Crisis Intervention-Ch 10. Suicide

Question 1

who quoted “ Anguish of mind has driven thousands to suicide; anguish of body, none. This proves that the health of the mind is of far more consequence to our happiness, than the health of the body, although both are deserving of much more attention than either of them receive.

Answer 1

C.C. Colton

Question 2

who explained that suicide is not an illness, rather suicide is “A human, psychological orientation toward life, not a biological, medical disease.

Answer 2

1989, Suicidologist Edwin Shneidman

Question 3

Epidemiology of Suicide:(study of how disease spread)

Answer 3

1998, the year for which the most recent statistics are available, suicide was the 8th leading cause of mortality in US. 30,000 deaths (83 deaths per day)

• homicide accounted for less than 21,000 deaths.
• 1999, suicide remained the 8th leading cause of death for all Americans.

Question 4

High Risk populations:

1999, US Public Health Service identified 5 US population to be at high risk for suicide.

Answer 4

1. youth
2. elderly
3. medically ill
4. specific population groups
5. persons with mental and substance abuse disor.

Question 5

High Risk populations:

leading cause of death for 5 to 14 yrs olds.

Answer 5

Suicide, 6th leading cause of death

Question 6

suicide is currently the third leading cause of death for

Answer 6

15-24 yr old

Question 7

suicide is 4th leading cause of death for

Answer 7

25 to 44 yr olds

Question 8

between ____ and ___, the reported rates of suicide among adolescents and young adults nearly tripled.

Answer 8

1952 and 1998

Question 9

Currently, suicide is the second leading cause of death for

Answer 9

white adolescents and young adults 15 to 24 exceeded only by unintentional injury.

Question 10

Risk factors for attempted suicide in youth are

Answer 10

1. depression
2. alcohol or drug use disorder
3. aggressive or disruptive behaviors

Question 11

Age:

1997, men accounted for 83% of suicides among persons aged ____ years and older.

Answer 11

65

Question 12

highest suicide rates reported were for white men over 85 years of age, however, this was not the leading cause of death for this age group.

Answer 12

empty

Question 13

1980-1997, largest relative increases in suicide rates occurred among people

Answer 13

80 to 84 years of age

Question 14

Age:

Answer 14

Americans 65 yrs or older account for 13% of US population, they accounted for 20% of all suicide deaths. (suicide among elderly are highest for those divorced or widowed.)

Question 15

older adult suicide victims, when compared to younger suicide victims, are more likely to be more depressed and more socially isolated. thus they frequently use highly lethal methods

Answer 15

empty

Question 16

Race:

Native America and Alaskan Natives have long had higher suicide rates than general population.

Answer 16

empty

Question 17

during period from 1979-1992

Answer 17

*suicide for Native Americans were 1.5 times the rates for general population.
*males 15 to 24 accounted for 64% of all suicides by Native American.s
*Suicide rates are higher than the national average for some groups of Asian Americans. ex: suicide rate among Asian Americans and Pacific Islanders in California is similiar to that of total population.
*Hawaii, the rate is higher.
*African American males aged 15 to 19 had increased over 105%
*

Question 18

in 1997, white males accounted for 72% of all suicides. Together, white males and white females accounted for more than 90% of all suicides in US

Answer 18

empty

Question 19

Gender:

Answer 19

*females attempt suicide more than males
*Males are at least 4 times more likely to die from suicide.
*Males under age 25 are much more likely to commit suicide than their female counterparts.
*1996 gender ratio:
age 15 to 19 was 5:1
age 20 to 24 was 7:1
*gay and lesbian youths are two to three tiems more likely to commit suicide than other youth.

Question 20

______ are the most common means of suicide among men and women, accounting for 59% of all suicide deaths.

Answer 20

firearms

Question 21

other states on firearms

Answer 21

1996- 79% of all firearm suicides were commited by white men.
between 1980 to 1996, suicide among African Americans males aged 15 to 19 yrs more than doubled with firearms.
*Firearms were most common method of suicide by both males and females, age 65 and older, 78%

Question 22

Region:
The Center for Disease Control examined suicide from 1990 to 1994 to determine whether regional variations in suicide rates are affected by differences in age, race, gender and to examine whether specific rates varied by region.

Answer 22

*154,444 suicides in US
*37% in south
25% in West
22% in Midwest
15% in Northwest.

Question 23

CDC files from 1990-1994, three leading methods of suicide.

Answer 23

firearms
strangulation
overdose

Question 24

Region suicides. After adjusting for age, race, sex, rates remained highest in the

Answer 24

West, followed by the south, Midwest and Northeast. Firearms were the leading method in all regions.

Question 25

Misclassified Deaths and Attempted Suicide:

Surgeon General’s Call to Action to Prevent Suicide

Answer 25

reported that annually, approx half a million people required emergency room treatment as a result of attempted suicide. 1999

Question 26

National Institute of Mental Health reported

Answer 26

there are an estimated 8 to 25 att suicides to one completion while the US Public Health Service reported there are an estimated 16 att suicides for each completed suicide, with gender ratio of 2:1. Attempted suicide higher with women, youth and lower with men and elder.

Question 27

strongest risk factors for attempted suicide in youth are

Answer 27

depression
alcohol or drug use disorder
aggressive or disruptive behavior
those risk factors associated with att suicide in adults are depression, alcohol abuse, cocaine use and separation or divorce

Question 28

Incidence of suicide pacts:
this professor believes that suicide pacts are most common in elderly couples, who often have been married to each other for many years, and cant imagine life w/o each other.

Answer 28

Dr David Shaffer, professor of Child psychiatry at Columbia Univ

Question 29

Shaffer said suicide pacts are very unusual in young people. When they do occur, there is almost always some _______relationship between the partners.

Answer 29

romantic;
typically, one partner is dominating over the other.
all members of the pact had signs of mental illness before their deaths.

Question 30

Conner identified several factors that seem to be prevalent in suicide pacts.

Answer 30

1. one or more people in the pact have mental illness or medical problem, in the midst of serverly painful emotional problems, depression, helplessness and hopelessness
2. person in misery can appreciate another persons misery and may feel better in company of others who feel same
3. these people are able to discuss their thoughts and feelings openly with each other, violent an suicidal thoughts
4. efforts to help each other fail and efforts to get help from others fall on deaf ears. At one time, they att to encourage each other to live, but eventually they lose hope

Question 31

According to Conner, the essential dynamic of a suicide pact is that the _____ and ____ of living becomes worse than the fear of dying.

Answer 31

pain and fear

Question 32

A suicide plan involving public display develops out of a motivation to give death a sense of _____ and _____

Answer 32

purpose and meaning

Question 33

A public suicide is usually intended to send a message, inflict _____ harm and to ____ others.

Answer 33

emotional harm and to punish others.

Question 34

A suicide following violent behavior is intended to escape ______ and _______

Answer 34

responsibility and accountability.

Question 35

Suicide by Cop:

Sincielli defines suicide by cop as a

Answer 35

collogquial term used to describe a suicidal incident whereby the suicidal subject consciously engages in a life-threatening behavior to the degree that it compels a police officer to respond with deadly force.

Question 36

Parent states that suicide by cop and victim-precipitated homicide are terms that are sometimes used interchangeably; however there is a distinct difference.

Answer 36

while these terms are similiar in that the decedent’s behavior did cause the use of deadly force by law enforcement in a defensive action, a psychological post mortem must be conducted to determine if decedents actions resulted from a clear intent to commit suicide.

Question 37

Hutson examined 437 officer involved shootings by the Los Angeles County Sheriffs Dept occuring between 1987 and 1997. Four factors:

Answer 37

1. evidence of suicidal intent
2. evidence they specifically wanted officer to shoot them
3. evidence they possessed a lethal weapon or what appeared to be a lethal weapon
4. evidence they intentionally escalated the encounter and provoked officers to shoot them

Question 38

Hutson found that suicide by cop accouted for

Answer 38

46 of the total 11%
10% involved suicide attempts
98% were males
17% used replica firearms
60% of suspects used their weapons

Question 39

Characteristics of those who commit suicide by cope:

Answer 39

1. lower socioeconomic class
2. history of intimate partner violence
3. history of past suicide attempts
4. high alcohol and drug dependency
5. mental illness/depression

Question 40

Motives for orchestrating a suicide by cop:

Answer 40

1. violent criminals go to death living their fantasy of dying in a shootout with police.
2. making police accountable for a persons death
3. avoiding sociological stigma or trying to reconcile the desire to kill themselves with belief that suicide is a sin
4. distancing themselves from the act by being shot by another
5. seems the only available method to them

Question 41

Another type of person who commits suicide by cop is the ______ criminal who takes ever increasing chances, daring law enforcement to take him out.

Answer 41

Fringe criminal- ex: committing outrageously risky, poorly planned, day light armed robberies

Question 42

One of the worst suicides by cop is when cops, usually on suspension or recently retired, for reasons having to do with deep resentment, loss, rage and what can be best described as a kind of temorary insanity, decide to set up colleagues on the job to kill them.

Answer 42

empty

Question 43

frequent reactions of officers following a suicide by cop:

Answer 43

1. anger
2. resentment
3. disbelief

Question 44

Suicide in Correctional Facilities:

Leading cause of death within jails

Answer 44

suicide

Question 45

Suicide is the _____ leading cause of death in prisons

Answer 45

third

Question 46

Hayes and Rowan found that suicide rate in county jails is approx ____ times greater than that of general population white suicide rate in prisons is approx ___ and ____ times greater than in the comunity

Answer 46

9 times

one and half times

Question 47

profile of typical victim of jail suicide.

Answer 47

• Most likely White male, between 22-30.
• detained on nonviolent charge, most of those were alcohol/drug related charges
• 2 out of every 3 inmates were being held in isolation.
• more than half were dead within 24 hrs
• 27% occurred within first 3 hours
• 88% under influence of alcohol or drugs
• 94% by hanging
• 48% used their bedding
• 89% victims not screened

Question 48

study funded by Office of Juvenile Justice and Delingquency Prevention, Parent reported

Answer 48

1. more than 11,000 juv engage in more than 17,000 incidents of suicidal behavior in juv facilities each year
2. suicides in secure custody found that youth suicide in juv detention and correctional facil were more than 4 times greater than youth suicide in general population

Question 49

Characteristics of jail environment make them ideal suicide-prone settings:

Answer 49

1. authoritarian of jail environment
2. no apparent control over future
3. fear and uncertainty over legal process
4. isolation from family, friends, community
5. shame of incarceration
6. dehumanizing aspects of incarceration
7. fears
8. officer and staff insensitivity to arrest and incarceration

Question 50

examining potential suicidal behavior, following predisposing factors:

Answer 50

1. excessive drinking or drug
2. recent loss of stabilizing resources
3. severe guilt or shame
4. same sex rape or threat
5. mental illness
6. poor health or terminal illness
7. approaching emotional breaking point

Question 51

Certain high-risk periods for the inmate which correlate with phases of his incarceration or steps in criminal justice process:

Answer 51

1. first 24 hrs of confinement
2. intoxication/withdrawal
3. waiting for trial
4. sentencing
5. impending release
6. holidays
7. darkness
8. decreased staff supervision
9. bad news

Question 52

Hayes believes the KEY to any suicide prevention program is ______

Answer 52

staff training

Question 53

Nomenclature of Suicide:
(system of naming of suicide)
Three elements of suicidal behavior are included:

Answer 53

1. identifiable outcome
   
   • injury
   • no injury
   • death
2. evidence of self infliction
3. evidence of intent to die by suicide

Question 54

Nomenclature of suicide

Answer 54

1. Suicide- death from injury
2. Suicide attempt w/injuries
3. Suicide attempt w/o injuries
4. Instrumental suicide-related behavior- Potentially self-injurious behavior, did not intend to kill himself, wanted to attain some other end; help, punish others, receive attention
5. Suicide-related behavior- Potentially self-injurious behavior; intended at some level to kill himself; comprises suicidal acts an instrumental suicide-related behavior
6. suicide threat- interpersonal action, verbal or nonverbal, stopping short of directly self-harming act. communicating or suggesting suicidal act
7. suicidal ideation- self-reported thoughts of engaging in suicide related behavior

Question 55

Theoretical Models to Explain Suicide:

Epidemiological approaches have focused on

Answer 55

demographic characteristics

Question 56

Theoretical Models to Explain Suicide:

Philosophical theorists have focused on issues such as the

Answer 56

nature and purpose of life

Question 57

Theoretical Models to Explain Suicide:

sociocultural and sociological theories have emphasized the role of

Answer 57

society and culture

Question 58

Theoretical Models to Explain Suicide:

philosophers theorists have stressed

Answer 58

mental illness

Question 59

Theoretical Models to Explain Suicide:

Psychodynamic models have centered on

Answer 59

unconscious conflicts

Question 60

Theoretical Models to Explain Suicide:

Psychological theories have focused on

Answer 60

psychological pain and unmet psychological needs

Question 61

Theoretical Models to Explain Suicide:

Biologists theorists have stressed

Answer 61

biochemical imbalances

Question 62

Theoretical Models to Explain Suicide:

Rudd and Joiner support Shneidman’s more inclusive model, which says suicide is caused by

Answer 62

psychache- psychological pain in the psyche (the mind)
Suicide and suicidal behavior are viewed as intrinsically psychological phenomena, a function of individual pain and tolerance, both of which are determined, influenced and modified by a multitude of factors:

Question 63

Theoretical Models to Explain Suicide:
Rudd and Joiner believe this model “psychache” will help those involved in crisis intervention because they attend to two variables:

Answer 63

1. experienced pain
2. demonstrated pain tolerance.
   “suicide occurs, then, when individuals believe that they have exceeded their pain tolerance.

Question 64

Factors Related to Suicide:

US Public Health Service identified two set of factors related to suicide prevention”

Answer 64

1. risk factors

2. protective factors

Question 65

Factors Related to Suicide:

Rudd and Joiner identified three types of factors which can be used to assess suicidal tendencies:

Answer 65

1. predisposing factors
2. risk factors
3. protective factors

Question 66

Factors Related to Suicide:

Rudd and Joiner predisposing (chronic and invariable factors)

Answer 66

as those outside the control of individual.ex: age, psychiatric diagnosis, history of suicidal behavior, history of abuse, family violence.
These factors are included as risk factors by US Public Health Service

Question 67

Factors Related to Suicide:

Risk factors

Answer 67

those which serve to increase the potential for suicidal behavior. Risk factors include:

1. loss of job, financial status, relationships, physical or cognitive ability.
2. health problems,
3. psychiatric diagnosis
4. substance abuse

Question 68

Factors Related to Suicide:

Protective Factors serve to

Answer 68

mitigate risk of suicidal behavior. Such factors include:

1. involvement in treatment
2. good physical health
3. good problem solving skills
4. available social support
5. intact marriage or children, hopefulness

Question 69

Factors Related to Suicide:

According to NIMH, strongest risk factors for att suicide in adults are

Answer 69

1. depression
2. alcohol abuse
3. cocaine use
4. separation or divorce

Question 70

Factors Related to Suicide:

According to NIMH, strongest risk factors for youth att suicide is

Answer 70

1. depression
2. alcohol or drug use disorder
3. aggressive or disruptive behaviors

Question 71

Factors Related to Suicide:

US Public health Service also identifies following as protective factors:

Answer 71

1. easy access to variety of clinical interventions and support
2. restricted access to highly lethal methods of suicide
3. support from ongoing medical and mental health care relationships
4. learned skills in conflict resolution and nonviolent handling of disputes
5. cultural and religious beliefs that discourage suicide and support self-preservation

Question 72

Assessment of Suicidal tendencies:

the ___ and ____ assessment of suicide is critically important for two reasons.

Answer 72

formal and informal

1. first- assessment help identify those persons who are most in need of intervention
2. second- assessment can provide an initial screening so that person who is at risk can be identified.

Question 73

Assessment of Suicidal tendencies:
The Modified Scale for Suicide Ideation is designed with standardized prompt questions so it can be completed by paraprofessionals. Consists of 18 items, evaluating three factors:

Answer 73

1. Suicidal desire
2. preparation for attempt
3. perceived capability of making an attempt

Question 74

Assessment of Suicidal tendencies:

Self-rated Scale for Suicide Ideation is modeled after the SSI-M. Has 19 items, which measures three factors:

Answer 74

1. Active suicidal desire
2. preparation
3. wish for death

Question 75

Assessment of Suicidal tendencies:
Reasons for Living Inventory has 48 items assessing potential reasons for not committing suicide should the thought occur. There are 6 subscales:

Answer 75

1. Survival and coping beliefs
2. responsibility to friends
3. child concerns
4. fear of suicide
5. fear of social disapproval
6. moral obligation

Question 76

Assessment of Suicidal tendencies:
Suicide Behaviors Questionnaire is a self-report instrument. 4 item questionnaire designed to be administered as a structured interview

Answer 76

empty

Question 77

Assessment of Suicidal tendencies:
Suicidal Behavior Questionnaire for Children is a simplified version of the SBQ, written at a third grade reading level.

Answer 77

empty

Question 78

Assessment of Suicidal tendencies:
Fairy Tales Test, also called the ___ and ____ Attitude Scale or the ____ ____ test. Consists of two parallel set of stories, with 4 stories in each set. Each have a animal or fantasy hero and delineates one of four attitudes:

Answer 78

Life and Death
Suicidal Tendencies

1. Attraction to life
2. Attraction to Death
3. Repulsion by life
4. Repulsion by death

Question 79

Assessment of Suicidal tendencies:
Informal Assessments are also appropriate for assessment and evaluation of potential suicide victims. Identified more specifically as warning signs rather than informal assessment,simple checklist have been provided for parents, educators, physicians and others who notice changes in behaviors of others around them

Answer 79

Ex: San Francisco Suicide Prevention Center offers an easy-to-remember acronym to evaluate suicide potential: P.L.A.I.D.P.A.L.S.
Plan
Lethal
Availability
Illness
Depression
Previous
Alone
Loss
Substance abuse

Question 80

Models of Suicide Treatment:

Two models of suicide treatment have been identified by Pulakos

Answer 80

1. Crisis Intervention model- paternalistic and controlling , assumes thoughts of suicide are acute and suicide is preventable. Primary focus is to keep the person alive until crisis is resolved at which time therapy can take place
2. continuing-therapy model-described by Berman as “laissez-faire”, emphasizes chronic suicidal behavior and assumes that suicide is not preventable. Focus on suicidal behavior and att suicide. This model involves freedom and responsibility; patient has the right to kill himself, ultimately responsible for his action.

Question 81

Models of Suicide Treatment:

One of primary difference between the two models is the assumption of the duration of the suicidal state.

Answer 81

• Crisis intervention model assumes that the suicidal crisis is an acute state
• Continuing-therapy model acknowledges that there can be both acute and chronic suicidal states, which require different therapeutic responses.
• Second major difference deals with ability to prevent suicide. Crisis intervention model assumes that suicide is preventable while the Continuing-therapy model states that all suicides are not preventable.

Question 82

Intervention for Suicide:

Treatment center:

Answer 82

suicidal person has to contact the suicide prevention center.

Question 83

Intervention for Suicide:

Telephone Hotlines is one way to screen and train personnel for answering hotlines is thru the use of

Answer 83

Suicide Intervention Response Inventory.

Assessment consists of 25 statements that suicidal person makes. Examiner is given two forced choice responses.

Question 84

Intervention for Suicide:
Partnership Strategies is an arrangement wherein a mental health center established a partnership with school officials to cooperatively address suicide among adolescents.

Answer 84

Mental health center established a 24 hr teen-counseling center, a toll free hotline.

Question 85

On-site Intervention Strategies:

Answer 85

1. Establish rapport- First STep in intervention
2. Seek information- exploration of the persons specific ideation.
3. make contacts- collateral phone calls to prior health care providers, family members, friends
4. Assess risk level- two step
   *Assessing the risk factors known to be
   associated with suicide.
   *After ascertaining risk factors, intervener can
   then determine risk level.

Question 86

On-site Intervention Strategies:

Rudd and Joiner recommended the following continuum of suicidality:

Answer 86

1. nonexistent-no identifiable suicidal ideation
2. mild- suicidal ideation of limited
3. moderate- frequent suicidal ideation
4. severe-frequent, intense,enduring ideation
5. extreme-frequent,intent, enduring ideation, specific planning, clear subjective intent.lack of self control, severe psychache, many risk factors, no protective factors

Question 87

On-site Intervention Strategies:
Determine Appropriate Course of Action will be determine by severity of the ideation. First guideline that must be followed is

Answer 87

NEVER IGNORE A SUICIDE THREAT OR ATTEMPT.

A suicidal person should not be left alone and needs immediate mental health treatment.

Question 88

Challenges in Preventing Suicide:

Lester suggests that in seeking to prevent suicide, three different levels of prevention should be considered:

Answer 88

1. Primary- involves the prevention of developing of suicidal tendencies in the individual which is extremely difficult because it presupposes there are known causes of suicide. Modern medications, psychotherapy, wellness programs
2. Secondary- early intervention with persons who are on the verge of suicide. 24 hr hotline, walk-in clinics, emergency outreach teams. Immediate crisis counseling
3. Tertiary- prevention of the recurrence of suicide in those who have already been suicidal.

Question 89

Increased Awareness of Suicide:
1999, The Surgeon General’s Call to Action to Prevent Suicide, introduced a plan for reducing suicide. Both evidence-based and highly prioritized by leading experts, 15 key recommendations serve as a framework for action. Steps are categorized as

Answer 89

1. Awareness
2. Intervention
3. Methodology
   (AIM)