Advances in assessment of suicide risk

Department of Psychology and Neuroscience, Baylor University, Waco, Texas, United States
Journal of Clinical Psychology (Impact Factor: 2.12). 02/2006; 62(2):185-200. DOI: 10.1002/jclp.20222
Source: PubMed


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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Available from: Craig J Bryan
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    • "The role of impulsivity in suicide is particularly noteworthy because impulsivity has long been conceptualized as a key risk factor for suicide attempts. Indeed, because impulsivity is thought to hasten the transition from thoughts to action, it has often been conceptualized as a critical clinical factor in the progression from suicidal thoughts to attempts (Bryan & Rudd 2006, Mann et al. 1999). However, recent research disputes these long-held clinical beliefs. "
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    ABSTRACT: Suicidal behavior is a leading cause of death and disability worldwide. Fortunately, recent developments in suicide theory and research promise to meaningfully advance knowledge and prevention. One key development is the ideation-to-action framework, which stipulates that (a) the development of suicidal ideation and (b) the progression from ideation to suicide attempts are distinct phenomena with distinct explanations and predictors. A second key development is a growing body of research distinguishing factors that predict ideation from those that predict suicide attempts. For example, it is becoming clear that depression, hopelessness, most mental disorders, and even impulsivity predict ideation, but these factors struggle to distinguish those who have attempted suicide from those who have only considered suicide. Means restriction is also emerging as a highly effective way to block progression from ideation to attempt. A third key development is the proliferation of theories of suicide that are positioned within the ideation-toaction framework. These include the interpersonal theory, the integrated motivational-volitional model, and the three-step theory. These perspectives can and should inform the next generation of suicide research and prevention. Expected final online publication date for the Annual Review of Clinical Psychology Volume 12 is March 28, 2016. Please see for revised estimates.
    Full-text · Article · Apr 2016 · Annual Review of Clinical Psychology
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    • "For example, Mann, Waternaux, Haas, and Malone (1999, p. 181) present an influential clinical model of suicidal behavior suggesting that impulsivity makes individuals " more likely to act on suicidal feelings. " Likewise, Bryan and Rudd (2006, p. 195) state that impulsivity " may actually be a more significant indicator of suicide attempt than the presence of a specific suicide plan. " Impulsivity has also widely been adopted as a risk factor for suicide in clinical guidelines. "
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    ABSTRACT: Suicide attempts are often regarded as impulsive acts. However, there is little consensus regarding the definition or clinical characteristics of an "impulsive" attempt. To clarify this issue, we examined 3 indicators of the impulsivity of an attempt: (a) preparation, (b) time contemplating the attempt, and (c) self-report that impulsivity motivated the attempt. We examined relationships among the indicators and their relationship to trait impulsivity and characteristics of the suicide attempt. Adult participants (N = 205) with a history of suicide attempts were administered validated interviews and questionnaires. In general, the 3 attempt impulsivity indicators correlated only moderately with each other and not at all with trait impulsivity or with important characteristics of the attempt (e.g., lethality, preattempt communication, motivations). However, there were 2 exceptions. First, intent to die was inversely related to the 3 attempt impulsivity indicators (rs ranged from -.17 to .45) such that more impulsive attempts were associated with lower intent. Second, self-report that the attempt was motivated by impulsivity was related to 3 facets of trait impulsivity (rs ranged from .16 to .41). These findings suggest that individuals endorsing trait impulsivity are likely to describe their attempts as motivated by impulsivity, regardless of the presence of preparation or prolonged contemplation. Overall, study results suggest that the common conception of a unidimensional impulsive attempt may be inaccurate and that the emphasis on general impulsivity in prevention guidelines should be tempered. Implications for suicide risk assessment and prevention are discussed. (PsycINFO Database Record
    Full-text · Article · Dec 2015 · Personality Disorders: Theory, Research, and Treatment
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    • "Most resonated with the idea that the loved one had, ended their pain and started ours (Hewett, 1980). Not surprisingly depression has been cited as a major problem after losing a loved one to suicide, and the closer the relationship the longer and more severe the effect (Zhang, 2005) which is a worrying find considering well documented long historical links with suicide to depression (Bryan, 2005). Further, as many as 28 people can be bereaved by the loss of each single person to suicide (Bland, 1994). "
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    ABSTRACT: Ireland has the second highest rate of child suicide in Europe (MacKay & Vincenten, 2014). This dissertation explores the risks, causes and aftermath of suicide in relation to how positive psychology (PP) can assist in addressing those insights in order to build resilience and reduce suicide ideation for school aged children in Ireland. Martin Seligman often referred to as the founder of positive psychology (, 2015) described this new and exciting discipline as, “the scientific study of optimal human functioning that aims to discover and promote the factors that allow individuals and communities to thrive” (Seligman & Csikszentmihalyi, 2000, p.5). Moreover positive psychology provides an empirically validated scientific base incorporating research and theory related to the thriving of the human condition, which in the form of applied positive psychology (APP) offers a sound framework to not only gain insights but apply positive psychology interventions (PPI’s) to optimise human function (Baker, 2012). Psychology as usual is often how the study of mental health pathology is used as a term to describe the human condition with its myriad of failings, while flourishing is synonymous with positive psychology describing the human condition at its best (Keyes, 2002). This renowned researcher purports that high levels of emotional, psychological and social well-being are the constituents of a flourishing individual (Robitschek & Keyes, 2009). Whereas low levels of the constituents described by Keyes relate to suicide ideation when considering connections with suicide to depression (Bryan, 2005) and feelings of failure and despair as reported in a recent college students study (McKenzie et. al, 2011). Positive psychology defined as the science of what makes life worth living (Positive Psychology UK, 2015) offers a relevant contrast for suicide which is concerned with proactively ending life. My client is the Principal of a secondary school in Southern Ireland, who suffered the tragic loss of three senior pupils by suicide over a period of five years. The occurrence of school aged children falling into patterns of such deep despair as to consider and sometimes succeed in ending their own lives is a most worrying and crucial issue to be addressed. From extensive meetings and discussions as to how positive psychology could provide insights into the risks and causes of such deaths and additionally offer hope for prevention in the future by instilling a culture of resilience in their pupils and the school, a mission statement was settled upon; “How can positive psychology help us to understand the risks and causes of suicide in school aged children and how can we apply those insights to instil resilience and prevent further tragedies in our school” To gain a comprehensive insight into such a complex subject matter point one explores suicide from three perspectives; those who have survived a serious attempt to end their own lives - parasuicide, those who have lost a relative or close one to suicide and lastly the organisations set up to address suicide ideation and effects. Point two takes the lead from these insights to give a good grounding in the areas of positive psychology research and theory that relate to the risks and causes of suicide and how they apply to school aged children. Point three is a plan of recommendations to address the problem through positive psychology interventions (PPI’s) which could be put in place to build resilience and prevent suicide in my clients’ and other schools. This dissertation concludes in a five slide presentation with a ten minute voice over.
    Full-text · Thesis · Aug 2015
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