Suicide Risk Assessment: A Review of Risk Factors for Suicide in 100 Patients Who Made Severe Suicide Attempts

University of Florida, Gainesville, Center for Psychiatry, Florida Hospital, Orlando, USA.
Psychosomatics (Impact Factor: 1.86). 02/1999; 40(1):18-27. DOI: 10.1016/S0033-3182(99)71267-3
Source: PubMed


A study of 100 patients who made a severe suicide attempt suggested that the managed care criteria often applied for approving admission to hospitals for potentially suicidal patients were not, in fact, predictive of features seen in patients who actually made such attempts. Severe anxiety, panic attacks, a depressed mood, a diagnosis of major affective disorder, recent loss of an interpersonal relationship, recent abuse of alcohol or illicit substances coupled with feelings of hopelessness, helplessness, worthlessness, global or partial insomnia, anhedonia, inability to maintain a job, and the recent onset of impulsive behavior were excellent predictors of suicidal behavior. The presence of a specific suicide plan or suicide note were not. Patients with managed care were overrepresented by 245% in the study.

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    • "Relatively little research has directly examined the role of hopelessness in the context of the ITS, a component that deserves greater attention (Hagan, Ribeiro, & Joiner, in press). Of the numerous predictors and risk factors of suicidality, hopelessness, a belief that one's present state is intractable, plays a crucial role among many theories of suicide because it is one of the most robust predictors of future suicide attempts (Hall, Platt, & Hall, 1999; McMillan, Gilbody, Beresford, & Neilly, 2007), current suicidal intent (Menon, Kattimani, Shrivastava, & Thazath, 2013; Weishaar & Beck, 1992), and death by suicide (Brown, Beck, Steer, & Grisham, 2000; Conner, Duberstein, Conwell, Seidlitz, & Caine, 2001). Hopelessness has a significant role in suicide risk among a number of populations, including psychiatric inpatients (Beck, Steer, Kovacs, & Garrison, 1985; Klonsky, Kotov, Bakst, Rabinowitz , & Bromet, 2012), outpatients (Beck, Steer, Beck, & Newman, 1993; Saltz & Marsh, 1990), military members (Bryan, Ray-Sannerud, Morrow, & Etienne, 2013), young adults in the community (Joiner & Rudd, 1995), and across cultures (Lamis et al., 2014), although mixed findings exist among adolescents (see Evans, Hawton, & Rodham, 2004, for a review). "
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    ABSTRACT: Recent theories posit diverse mechanisms of suicide risk, yet many models converge on one variable—hopelessness. The purpose of this study was to examine the role of hopelessness in the Interpersonal Theory of Suicide (ITS), specifically, whether hopelessness moderated the interaction of thwarted belongingness and perceived burdensomeness when predicting current suicidal ideation, plans, and urges. Moderation was tested in two independent samples, one nonclinical (n = 189) and one clinical (n = 760), through hierarchical multiple linear regression analyses. After controlling for demographic covariates, depressive and anxious symptoms, main effects of thwarted belongingness, perceived burdensomeness, hopelessness, and all two-way interactions, the three-way interaction between thwarted belongingness, perceived burdensomeness, and hopelessness was a positive and significant predictor of suicidal risk in both samples. Probing revealed that the interaction between thwarted belongingness and perceived burdensomeness significantly predicted current suicidal risk only at high levels of hopelessness, consistent with predictions of the ITS. Read More:
    No preview · Article · Jul 2015 · International Journal of Cognitive Therapy
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    • "[12] Acute agitation has also been documented as a precursor of near-lethal attempts. Hall et al. (1999) reported that about 90% of emergency room patients admitted following an attempt reported experiencing " severe psychic anxiety " during the month preceding the attempt; close to 80% endorsed panic attacks. [13] "
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    ABSTRACT: According to the interpersonal theory of suicide (1, 2), the difficulties inherently associated with death by suicide deter many individuals from engaging in suicidal behavior. Consistent with the notion that suicide is fearsome, acute states of heightened arousal are commonly observed in individuals immediately prior to lethal and near-lethal suicidal behavior. We suggest that among individuals who possess elevated levels of the capability for suicide, the heightened state of arousal experienced during periods of acute agitation may facilitate suicidal behavior in part because it would provide the necessary energy to approach a potentially lethal stimulus. Among individuals who are low on capability, the arousal experienced during agitation may result in further avoidance. In the present project we examine how acute agitation may interact with the capability for suicide to predict suicidality in a large military sample (n = 1,208) using hierarchical multiple regression. Results were in line with a priori hypotheses: among individuals high on capability, as agitation increases, suicidality increases whereas as agitation increases among individuals low on capability, suicidality decreases. Results held beyond the effects of thwarted belongingness, perceived burdensomeness, and suicidal cognitions. Beyond further substantiating the link between agitation and suicide, findings of the present study provide evidence for the construct validity of the acquired capability as well as offer initial evidence for moderating role of capability on the effect of agitation on suicide. Limitations of the current study highlight a need for future research that improves upon the techniques used in the present study. Implications for science and practice are discussed.
    Full-text · Article · Jan 2015 · Depression and Anxiety
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    • "Fujino et al., 2005 [26] 13,259 Population DFA, DMS, EMA, NRS Suicide DMS predicted suicide over 14-year follow-up (RR ¼ 2.1, 95% CI: 1.1e3.9) Hall et al., 1999 [49] 100 Inpatient suicide attempters DFA, DMS, EMA Suicide attempt 46% of suicide attempters had global insomnia; 92% had partial insomnia Krakow et al., 2011 [50] "
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    ABSTRACT: Despite current knowledge of risk factors for suicidal behaviors, suicide remains a leading cause of death worldwide. This suggests a strong need to identify and understand additional risk factors. A number of recent studies have identified insomnia as a modifiable, independent suicide risk factor. Although a link between insomnia and suicide is emerging, further research is required in order to understand the nature of the relationship. Accordingly, this paper presents an overview of the insomnia and suicide literature to-date, and a discussion of two major limitations within this literature that hinder its progress. First, the classification and assessment of insomnia and suicide-related thoughts and behaviors are inconsistent across studies; and second, there is a lack of empirical studies focused on investigating mediators of the insomnia and suicide relationship. Suggestions are offered within this paper for future studies to address these issues and facilitate new developments in this important research area. Following these suggested lines of research will ultimately inform whether insomnia treatments, particularly cognitive-behavioral therapy for insomnia, can be used to target suicide risk prevention and intervention. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Full-text · Article · Oct 2014 · Sleep Medicine Reviews
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