Psychiatry Res. 2017;9(95):253–9.

    Article  Google Scholar 

  6. Colpe LJ, Pringle BA. Data for building a national suicide prevention strategy: what we have and what we need. Am J Prev Med. 2014;47(3 Suppl 2):S130–6.

    Article  Google Scholar 

  7. De Winter R, Hazewinkel M, Meyer C, van den Bos A, Enterman J, Heidstra A, et al. Protocol voor de VAMOS-G studie. Garmerwolde; 2020.

    Google Scholar 

  8. Baldessarini R, Tondo L. Suicidal risks in 12 DSM-5 psychiatric disorders. J Affect Disord. 2020;15(271):66–73.

    Article  Google Scholar 

  9. Zalsman G, Hawton K, Wasserman D, Van Heeringen K, Arensman E, Sarchiapone M, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016;3(7):646–59.

    Article  Google Scholar 

  10. Huisman A. Learning from suicides. Towards an improved supervision procedure of suicides in mental health care in the Netherlands. Amsterdam: Vrije Universiteit; 2010.

    Google Scholar 

  11. De Winter R, Hazewinkel M, van de Sande R, de Beurs D, de Groot M. Outreach psychiatric emergency service. Characteristics of patients with suicidal behavior and subsequent policy. Crisis. 2020;41(5):375–82. https://doi.org/10.1027/0227-5910/a000651.

    Article  Google Scholar 

  12. Huber C, Schneeberger A, Kowalinski E, Fröhlich D, Von Felten S, Walter M, et al. Suicide risk and absconding in psychiatric hospitals with and without open door policies: a 15- year, observational study. Lancet Psychiatry. 2016;3(9):842–9.

    Article  Google Scholar 

  13. Martin J, LaCroix J, Novak L, Ghahramanlou-Holloway M. Typologies of suicide: a critical literature review. Arch Suicide Res. 2019;24(2):1–30.

    Google Scholar 

  14. Durkheim E. Suicide: a study in sociology. New York: Free Press; 1951.

    Google Scholar 

  15. Shneidman E. Orientations toward death. A vital aspect of the study of lives. Int J Psychiatry. 1966;2(2):167–200.

    Google Scholar 

  16. Reynolds F, Berman A. An empirical typology of suicide. Arch Suicide Res. 1995;1(2):97–109.

    Article  Google Scholar 

  17. Chen EYH, Chan WSC, Chan SSM, Liu KY, Chan CLW, Wong PWC, et al. A cluster analysis of the circumstances of death in suicides in Hong Kong. Suicide Life Threat Behav. 2007;37(5):576–84.

    Article  Google Scholar 

  18. O’Connor RC, Sheehy NP, O’Connor DB. The classification of completed suicide into subtypes. J Ment Health. 1999;8(6):629–37.

    Article  Google Scholar 

  19. Wold CI. Sub-groupings of suicidal people. Omega J Death Dying. 1971;2(1):19–29.

    Article  Google Scholar 

  20. Logan J, Hall J, Karch D. Suicide categories by patterns of known risk factors. Arch Gen Psychiatry. 2011;68(9):935–41.

    Article  Google Scholar 

  21. Sinyor M, Schaffer A, Streiner D. Characterizing suicide in Toronto: an observational study and cluster analysis. Can J Psychiatry. 2014;59(1):26–33.

    Article  Google Scholar 

  22. Williams J. The cry of pain. London: Penguin; 2001.

    Google Scholar 

  23. Joiner T. Why people die by suicide. Cambridge, MA/London: Harvard University Press; 2005.

    Google Scholar 

  24. Baumeister RF. Suicide as escape from self. Psychol Rev. 1990;99(1):90–113.

    Article  Google Scholar 

  25. O'Connor R. Towards an integrated motivational-volitional model of suicidal behaviour. In: O’Connor R, Platt J, Gordon J, editors. International handbook of suicide prevention research, policy and practice. Chichester: Wiley; 2011.

    Chapter  Google Scholar 

  26. Andreasson K. Suicide prevention and borderline personality disorder-the DiaS trial. Copenhagen: PhD Thesis University of Copenhagen; 2016.

    Google Scholar 

  27. Barnhofer T, Crane C, Brennan K, Duggan D, Crane R, Eames C, et al. Mindfulness-based cognitive therapy (MBCT) reduces the association between depressive symptoms and suicidal cognitions in patients with a history of suicidal depression. J Consult Clin Psychol. 2015;83(6):1013–20.

    Article  Google Scholar 

  28. Jobes D, Linehan M. Managing suicidal risk. A collaborative approach. 2nd ed. New York: Guilford Press; 2016.

    Google Scholar 

  29. Jobes D, Chalker S. One size does not fit all: a comprehensive clinical approach to reducing suicidal ideation, attempts, and deaths. Int J Environ Res Public Health. 2019;16(19):3606.

    Article  Google Scholar 

  30. Mann J, Currier D. Medication in suicide prevention insights from neurobiology of suicidal behavior. In: Dwivedi Y, editor. The neurobiological basis of suicide. Boca Raton (FL): CRC Press/Taylor&Francis; 2012.

    Google Scholar 

  31. Mewton L, Andrews G. Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes. Psychol Res Behav Manag. 2016;9(1):21–9.

    Article  Google Scholar 

  32. Van Hemert A, Kerkhof A, de Keijser J, Verwey B, van Boven C, Hummelen J, et al. Multidisciplinaire richtlijn voor diagnostiek en behandeling van suïcidaal gedrag. Utrecht: De Tijdstroom. 2012;2012

    Google Scholar 

  33. De Beurs D. Improving care for suicidal patients by implementing guideline recommendations. On the effects of an e-learning supported train-the-trainer program and the assessment of suicide ideation. Amsterdam: Vrije Universiteit; 2015.

    Google Scholar 

  34. De Groot M, De Beurs DP, De Keijser J, Kerkhof AJFM. An e-learning supported train the-trainer program to implement a suicide practice guideline. Rationale, content and dissemination in Dutch mental health care. Internet Interv. 2015;2(3):223.

    Article  Google Scholar 

  35. Goldney D. Suicide prevention: a practical approach. Oxford: Oxford University Press; 2008.

    Book  Google Scholar 

  36. Williams J, Barnhofer T, Duggan D. Psychology and suicidal behavior: elaborating the entrapment model. In: Hawton K, editor. Prevention and treatment of suicidal behavior from science to practice. Oxford: Oxford University Press; 2005.

    Google Scholar 

  37. Shea S. Psychiatric interviewing, the art of understanding. Philadelphia: Saunders Company; 1998.

    Google Scholar 

  38. De Beurs D, De Groot M, De Keijser J, Mokkenstorm J, Van Duijn E, De Winter R, et al. The effect of an e-learning supported train-the-trainer programme om implementation of suicide guidelines in mental health care. J Affect Disord. 2015;175C:446–53.

    Article  Google Scholar 

  39. De Beurs D, De Groot M, De Keijser J, Van Duijn E, De Winter R, Kerkhof A. Evaluation of benefit to patients of training mental health professionals in suicide guidelines: cluster randomised trial. Br J Psychiatry. 2016;208(5):477–83.

    Article  Google Scholar 

  40. Neeleman J. The social and epidemiological context of suicidal behaviour. Groningen: Rijksuniversiteit; 1997.

    Google Scholar 

  41. National institute for health and care excellence. Suicide prevention quality standard. Manchester/London: NICE; 2019.

    Google Scholar 

  42. New Zealand Guideline Group. The assessment and management of people at risk of suicide. Wellington: NZGG/Ministry of Health; 2012.

    Google Scholar 

  43. American Psychiatrist Association. Practice guideline for the assessment and treatment of patients with suicidal behaviors [published correction in Am J Psychiatry. 2004 Apr;161(4):776]. Am J Psychiatry. 2003;160(11 Suppl):1–60.

    Google Scholar 

  44. Van Luyn B, Kaasenbrood A. Suïcidaliteit in de acute en sociale psychiatrie. In: Kerkhof A, Van Luyn B, editors. Suïcidepreventie in de praktijk. Houten: Boh Stafleu Van Loghum; 2010. p. 217–34.

    Chapter  Google Scholar 

  45. Van Luyn B. Behandeling van suïcidaliteit bij persoonlijkheidsstoonissen. In: Kerkhof A, Van Luyn B, editors. Suïcidepreventie in de praktijk. Houten: Boh Stafleu Van Loghum; 2010. p. 187–98.

    Chapter  Google Scholar 

  46. de Groot M, De Winter R. Beoordeling van het suïciderisico. Houten: Ing. Alex Langhout; 2020.

    Google Scholar 

  47. De Winter R. Towards an improvement of the differentiation of depressive disorders. A multidimensional approach. Leiden: Leiden University Medical Center (LUMC); 2009.

    Google Scholar 

  48. Zaninotto L, Solmi M, Toffanin T, Veronese N, Cloninger C, Correll C. A meta-analysis of temperament and character dimensions in patients with mood disorders: comparison to healthy controls and unaffected siblings. J Affect Disord. 2016;194(2):84–97.

    Article  Google Scholar 

  49. De Winter R, van den Bos A. Differentiatie van suïcidaal gedrag. Voorjaarscongres Nederlandse Vereniging Voor Psychiatrie (NVVP); 2018; Maastricht.

    Google Scholar 

  50. De Winter R, de Groot M. Differentiation of suicidal behaviour, a practical clinical approach. European Symposium on Suicide and Suicidal behaviour 17 (ESSSB17); September, 5 2018.; Gent, 2018.

    Google Scholar 

  51. De Winter R, Meyer C, van den Bos A, Kool N, de Groot, M. Differentiation of suicidal behaviour, a practical clinical approach. In: (IASP) IAfSP, editor.; September 17–21, 2019; Londonderry 2019.

    Google Scholar 

  52. De Groot M, De Winter R. Beoordeling van het suïcide risico. In: Van Heeringen K, Portzky G, De Beurs D, Kerkhof A, editors. Handboek Suïcidaal Gedrag. Amsterdam: De Tijdstoom/Boom; 2019. p. 285–304.

    Google Scholar 

  53. De Winter R. Differentiatie van suïcidaal gedrag. Digitaal Voorjaarscongres Nederlandse Vereniging voor Psychiatrie (NVVP); June, 17; Maastricht2020.

    Google Scholar 

  54. 113 Zelfmoordpreventie. Suïcidepreventietoolkit Amsterdam2020. Available from: https://web.alii.care/protocols/3171?client=113.

  55. Calati R, Courtet P, Lopez-Castroman J. Refining suicide prevention: a narrative review on advances in psychotherapeutic tools. J Curr Psychiatry Rep. 2018;20(2):14.

    Article  Google Scholar 

  56. Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts. A randomised controlled trial. J Am Med Assoc. 2005;294(5):563–70.

    Article  CAS  Google Scholar 

  57. Mann J, Currier D. Medication in suicide prevention insights from neurobiology of suicidal behaviour. In: Dwivedi Y, editor. The neurobiological basis of suicide. BocaRaton (FL): CRC Press/Taylor & Francis; 2012.

    Google Scholar 

  58. Tondo L, Baldessarini R. Antisuicidal effects in mood disorders: are they unique to lithium? Pharmacopsychiatry. 2018;5(15):177–88.

    Google Scholar 

  59. Dadiomov D, Lee K. The effects of ketamine on suicidality across various formulations and study settings. Mental Health Clinc. 2019;9(1):48–60.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychiatry, VU University/Mental Health Institute Rivierduinen, Amsterdam/Leiden, The Netherlands

    Remco F. P. de Winter, Connie Meijer, Nienke Kool & Marieke H. de Groot

Authors
  1. Remco F. P. de Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Connie Meijer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nienke Kool
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marieke H. de Groot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Remco F. P. de Winter .

Editor information

Editors and Affiliations

  1. Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy

    Maurizio Pompili

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

de Winter, R.F.P., Meijer, C., Kool, N., de Groot, M.H. (2022). Differentiation of Suicidal Behavior in Clinical Practice. In: Pompili, M. (eds) Suicide Risk Assessment and Prevention. Springer, Cham. https://doi.org/10.1007/978-3-030-42003-1_17

Download citation

Publish with us

Policies and ethics

Search

Navigation