suicide & suicide assessment

Question 1

explain how frequent suicide is in practice

Answer 1

-Almost every psychologist has professional experiences with individuals who commit suicide
-Almost 1/3 have a patient attempt suicide

Question 2

why is it important to know the why behind risk assessment decisions

Answer 2

If you understand the why behind decisions, you will better be able to adjust and modify after situations occur

Question 3

explain the basics of suicide and what it means for assessment

Answer 3

-Complex interaction between many different biological, social, and psychological risk and protective factors
-Common and idiosyncratic factors
-No pathway or trajectory toward suicide

Therefore, be open to patient experiences even if they do not fit a predetermined model

Question 4

what kind of assessment should we be using with suicide

Answer 4

-Use narrative assessment
-Ask about lifetime suicidal thoughts and behaviors

Question 5

if patients have recent suicidal thoughts what should we ask

Answer 5

-About the intensity, duration, frequency, and onset of suicidal ideation
-Recent stressors, health, relationships, money
-Past attempts, their contexts and reactions of others
-Plans or preparatory behaviors
-Protective factors, such as relationships beliefs or reasons for living
-Ask about loneliness (Predictor of ideation and behavior)
-social support
-perceived burdensomeness

Question 6

why is it important to ask about social support

Answer 6

-Interventions strive to promote good and supportive relationships
-Also seen in therapy relationship
-People with strong social support are less likely to have thoughts of suicide (family involvement in treatment is helpful)

Question 7

how does narrative assessment look

Answer 7

Could follow a structured outline, could be more free flowing but the goal is to allow people to tell their own stories in their own words without interruption; can always get more specific details later
-Validation: understand their origins without agreeing

Question 8

what are the 6 ways to improve assessment

Answer 8

-know your role
-suicide risk fluctuates
-ask about suicide adjacent thoughts
-use, but do not overvalue screening instruments
- ask patients about their risk
-consider cultural factors

Question 9

explain knowing your role

Answer 9

-Article written by psychologist who received a call that their patient was dead, obviously upsetting
-But it is not our job to guarantee that the person’s life will be saved, but to deliver services consistent with professional standards
-We can still provide best possible clinical care to every patient including those with suicidal thoughts

Question 10

paternalistic approaches in assessment?

Answer 10

avoid them,

-Authoritarian and fear driven approaches to suicide normally fail
-Cannot order a patient to stay alive
-Focus on creating conditions that enable their innate desire to get well

Question 11

explain how to use intrinsic motivations like self determination theoty

Answer 11

-Competence or mastery: learn to monitor self , regulate emotions
-Affiliation or connection: develop a relationship with the patient and promote the patient’s interactions with others
-Control or autonomy: involve patients as co creators of their treatment
-Listen, explain, involve, ask
-Together we will find solutions
-Collaboratively develop safety plans
-Asking patients of their risk of suicide
-Respecting preferences

Question 12

explain suicide risk fluctuating

Answer 12

Using ecological momentary assessments
-36% decide to act within 5 minuets
-44% within 10 minutes
-73% within 3 hours
-These things also disparate quickly as well

Ask about changing thoughts
-Often times these things change throughout the day, come on quickly

Assume fluctuation
-Many people (up to 1/3) do not reveal to suicidal thoughts
-One reason for non disclosure is that the thoughts are not particularly strong that day
-Ask twice, in written form “have you ever had thoughts of suicide” and in oral form

Question 13

explain asking about suicide adjacent thoughts

Answer 13

-Perceived burdensomeness: thinking others would be better off if they were dead
-Entrapment: life is unbearable and I cannot stand it much longer
-Passive suicidal ideation: I wish the lord would just take me away, wishing you were dead
-Some other thoughts and behaviors might be culturally specific, cultural idioms of distress
-All of the factors (perceived burdensomeness, rumination, negative urgency, and thwarted belongingness) all interact

Question 14

simple vs. complex theories

Answer 14

-Simple theories look for one or a few drivers
-Complex theories acknowledge the importance and commonality of these drivers but hold that these and other thoughts, risk, and protective factors may interact in complex ways

Question 15

explain the common continuum of suicide and how people move along

Answer 15

-Passive or wish to die
-Active thoughts
-Suicidal plans
-Suicide attempts
-Valid theory, accounts for 36% of all attempts; other models have people skipping steps or moving through more rapidly

move through gradually and sequentially

Question 16

explain use, but do not overuse screening instruments

Answer 16

-All screening instruments have limitations
-None are high in sensitivity (ability to identify suicidal patients) and specificity (ability to exclude suicidal patients)
-May supplement, not replace judgment
-Not one screener is better than the other (e.g Columbia)

Question 17

explain asking patients about their risk

Answer 17

-Accuracy of determining risks improves when therapists consider their patient’s own assessment of the risk that they will die from suicide
-When suicide attempt survivors were asked how treatment could’ve improve, they said collaboration
-Ask patients what is the likelihood they will die from suicide
-Scale from 1-10, ask why they gave that score
-Patient rated risk predicted self harm two months later

Question 18

explain considering cultural factors in assessment

Answer 18

-Patient preferences and needs as a facet of evidence informed practice
-Evidence based practices involves a tripartite model for integrating research evidence with clinical skills and patient identities and preferences

Patient characteristics and values
-Variations in presenting problems, etiology, context, age, developmental status, and history
-Cultural and linguistic factors
-Personal preferences for treatment, values, such as gender of psychologist, integration of religion and spirituality
-Patient coping style, reactance, stage of change

Accommodating patient preferences is related to change

Failure to address patients treatment preferences and to adapt to culture is linked to more patient dissatisfaction, less motivation and a higher dropout rate

View patients as experts on their own experiences

Question 19

explain why Chu’s cultural model was developed

Answer 19

What we know about risk assessment in general is applicable to doing risk assessments with suicidal persons of color; however, by themselves they may be inadequate for persons of color

Question 20

explain the three parts of Chu’s cultural model

Answer 20

cultural idioms of distress, cultural life events or experiences, and cultural meanings of suicide

Question 21

what are cultural idioms of distress

Answer 21

Not every culture expresses emotional distress in the same way
-Paranoia or overly suspicious behavior is a common feature among depressed black men (these men are often over diagnosed with psychotic disorders)
-Somatization may be a symptom of depression among Asian Americans

Question 22

explain the two cultural life events or experiences that are important to know and what they are

Answer 22

Minority distress
-Stresses caused by discrimination and prejudicial experiences

Social discord
-Although social losses are often a precipitant of suicidal thoughts in all people, they may have a disproportionate impact on persons of color because of: collectivist nature of culture and intergenerational acculturation stress

Question 23

explain cultural meanings of suicide

Answer 23

What does suicide mean and what are acceptable motivators for suicidal behavior

Do cultural prohibitors against suicide lead people to become “hidden” ideators
-More common among native americans

Question 24

what is O’conners IMV model

Answer 24

integrated motivational volitional model of suicide, suicide is complex interplay of biology, psychology, environment and culture

Question 25

what are the three parts of the IMV model

Answer 25

pre motivational
motivational
volitonal

Question 26

what is pre motivational

Answer 26

vulnerabilities that lead to dysfunctional thinking patterns or inadequate emotional regulation
-Historical factors like adverse child events, attachment styles, traumas

Question 27

what is motivational

Answer 27

development of suicidal thoughts because of circumstantial precipitants combined with suicide adjacent thoughts such as perceive burdensomeness or entrapment
-Current stressors, thinking styles, emotional dysregulation, suicide adjacent thoughts, leading to suicidal thoughts

Question 28

what is volitional

Answer 28

access to lethal means and acquired capability, when combined with suicidal ideation may lead to a suicide attempt
-Habituation to pain and suffering, access to lethal means
-Higher rates of suicide among police officers, nurses, etc who witness violence and pain all of the time

Question 29

explain the cultural model and IMV (across the three different steps)

Answer 29

Pre-motivational: do you assess for minority stress and cultural traumas or appreciate the impact of social disruptions

Motivational: are you sensitive to cultural idioms of distress (e.g. suicide-adjacent behavior among Asian American women could include withdrawal and somatizations)?

Volitional: do you consider how cultural meanings may inhibit the disclosure of thoughts (hidden ideators) or influence the preferred means of suicide
-Do you consider that culturally unique stressful experiences may increase an individual’s habituation to pain and suffering

Question 30

explain gun ownership as a culture

Answer 30

Nearly 40% of Americans live in home with firearms
-Many own multiple
-Majority of them own for personal safety, followed by hunting

Some patients have guns, others are gun owners which means that firearm ownership is a part of their identity (what I have is what I am), their social networks, and their sense of themselves
-Discussing firearm safety requires cultural sensitivity

Question 31

explain Chu’s model and firearm ownership

Answer 31

Idiom of distress: some may have precarious masculinity which may lead to less awareness of emotional distress and expression of distress indirectly through impulsivity and alcohol/drug use
-E.g. in the VA, asking patients how they reacted to a situation rather than how they felt

For some firearm ownership is linked to trauma

Cultural meanings of suicide: through use of a firearm as preferred means of death
-Have to be sensitive with these individuals
-Appeal to their basic values, talk about firearm ownership in a basic way, ask about safety precautions

Question 32

two goals in the initial session

Answer 32

1) Patients should have a chance to tell their story
2) Patients feel like you care about them
-Do not be afraid to tell them that you care about them

In a narrative assessment you have to balance getting the information you need with letting the patient get their information out

Question 33

what are two things important to know

Answer 33

safety planning interventions and lethal means counseling (both of these things reduce attempts and successful attempts)

Question 34

when will people not disclose

Answer 34

stigma, fear of unwanted interventions (e.g. calling the hospital)