Suicide

Question 1

What is Suicidal ideation ?

Answer 1

“thinking about, considering or planning for suicide”

Question 2

What is a Suicide attempt ?

Answer 2

“ a non-fatal self-directed, potentially fatal and injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury”

Question 3

Suicide Definition

Answer 3

“ Death caused by self-directed injurious behavior with any intent to die as a result of the behavior”

Question 4

Non-suicidal self directed violence definition

Answer 4

“Behavior that is self-directed and deliberately results in injury or potential injury to oneself. There is no evidence, whether implicit or explicit, of suicidal intent”

Question 5

Undetermined self-directed violence definition

Answer 5

“ behavior that is self-directed and deliberately results in injury or the potential injury to oneself. Suicidal intent is unclear based upon the available evidence”

Question 6

Proximal risk definition

Answer 6

“External circumstances believed to have played a role in precipitating self –directed violence” (i.e. breaking up with boyfriend)

Question 7

Imminent risk definition

Answer 7

“potential that an individual will immediately engage in self-directed violence with suicidal intention upon completion of the clinical interaction”

Question 8

Unacceptable Terms

Answer 8

Completed Suicide: implies achieving a desired outcome
Failed attempt: judgmental
Nonfatal suicide: contradictory
Para-suicide: WHO current recommendation is non-suicidal self directed violence
Successful suicide: achieving a desired outcome
Suicide gesture, Manipulative Act and Suicide threat: pejorative, gives a value judgment

Question 9

Types of suicide: Egoistic

Answer 9

low social integration, sense of meaningless among individuals (“I don’t belong”)

Question 10

Types of suicide: Altruistic

Answer 10

person feels deeply committed to group norms and goals; see own life as unimportant, they die for a “cause”

Question 11

Types of suicide: Anomic

Answer 11

Life seems aimless, breakdown of standards and norms (“There is no point/ ther is no purpose”)

Question 12

Types of suicide: Fatalistic

Answer 12

The individual sees no hope of change. (“Things will never get better”)

Question 13

Highest Rates: Ethnic & Gender

Answer 13

Highest Rates
American Indian/Alaska Natives
14.3 per 100,000

Non-Hispanic Whites
13.5 per 100,000
Four times as many males as females die by suicide

Question 14

Lowest Rates: Ethnic & Gender

Answer 14

Lowest Rates
Hispanics – 6.0 per 100,000
Non-Hispanic Blacks – 5.1 per 100,000
Asian/Pacific Islanders – 6.2 per 100,000

Question 15

Screening assessment: Is Path Warm? (What does it stand for)

Answer 15

I- ideation  What thinking about doing
S- substance abuse
P- purposelessness What's their sense of purpose
A- anxiety
T- trapped
H-hopelessness
W- withdrawal
A-anger
R-recklessness
M-mood change

Question 16

Additional Warning Signs

Answer 16

Increased substance use
No reason for living/sense of purpose
Anxiety, agitation
Unable to sleep or sleeping all the time
Feeling like there is no way out/no other options
Giving away items/ tying up loose ends
Dramatic change from despair to peacefulness

Question 17

Risk Factors for Suicide

Answer 17

Depression and other mental disorders
Prior suicide attempt
Family history of mental disorder or substance abuse
Family history of suicide
Family violence including physical or sexual abuse
Firearms in the home (method used in more than half of suicides)
Incarceration
Exposure to suicidal behavior of others such as family members, peers or media figures

Question 18

Protective Factors: Personal Resources

Answer 18

1. Resiliency
2. Social competency/ problem solving
3. Perception of social support from others
4. Positive expectations/optimism for the future

Question 19

Protective Factors: Community Resources or relationships

Answer 19

Bonding or connectedness to family
Effective clinical treatment relationship
Cultural and religious beliefs that discourage suicide and support self preservation
Quality and access to social services and healthcare
Presence and involvement of caring social networks (social engagement)

Question 20

Evidence Based Assessment

Answer 20

1. Columbia Suicide Severity Rating Scale (C-SSRS)
2. Demonstrated ability to predict suicide attempts in suicidal and non-suicidal individuals (predictive validity)
3. Mental health training is not required to administer
4. Reduction in unnecessary interventions/redirecting scarce resources within hospitals, schools and department of corrections

Question 21

Effective clinical Treatment

Answer 21

Cognitive therapy: addresses cognitive distortions and facilitates problem-solving. Reduced rates by 50% in 1 year follow up

Dialectical Behavior therapy: Reduced attempts by half for those with borderline personality disorder in 2 year follow up

Clozaril (Clozapine) approved by FDA for suicide prevention in Schizophrenia

Question 22

Barriers to Effective Treatment

Answer 22

Provider discomfort & indifference

Focus on historical details (re-traumatization)

Lack of Knowledge

Liability and fear of Litigation

“I don’t have time”

Question 23

Principles for Effective Intervention (e-CPR)

Answer 23

Emotional CPR (e-CPR)
    C= Connecting
    P = emPowering
    R = Revitalizing
Informed by a number of best practice approaches including: trauma-informed care, crisis counseling, emotional intelligence, suicide prevention and cultural attunement.