Assessing and Treating Different Suicidal States in a Danish Outpatient Sample

Abstract

The studies presented compare two methodologies for categorizing suicidal patients based on clinical data. Discussion follows regarding implications for risk assessment and treatment. In these studies, 52 outpatient subjects were placed into different groups based on coding their "suicidal motivation" (Study 1) and their "internal struggle" ratings (Study 2) using data collected at intake. Self-report ratings of 6 Suicide Status Form (SSF) Core Constructs (Psychological Pain, Stress, Agitation, Hopelessness, Self-Hate, and Overall Risk of Suicide) recorded both at intake and at completion of treatment were then compared to determine differences in Core Construct ratings among groups at different time points. In Study 1, overall differences among motivation groups (Life-motivated, Ambivalent, and Death-motivated) were significant for ratings at treatment completion of Overall Risk of Suicide, Self-Hate, and Psychological Pain. In Study 2, overall differences among groups (Wish to live, Ambivalent, and Wish to die) were significant for ratings at intake of Overall Risk of Suicide. At completion of treatment, overall differences among groups were significant for ratings of Overall Risk of Suicide, Hopelessness, and Self-Hate. In addition, significant interactions were found between test time and group for Overall Risk of Suicide and Self-Hate. Results suggest that categorizing suicidal patients by motivation and by the nature of their internal struggle could be beneficial to differential risk assessment with implications for clinical treatment.

The ABC’s of Suicide Risk Assessment: Applying a Tripartite Approach to Individual Evaluations

“…Following on Shneidman’s [ 18 ] depiction of suicidality as a “storm in the mind,” and ABC theory, the suicidal barometer model (SBM) was recently introduced to guide risk evaluations. The SBM is based on theory and empirical evidence that suicidality is a volatile state, with strong implications for both current and future personal risk [ 11 , 21 , 22 ]. The SBM proposes that risk measures should capture the individual’s experience of that internal storm, through subjective behavioral intentions, life-death affect, and suicidal cognition.…”

Clinical assessment and treatment of suicidal risk: A critique of contemporary care and CAMS as a possible remedy.

“…In subsequent research using this simple equation (that was a later called a "suicide index score"), Brown, Steer, Henriques, and Beck (2005) found significant odds ratios for suicidal behaviors associated with the wish-to-die subtype based on a one-time index rating of these constructs. Additional research has further replicated reliable subtypes of suicidal states using this cross-sectional trichotomy assessment methodology based on index wish-to-live and wish-to-die patient self-reports (Corona et al, 2013;O'Connor et al, 2012).…”

Factors determining the balance between the wish to die and the wish to live in older adults

“…The association between a three‐group typology and suicide risk has also been studied. Consistent with the internal struggle hypothesis, the discrepancy between patient's WTL and the WTD was a risk factor of suicide risk: when the orientation toward dying dominates, the risk increases (Brown et al ., ; Harris et al ., ; O'Connor et al ., ; Corona et al ., ).…”

“…The WTL and the WTD may be interpreted as distinguishable subjective phenomena, deduced by the finding that the majority of suicide attempters reported “an internal debate” over whether to live or to die. The ISH was investigated in different adult study populations such as psychiatric outpatients (Brown et al ., ), internet users (Harris et al ., ), outpatients of mental health centers (Corona et al ., ), and psychiatric inpatients (O'Connor et al ., ). Interestingly, implicit evidence for the internal struggle hypothesis was also found in a study that investigated underlying motives of suicide attempts: all suicide attempters (between 14 and 70 years of age) who reported a WTD also reported at least one other “non‐death” motive (McAuliffe et al ., ).…”