Advances in assessment of suicide risk

Department of Psychology & Neuroscience, Baylor University, TX 97334, USA.
Journal of Clinical Psychology (Impact Factor: 2.12). 02/2006; 62(2):185-200. DOI: 10.1002/jclp.20222
Source: PubMed

ABSTRACT This article reviews and integrates empirically grounded advances in the assessment of suicidality. The practices discussed are consistent with existing standards of care, practice guidelines, and applicable research. The authors differentiate between risk assessment and prediction and then emphasize the important role of time in risk assessment. We present and illustrate a continuum of suicidality for risk assessment and offer practical recommendations for clinical decision making and treatment.

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    • "" A growing body of research supports the assertion that measuring suicide-specific thought processes independent of psychiatric symptoms and disorders may improve assessment, treatment, and clinical decision-making. For instance, the role of hopelessness is now well established (Brown et al., 2000; Bryan & Rudd, 2006), and more recent empirical work has supported the incremental utility of perceived burdensomeness (e.g., " People would be better off without me " ) over psychiatric symptoms (Joiner et al., 2009). "
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    ABSTRACT: Background Newer approaches for understanding suicidal behavior suggest the assessment of suicide-specific beliefs and cognitions may improve the detection and prediction of suicidal thoughts and behaviors. The Suicide Cognitions Scale (SCS) was developed to measure suicide-specific beliefs, but it has not been tested in a military setting. Methods Data were analyzed from two separate studies conducted at three military mental health clinics (one U.S. Army, two U.S. Air Force). Participants included 175 active duty Army personnel with acute suicidal ideation and/or a recent suicide attempt referred for a treatment study (Sample 1) and 151 active duty Air Force personnel receiving routine outpatient mental health care (Sample 2). In both samples, participants completed self-report measures and clinician-administered interviews. Follow-up suicide attempts were assessed via clinician-administered interview for Sample 1. Statistical analyses included confirmatory factor analysis, between-group comparisons by history of suicidality, and generalized regression modeling. Results Two latent factors were confirmed for the SCS: Unloveability and Unbearability. Each demonstrated good internal consistency, convergent validity, and divergent validity. Both scales significantly predicted current suicidal ideation (βs >0.316, ps <0.002) and significantly differentiated suicide attempts from nonsuicidal self-injury and control groups (F(6, 286)=9.801, p<0.001). Both scales significantly predicted future suicide attempts (AORs>1.07, ps <0.050) better than other risk factors. Limitations Self-report methodology, small sample sizes, predominantly male samples. Conclusions The SCS is a reliable and valid measure that predicts suicidal ideation and suicide attempts among military personnel better than other well-established risk factors.
    Journal of Affective Disorders 04/2014; 159:15–22. DOI:10.1016/j.jad.2014.02.021 · 3.71 Impact Factor
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    • "The manner in which sexual minority status affects the relation between CM and adolescent suicidal ideation and behavior also warrants study. Results from a recent metaanalysis suggest that sexual minority youth (including gay, lesbian, bisexual, and transgender individuals) are more likely to report a history of CM (Friedman et al. 2011), and prior research has demonstrated a link between sexual minority status and increased risk of suicidal ideation and/ or attempts (Bryan and Rudd 2006). Surprisingly, no study to date has examined sexual minority status as a potential moderator of the relationship between CM and suicidal ideation and/or attempts, or unique processes whereby sexual minority youth develop suicidal ideation or behavior subsequent to CM. "
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    ABSTRACT: A large body of research suggests that child maltreatment (CM) is associated with adolescent suicidal ideation and attempts. These studies, however, have not been critically examined and summarized in a manner that allows us to draw firm conclusions and make recommendations for future research and clinical work in this area. In this review, we evaluated all of the research literature to date examining the relationship between CM and adolescent suicidal ideation and attempts. Results generally suggest that childhood sexual abuse, physical abuse, emotional abuse, and neglect are associated with adolescent suicidal ideation and attempts across community, clinical, and high-risk samples, using cross-sectional and longitudinal research designs. In most studies, these associations remain significant when controlling for covariates such as youth demographics, mental health, family, and peer-related variables. When different forms of CM are examined in the same multivariate analysis, most research suggests that each form of CM maintains an independent association with adolescent suicidal ideation and suicide attempts. However, a subset of studies yielded evidence to suggest that sexual abuse and emotional abuse may be relatively more important in explaining suicidal behavior than physical abuse or neglect. Research also suggests an additive effect-each form of CM contributes unique variance to adolescent suicide attempts. We discuss the current limitations of this literature and offer recommendations for future research. We conclude with an overview of the clinical implications of this research, including careful, detailed screening of CM history, past suicidal behavior, and current suicidal ideation, as well as the need for integrated treatment approaches that effectively address both CM and adolescent suicidal ideation and suicide attempts.
    Clinical Child and Family Psychology Review 06/2013; 16(2):146-172. DOI:10.1007/s10567-013-0131-5 · 4.75 Impact Factor
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    • "Unfortunately, in contrast to the extant research on suicide risk factors, much less research has empirically identified protective factors associated with reduced suicide risk (Bryan and Rudd, 2006), although interest in protective factors seems to be growing (Johnson et. al., 2011; Osman et al., 2010). "
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    ABSTRACT: BACKGROUND: Suicide risk among U.S. military personnel has been increasing over the past decade. Fluid vulnerability theory (FVT; Rudd, 2006) posits that acute suicidal episodes increase in severity when trait-based (e.g., shame) and state-based (e.g., hopelessness) risk factors interact, especially among individuals who have been previously suicidal. In contrast, trait-based protective factors (e.g., pride) should buffer the deleterious effects of risk factors. METHODS: 77 active duty military personnel (95% Air Force; 58.4% male, 39.0% female; 67.5% Caucasian, 19.5% African-American, 1.3% Native American, 1.3% Native Hawaiian/Pacific Islander, 1.3% Asian, and 5.2% other) engaged in outpatient mental health treatment completed self-report surveys of shame, hopelessness, pride, and suicidal ideation. Multiple generalized regression was utilized to test the associations and interactive effects of shame, hopelessness, and worst-point past suicidal ideation on severity of current suicidal ideation. RESULTS: Shame significantly interacted with hopelessness (B=-0.013, SE=0.004, p<0.001) and worst-point suicidal ideation (B=0.027, SE=0.010, p=0.010), augmenting each variable's effect on severity of current suicidal ideation. A significant three-way interaction among shame, worst-point suicidal ideation, and pride was also observed (B=-0.010, SE=0.0043, p=0.021), indicating that pride buffered the interactive effects of shame with worst-point suicidal ideation. LIMITATIONS: Small sample size, cross-sectional design, and primarily Air Force sample. CONCLUSIONS: Among military outpatients with histories of severe suicidal episodes, pride buffers the effects of hopelessness on current suicidal ideation. Results are consistent with FVT.
    Journal of Affective Disorders 11/2012; 147(1-3). DOI:10.1016/j.jad.2012.11.006 · 3.71 Impact Factor
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