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
