Suicide Crisis Syndrome: A systematic review

Abstract

BackgroundThe objective of this systematic review is to describe the scientific evidence for the Suicide Crisis Syndrome (SCS), a presuicidal cognitive and affective state consisting of five symptomatic dimensions: entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The aim of this article is to summarize the emerging literature on the SCS and to assess the extent to which a uniform syndrome can be assumed.MethodsA systematic literature search was conducted in three different databases (PubMed, PsycInfo, and Google Scholar) using the search terms “Suicide Crisis Inventory,” “Suicide Crisis Syndrome,” “Narrative Crisis Model of Suicide,” and “Suicide Trigger State.”ResultsIn total, 37 articles from 2010 to 2022 were identified by search criteria. Twenty‐one articles published between 2017 and 2022 were included in the systematic review. All but three studies were conducted in the United States and examined clinical samples of adult high‐risk psychiatric in‐ and outpatients. Sample sizes ranged from N = 170 to 4846. The findings confirm the unidimensional structure of the proposed disorder and support the predictive validity for short‐term suicidal behavior above and beyond suicidal ideation.ConclusionDespite the promising predictive validity of the SCS, a precise prediction of future suicidal behavior remains difficult.

The Narrative-crisis Model of Suicide as an Emerging Framework for Suicide Risk Stratification, Management, and Prevention

“…The SCS is a more acute cognitive-affective state and involves five components in its latest formulation: entrapment (frantic state of cognitive hopelessness where the individual feels that they are stuck in a crisis with no avenues to solve or escape from the problem), affective dysregulation (emotional pain, panic attacks, dissociation, rapid mood swings, and acute anhedonia), hyperarousal (insomnia, agitation), social withdrawal (evading social contact and feelings of isolation), and cognitive dyscontrol (cognitive inflexibility, ruminative thoughts, and inability to control the thoughts). 11 narrative, interventions targeting the cognitive inflexibility of the negative self-narrative may be indicated. Some examples of suicide-specific cognitive interventions that are consistent with the principles of NCM and hence can be used to target the suicidal narrative are collaborative assessment and management of suicidality (CAMS), cognitive-behavioral therapy for suicide prevention (CBT-SP), and the attempted suicide short intervention program (ASSIP).…”

“…The SCS is a more acute cognitive-affective state and involves five components in its latest formulation: entrapment (frantic state of cognitive hopelessness where the individual feels that they are stuck in a crisis with no avenues to solve or escape from the problem), affective dysregulation (emotional pain, panic attacks, dissociation, rapid mood swings, and acute anhedonia), hyperarousal (insomnia, agitation), social withdrawal (evading social contact and feelings of isolation), and cognitive dyscontrol (cognitive inflexibility, ruminative thoughts, and inability to control the thoughts). 11 …”