Assessing Risk for Imminent Suicide

Abstract

Most suicide victims see a health professional shortly before their death; yet, at present, clinicians have no tools for identifying those at acute risk. Clinical instruments valuable in predicting suicide over a 10-year period were not effective in predicting completed suicides within a period of 6 months. In fact, the difference between chronic and imminent suicide risk has only recently been articulated in the literature. A promising approach is to assess suicide risk along multiple dimensions. In this article, we review an evaluation model that consists of four domains: 1) long-term suicide risk, 2) implicit acceptance of suicide as a solution to problems, 3) acuity of the suicidal state, and 4) clinicians' emotional response (ie, countertransference) to the acutely suicidal patient. The first domain has already been integrated into clinical practice. The review focuses on the next three dimensions and suggests ways to utilize them in clinical practice.

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis

“…The SCS concept was first proposed by Yaseen et al () using the Suicide Trigger Scale, second version (STS‐2). This version of the STS was the first to be tested prospectively, and it distinguished two factors of the then‐termed “suicide trigger state.” The first factor described the loss of cognitive control over one's thoughts and was termed “ruminative flooding.” The second factor described the affective state of “frantic hopelessness,” similar to entrapment (Galynker, Yaseen, & Briggs, ). In addition to frantic hopelessness and ruminative flooding, the later expanded version of the scale, the STS‐3, also described a factor of unusual body sensations and dissociation termed “psychotic somatization” (Yaseen, Gilmer, Modi, Cohen, & Galynker, ).…”

Prediction of suicidal behavior in high risk psychiatric patients using an assessment of acute suicidal state: The suicide crisis inventory

“…Our prior assessment tool for short‐term suicide risk, the Suicide Trigger Scale (STS) (Galynker, Yaseen, & Briggs, ; Yaseen et al., , ), demonstrated prediction of SB within 6 months following hospital discharge among patients admitted for high suicide risk (Yaseen et al., ). Factor analysis identified two factors most predictive of future SB: the affective state of “frantic hopelessness” characterized by an urge to escape one's situation and hopelessness of doing so, akin to entrapment (Baumeister, ; Gilbert & Allan, ; Williams & Pollock, 2000), and the cognitive state of “ruminative flooding” characterized by loss of control over overwhelming rigid and repetitive thoughts (Galynker et al., ; Yaseen et al., ).…”

Attitudes of acceptability and lack of condemnation toward suicide may be predictive of post-discharge suicide attempts

“…In light of the above it appears that the SOQ, although it does not contain questions explicitly probing lifetime history of SA and SI, may do so implicitly by probing patients’ permissive vs. prohibitive attitudes towards suicide as a legitimate solution for life’s problems. As such, the SOQ or its subscales have a potential to be useful in prospectively identifying those at risk for suicide, whether alone or as a module in a multimodal assessment of suicide risk [ 43 ]. As a suicide risk assessment tool, the SOQ would be most useful when used with high-risk patients, such as those admitted to an acute psychiatric unit for SA or dangerousness to self.…”