Suicide Flashcards
A Typology for Suicidal Behaviour
Agency
An act of suicide must be self-instigated or self-initiated, but not necessarily self-inflicted.
Intent
Intent to die has been a long-standing, critical, and controversial component of the definition of suicide. Intent is the desire for a certain outcome.
Outcome
Suicide must have death as an outcome. A suicide attempt must at least have the actual or believed potential for death as an outcome.
Different Types of Thoughts Related to Suicide
Active suicidal thoughts (thoughts of killing oneself)
Morbid ruminations (thoughts about death, dying, and not wanting to be alive, but without active thoughts of killing oneself)
Non-suicidal self-injury (underlying motivation is emotion regulation or for a reason other than death). Self-injurious behaviour is classified as suicidal, as opposed to non-suicidal, if any non-zero stated or inferred intent to die is a reason for the behaviour.
Biological Theories of Suicide
inherited, physiological risk component to suicide, sometimes referred to as a diathesis. This biological diathesis, according to biological theories, is then aggravated through environmental factors referred to as stress.
Currently, little understanding of how biological predispositions may result in increased suicidal behaviour or how environmental factors may trigger such predispositions.
Hopelessness Theory of Suicide
that overwhelming thoughts and feelings of hopelessness were what caused people to develop suicidal ideation, and eventually die by suicide.
There are a number of studies indicating that hopelessness is a risk factor for suicide attempts and completion.
Interpersonal-Psychological Theory of Suicidal Behaviour
According to the interpersonal-psychological theory of suicidal behaviour, an individual will only engage in serious suicidal behaviour if he or she has both the desire to die by suicide, and the capability to act on that desire.
The interpersonal-psychological theory points to two key interpersonal states that are associated with the desire for death by suicide: the experience of feeling alienated from valued social groups, such as peers and family (i.e. thwarted belongingness), and the perception that the self is so incompetent that one’s presence is a liability to others (i.e. perceived burdensomeness).
Screening and Assessment of Suicidal Behaviour
Screening: The goal of screening is to identify patients who have suicidal thoughts
Assessment: The primary goals of assessment are to estimate the risk that the patient will die from suicide, and to gather information that will inform suicide management and treatment strategies.
Suicide Predisposing Factors
Previous suicide attempt(s)
Psychological disorders (incl. depression, alcoholism, schizophrenia, and some personality disorders)
Physical illness (terminal, painful, shameful, or debilitating illness, AIDS)
Family history of suicide, alcoholism, and/or other psychological disorders
Divorced, widowed, or single status
Living alone
Unemployed or retired
Bereavement or sexual abuse in childhood
Suicide Precipitating Factors
Easy access to means of attempting/ dying by suicide
Marital separation
Change in occupational or financial status
Family disturbances
Bereavement
Rejection by a significant person
Suicide Protective Factors
Cognitive Style and Personality
Family Patterns
Cultural and Social Factors
Environmental Factors
Assessment of Suicide Components
(a) previous suicidal behaviour;
(b) the nature of current suicidal thinking and behaviours;
(c) precipitant stressors;
(d) general psychiatric symptoms;
(e) the presence of hopelessness;
(f) impulsivity and self-control; and
(g) protective factors
Assessment of Suicide Cultural Considerations
The concept of shame is important to many Aboriginal and Torres Strait Islander communities. It can be a barrier to engagement.
Traditional ceremonial practices (e.g. “sorry business” or initiation in traditionally oriented regions)
Discussing the loss of someone close, especially a family member or someone to suicide
Sensitivities to gender and age balance between the patient and clinician
Issues within wider the social context, such as exposure to self-harm
Framework for conducting assessments
Upon first meeting the person, clinicians should greet each family and community member present as a sign of respect.
Prior to commencing formal assessment, the person should be asked whether they want their family or others involved
The inclusion of Aboriginal and Torres Strait Islander clinicians or support staff is ideal, but not necessary
The clinician should ask, “what language do you normally speak at home?” in order to learn more about the person’s background and to determine if an interpreter is required.
If possible, the person should be given the choice to have the assessment conducted in a physical location that is more informal but still safe and private.
Trajectory of Suicidal Thinking
The assumed trajectory is for clients to go from suicidal ideation to suicidal plans and then to suicide attempts.
This sequence of suicidal ideation to suicidal plan to suicide attempt does not always appear to occur.
Exploring Previous Suicide Attempts
Precipitant
Motivation
Outcome
Reaction
Exploring Intent:
The specificity of suicidal thinking is one marker of intent
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Preparation behaviour.
Rehearsal behaviour.
Stated reasons for living and reasons for dying.
Any efforts to prevent discovery or rescue.
Management of Suicide Risk elements:
An easy-to-understand model of suicidality
Targeting identifiable skills
A focus on treatment compliance
Clients take personal responsibility for treatment
Clear plan to manage crisis
Making things easy by writing
No Suicide Contract vs. Commitment to Treatment Statement
Although a few patients have reported that such no-suicide contracts helped ensure their safety, evidence does not support their use (Edwards & Sachman, 2010).
A commitment to treatment statement (CTS) is as an agreement between the client and therapist in which the patient agrees to make a commitment to the treatment process and living by:
(1) identifying the roles, obligations, and expectations of both the therapist and the patient in treatment;
(2) communicating openly and honestly about all aspects of treatment including suicide; and
(3) accessing identified emergency services during periods of crisis that might threaten the patient’s ability to honour the agreement
Safety plan steps:
Step 1: Recognise warning signs that precede a suicidal crisis.
Step 2: Identify and employ internal coping strategies that the client can do alone.
Step 3: Use social contacts with people and healthy social settings as a means of distraction. Suicidal thoughts and the current crisis are not discussed at this point.
Step 4: Contact family members or friends for help. In Step 4 the client discusses the suicidal crisis openly with the designated contacts.
Step 5: Contact a mental health professional and use emergency services if needed.
Step 6: Reduce access to lethal means.
