Lecture 7 Flashcards
Suicide prevention
Article: Brodsky et al. (2018) “The zero suicide model: applying evidence-based suicide prevention practices to clinical care”
Brodsky et al. (2018)
The zero suicide (ZS) model is proposed as a framework in clinical settings to giode evidence-based suicide prevention practices
ZS model and clinical training
Brodsky et al. (2018)
ZS model fovuses on intergrating a multi-level approach in clinical settings.
It includes 7 main components:
1. Identify
2. Engage
3. Treat
4. Transition
5. Lead
6. Train
7. Improve
Screening and risk assessment
Brodsky et al. (2018)
Tools:
- Columbia Suicide Severity Rating Scale (C-SSRS)
- SAFE-T
These tools measure suicidal ideation and other risk factors (demographics, trauma, psychiatric history)
SAFE-T assessment is shown to improve clinicians’ ability to recognize risk factors.
Psychosocial treatment interventions
Brodsky et al. (2018)
- CBT
- DBT
Reduce suicidal ideation and behaviors
Collaborative assessment and management of suicidality (CAMS) also shows efficacy in reducing suicidal thoughts, providing a structured treatment approach.
Brief interventions
Brodsky et al. (2018)
- Safety plan intervention (SPI): focus on safety planning, including coping strategies, social support and means restriction
- Crisis response planning: patients create a personalized plan for managing suicidal thoughts
Follow-up and monitoring
Brodsky et al. (2018)
Follow-up after high-risk events can reduce suicidal behaviors.
Brief intervention and contact: structured follow-up calls, and peer support –> have shown positive effects, such as reducing repeat attempts and enhancing hope.
Assess, intervene, and monitor for suicide prevention (AIM-SP)
Brodsky et al. (2018)
AIM-SP underpins ZS, providing a structured approach to implementation.
AIM-SP recommends systematic screening, suicide-specific interventions, and proactive monitoring.
Fluctuations in suicide risk
Brodsky et al. (2018)
Suicidal ideation is dynamic.
Importance of continuous monitoring and adjusting care based on real-time risk factors, such as changes in mood or loneliness
Article Bertolote &Wasserman (2021) H21
Bertolote&Wasserman (2021) H21
Theorieen suicidaal gedrag:
- Durkheims theorie
- Baumeister ontsnappingtheorie
- Shneidmans theorie van psychache
- Longehans DBT en emotieregulatietheorie
- Becks cognitieve theorie en centrale rol van hopeloosheid
- Rudds fluid vulnerability theory (FVT)
- Williams theorie over algemeen geheugen en de cry pain model of suicide
- Joiners interpersoonlijke theorie van suicide
Durkheim’s theory (1897)
Bertolote&Wasserman (2021) H21
2 key social forces that influence suicide:
- social integration (how well an individual is integrated into society)
- moral regultaion (the extent to which society regulates individual behavior)
Durkheim’s theory
What are the types of suicide?
Bertolote&Wasserman (2021) H21
- Egoistic suicide: due to lack of social integration
- Altruistic suicide: excessive intergration leading to self-sacrifice (you are so apart of society that the individual in you isn’t there anymore)
- Anomic suicide: insufficient moral regulation, often following economic or societal distress
- Fatilistic suicide: excessive moral regulation, where future feels overly regulated (“enslaved by society”)
Baumeister’s escape theory (1990)
Bertolote&Wasserman (2021) H21
Suicide attempt as ultimate attempt to escape from self-perceived failures and overwhelming psychological pain.
Baumeister’s theory
Sequential process:
Bertolote&Wasserman (2021) H21
- Negative discrepancy: discrepancy between life you’re leading and what you were hoping for
- Internal attribution: the feeling that the discrepancy is due to youself/your own fault
- Cognitive deconstruction: focus on the pain and focus on escaping the pain
Shneidman’s theory of psychache (1993)
Bertolote&Wasserman (2021) H21
Psychache = an unbearable mental anguish (ondraaglijk) stemming from unmet psychological needs, such as love, control, or self-esteem
Suicide is driven by psychache, it’s an attempt to escape from this overwhelming pain
- Suicide prevention should focus on understanding, identifying and reducing psychache
- Undestanding a person’s psychological pain is key to intervention
Linehan’s emotional regulation theory (1993)
Bertolote&Wasserman (2021) H21
Suicide is behavior used to manage overwhelming emotions, particularly when individuals lack effective coping mechanisms.
- Suicidal behavior emerges as an effort to cope or regulate affect, not necessarily because someone is motivated to die.
- Integrates biological, social, and individual factprs; invalidating environments contribute to the development of emotional dysregulation
- DBT focuses on teaching skills like emotion regulation, mindfulness, and distress tolerance
Beck’s cognitive theory (1967; 1990)
Bertolote&Wasserman (2021) H21
Beck posits that suicide stems form hopelessness - beliefs that the future is bleak and change is impossible
- Ask: “how dark does your future seem to you?”
- Individuals develop negative cognitive (“suicide”) schemas, which distort their perception of reality, leading to feelings of wothlessness and despair, The more pervasive these negative thoughts, the higher the risk of suicide
- Cognitive change, i.e. addressing and restructuring negative thoughts, is central to effect treatment of suicidality
Rudd’s fluid vulnerability theory (2006)
Bertolote&Wasserman (2021) H21
Individuals have a baseline level of suicide risk, which can increase or decrease depending on life events.
- Fluid vulnerability: suicidal behaviors and thoughts can be reactivated by stressors, even after a period of stability
- Each suicidal episode makes future episodes more likely by reinforcing cognitive vulnerabilities
- As Beck, FVT emphasized the importance of cognitive change in the treatment and recovery process.
William’s overgeneral memory & cry of pain model (2006)
Bertolote&Wasserman (2021) H21
Center on overgeneral memory, where individuals struggle to recall specific positive memories, leading to a sense of hopelessness.
- The cry of pain model suggests that when people feel trapped and see no escape, suicide becomes a potential way out.
- Impaired problem solving
- Hopelessness
- This model connects memory processes with emotional responses, highlighting the difficulty in problem-solving when under distress
Joiner’s interpersonal theory (2005)
Bertolote&Wasserman (2021) H21
Suicide occurs when 2 conditions are met:
1. Individuals must have a desire to die
2. The capability to engage in lethal self-injury
- Perceived burdensomeness: to belief one’s existence is a burden on others
- Thwarted belongingness: a deep sense of isolation and loneliness
- Acquired capability: learned fearlessness towards death - enables a person to overcome the instinct for self-preservation
Bertolote & Wasserman (2021) H38
Bertolote&Wasserman (2021) H38
- Suicidaliteit in verschillende clusters
- Risicofactoren voor suicidaal gedrag in PDs
- Comorbide psychiatrische stoornissen en PDs en suiciderisico
- Behandelingsimplicaties
Cluster A
Bertolote&Wasserman (2021) H38
Wordt niet gezien als risicofactor voor suicide –> maar enig bewijs dat schizoide PD geassocieerd is met suicide.
- Weinig onderzoek cluster A en dus weinig bewijs
Risicofactoren:
- Interpersoonlijke moeilijkheden
- Lage niveaus van emotionele uiting
Cluster B
BPD
Bertolote&Wasserman (2021) H38
BPD is sig risicofactor voor suicide en is enige PD met terugkerende suicidale en zelfbeschadiging.
- Vooral hoog als BPD comorbide is met affectieve stoornissen of SUDs
Risicofactoren BPD:
- Slechte impulscontrole
- Affectieve instabiliteit
Cluster B
ASPD
Bertolote&Wasserman (2021) H38
ASPD kan het suiciderisico verhogen door negatieve emotionaliteit en lage inhibitie
- Laag dodental onder pogingen (pogingen faken om gevangenschap te vermijden)
- Zelfbeschadiging (kan om anderen te manipuleren of resultaat van eigen frustratie, maar zonder intentie om dood te gaan)
Histrionic + ASPD geassocieerd met suicidegebaren.
Cluster B
NPD
Bertolote&Wasserman (2021) H38
NPD geassocieerd met suicidepogingen (2,4x meer kans om poging te doen dan geen narcistische pd)
- Weinig data over NPD en HPD –> meer onderzoek nodig
