Rebuilding the Tower of Babel: A Revised Nomenclature for the Study of Suicide and Suicidal Behaviors Part 2: Suicide‐Related Ideations, Communications, and Behaviors

Abstract

A revised and refined version of the O'Carroll et al. (1996) nomenclature for suicidology is presented, with a focus on suicide-related ideations, communications, and behaviors. The hope is that this refinement will result in the development of operational definitions and field testing of this nomenclature in clinical and research settings. This revision would not have been possible without the international collaboration and dialogue addressing the nomenclature of suicidology since the O'Carroll et al. nomenclature appeared in 1996.Although it is doubtful that we will ever be able to construct universally unambiguous criteria to comprehensively characterize suicidal behaviors (and, overall, firmly establish the intention behind them), for scientific clarity it would be highly desirable that the set of definitions and the associated terminology be explicit and generalizable.

Pediatric Suicide-Related Presentations: A Systematic Review of Mental Health Care in the Emergency Department

“…Future studies must address methodological limitations of the reviewed literature and further evaluate already established clinical interventions to establish utility and benefit to patient and family outcomes. This will involve: (1) justifying the level of care to be provided in the ED and appropriate outcomes that should result, 65 (2) including 'process evaluations' to determine the effectiveness the individual intervention elements of care that are deemed essential to the ED, (3) including well-defined treatment-as-usual control groups which are now considered the standard for conducting suicide-related treatment research, 67 (4) distinguishing between short-term and long-term outcome variables that are appropriate for this field, 46,68 (5) strict operationalization of the various subtypes of suicidality, [44][45] and (6) using multi-site studies to recruit pediatric-only populations to avoid over-generalizing study effects on a broad patient age range. Finally, studies must sample subsets of suicide-related behaviors to increase the likelihood that studies are feasible, ethical and clinically meaningful.…”

“…Five studies included adolescents aged 12 and 18 years, [27][28][34][35][36] four studies included participants ≥ 15 years of age, [29][30][32][33] and one study reported a median age of 23 years for their study population. 31 All studies were classified into three categories according to participant inclusion criteria using the Silverman et al [44][45] recommendations for defining and classifying patients' suicide-related presentations and observed intent: (1) Studies that recruited subjects with 'suicide attempts' included patients whose behavior indicated a clear intent to die; (2) Studies that recruited subjects with 'self-harm' included patients whose behavior indicated no intent to die; (3) Studies that recruited subjects with 'ideation/ planning' included patients who expressed ideation or planning without any clearly expressed suicide-related behaviors; and (4) Studies that recruited subjects with 'undefined behaviors' included patients where intent was undetermined or undefined. A conservative approach to categorization was employed.…”

“…On a final note, the few multi-site trials in this review limited geographical representation, and importantly, the level of behavioral risk and suicide-related terminology varied in meaning across studies thus reducing consistency with current recommendations. 45,47 …”

Last Suicide Attempt before Completed Suicide in Severe Depression: An Extended Suicidal Process May Be Found in Men Rather Than Women

“…Some more recent investigators also use a broad definition of self-harm without considering the degree of intent (Hawton et al 1997, Hawton et al 2003, Silverman et al 2007), which would include suicidal gestures and probably some aborted attempts. The latter have been described by Marzuk et al (1997) and have been associated with actual suicide attempts (Barber et al 1998).…”

Revisiting impulsivity in suicide: Implications for civil liability of third parties

“…Moreover, four times that many people are hospitalized due to injuries sustained while attempting suicide (CDC, 2004). For the purposes of this paper we will use Silverman and colleagues ' (Silverman, Berman, Sanddal, O'Carroll, & Joiner, 2007) definition of a "suicide attempt," which is "a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die." Suicide is thus a serious mental health issue and public health problem.…”