Article

Suicide Risk Assessment in Clinical Practice: Pragmatic Guidelines for Imperfect Assessments

Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77080, USA.
Psychotherapy Theory Research Practice Training (Impact Factor: 3.01). 03/2012; 49(1):81-90. DOI: 10.1037/a0026148
Source: PubMed

ABSTRACT

This practice review focuses on the challenges of conducting sensitive and accurate assessments of the relative risk for suicide attempts and completed suicides. Suicide and suicide attempts are a frequently encountered clinical crisis, and the assessment, management, and treatment of suicidal patients is one of the most stressful tasks for clinicians. An array of risk factors, warning signs, and protective factors associated with suicide risk are reviewed; however, we are not yet in possession of evidence-based diagnostic tests that can accurately predict suicide risk on an individual level without also creating an inordinate number of false-positive predictions. Given the current limitations of assessment strategies, clinicians are advised to keep in mind that patients contemplating suicide are under enormous psychological distress, requiring sensitive and thoughtful engagement during the assessment process. An overarching goal of these assessments should be conducted within the therapeutic frame, in which efforts are made to enhance the therapeutic alliance by negotiating a collaborative approach to assessing risk and understanding why thoughts of suicide are so compelling. Within this treatment heuristic, the Suicide Assessment Five-step Evaluation and Triage (SAFE-T) is recommended as a pragmatic multidimensional assessment protocol incorporating the best known risk and protective factors.

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Available from: James Christopher Fowler, Jan 02, 2014
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    • "However, these suicide assessment scales provide insufficient predictive validity for future suicide attempts. They are limited by the willingness of some patient to share information, the ability of a clinician to properly and consistently develop an assessment, and their limited positive predictive value and high rate of false positives.25 Despite the current limitations in connecting clinical and research assessments, the importance of using research to establish broad and predictive risk factors for SB is paramount. "
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    • "Furthermore , throughout this paper , we referred to suicide risk by measuring hopelessness as a proxy of such risk . This is a limitation because , despite its predictive value , hopelessness is a marker that can indicate false positives when assessing suicide risk , while several other contributing factors can increase suicide risk ( Pompili 2010 ; Fowler 2012 ) . This points to the fact that our emphasis on suicide risk using the measurement of hopelessness could be mitigated by taking into account contributing factors that were not part of the data collection for this study . "
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    • "Furthermore , throughout this paper , we referred to suicide risk by measuring hopelessness as a proxy of such risk . This is a limitation because , despite its predictive value , hopelessness is a marker that can indicate false positives when assessing suicide risk , while several other contributing factors can increase suicide risk ( Pompili 2010 ; Fowler 2012 ) . This points to the fact that our emphasis on suicide risk using the measurement of hopelessness could be mitigated by taking into account contributing factors that were not part of the data collection for this study . "
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