Warning Signs for Suicide: Theory, Research, and Clinical Applications

Rudd, M. David; Berman, Alan L.; Joiner, Thomas E.; Nock, Matthew K.; Silverman, Morton M.; Mandrusiak, Michael; Orden, Kimberly A. Van; Witte, Tracy K.

doi:10.1521/suli.2006.36.3.255

Cited by 434 publications

(379 citation statements)

References 16 publications

Supporting

Mentioning

354

Contrasting

Unclassified

Order By: Relevance

“…Warning signs are symptoms or stressors that are observed in the final day(s) before an event (Rudd, 2003;Rudd et al, 2006). Widely utilized in public education campaigns to prevent heart attacks, strokes, youth violence, and other health-related problems (Anonymous, 2004;Anonymous, 2008;Peterson and Newman, 2000), the concept of warning signs is starting to gain momentum in suicide prevention.…”

Section: Introductionmentioning

confidence: 99%

Warning signs for suicide within a week of healthcare contact in Veteran decedents

Britton

Ilgen

Rudd

et al. 2012

Psychiatry Research

Self Cite

View full text Add to dashboard Cite

Objectives-This study examined warning signs for suicide observed in the final day(s) of life in Veteran decedents who received healthcare from Veterans Health Administration (VHA) (N=381), using data obtained from detailed chart reviews.Methods-Veterans who died within a week (7 days) of healthcare contact (18%) were compared to those who died later (82%). Multivariate logistic regression was used to examine differences in suicidal thoughts, psychiatric symptoms, and somatic symptoms as documented at the last visit, after controlling for demographic variables. A second multivariate regression examined whether the identified warning signs were also risk factors for suicide within a month (30 days) of contact.Results-Documented suicidal ideation, OR (95% CI) = 3.46 (1.15-10.38), and psychotic symptoms, OR (95% CI) = 2.67 (1.11-6.42), at the last visit increased the likelihood of suicide within a week of healthcare contact. Both variables also increased the odds of suicide within a month of contact.Conclusions-The assessment of suicidal ideation is critical to identifying Veterans at immediate risk. However, recognition of psychotic symptoms may also improve identification. In addition to indicating immediate risk, some warning signs may also suggest on-going risk.

show abstract

Section: Introductionmentioning

confidence: 99%

Warning signs for suicide within a week of healthcare contact in Veteran decedents

Britton

Ilgen

Rudd

et al. 2012

Psychiatry Research

Self Cite

View full text Add to dashboard Cite

show abstract

“…Following recommendations regarding acute warning signs and lethality [5,23], the structured risk assessment included a question about serious consideration of suicide and suicide planning. Additional questions assessed whether SI had been shared with a local care provider and whether the respondent had disclosed any information to the interviewer that was unknown to his/her local providers.…”

Section: Phase 1: Planning and Developmentmentioning

confidence: 99%

“…Socio-demographic risks for suicide include age, gender, and ethnicity, with white men and older adults accounting for disproportionately high rates of completed suicides [4]. Distal suicide risk factors such as mental and medical illnesses represent relatively stable backdrops against which SI or suicidal behavior occurs [5]. For example, existing research indicates that suicide risk is elevated among persons with mental illness generally [6] and particularly among those with mood disorders [7], substance abuse/dependence problems [8], anxiety and posttraumatic stress disorder [9][10][11], self-reported physical illness [7,12], and chronic pain [13].…”

mentioning

confidence: 99%

“…More proximal or transient factors in this domain include social isolation [14,15], interpersonal relationship disruption [7], acute and severe life stressors [16], and unemployment [17]. Finally, in particularly high-risk situations, proximal and acute warning signs suggest the possibility of imminent suicidal behavior [5]. These warning signs include a patient's expressed intent to die, preparatory behavior and planning such as gaining access to lethal means, and implementation of self-harm action plans [5].…”

mentioning

confidence: 99%

“…Finally, in particularly high-risk situations, proximal and acute warning signs suggest the possibility of imminent suicidal behavior [5]. These warning signs include a patient's expressed intent to die, preparatory behavior and planning such as gaining access to lethal means, and implementation of self-harm action plans [5].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Suicide risk management: development and analysis of a telephone-based approach to patient safety

Campbell

Bonner

Bolkan

et al. 2011

Behav. Med. Pract. Policy Res.

View full text Add to dashboard Cite

Research-based queries about patients' experiences often uncover suicidal thoughts. Human subjects review requires suicide risk management (SRM) protocols to protect patients, yet minimal information exists to guide researchers' protocol development and implementation efforts. The purpose of this study was to examine the development and implementation of an SRM protocol employed during telephone-based screening and data collection interviews of depressed primary care patients. We describe an SRM protocol development process and employ qualitative analysis of de-identified documentation to characterize protocol-driven interactions between research clinicians and patients. Protocol development required advance planning, training, and team building. Three percent of screened patients evidenced suicidal ideation; 12% of these met protocol standards for study clinician assessment/intervention. Risk reduction activities required teamwork and extensive collaboration. Research-based SRM protocols can facilitate patient safety by (1) identifying and verifying local clinical site approaches and resources and (2) integrating these features into prevention protocols and training for research teams. Suicidal ideation (SI) and behavior are significant for healthcare management across clinical and research settings. Within research studies, ethical practice mandates suicide risk management (SRM) protocols to guide researchers' efforts to maximize patient safety [1,2]. Key stakeholders in the adequacy of these protocols include patients who participate in research, the researchers who study patients at risk for suicide, and the Institutional Review Boards (IRB) that oversee research activities. Several important management tasks are relevant for research-based SRM. Detection tasks include identifying those research participants who evidence high risk and require SRM protocol entry [2]. Essential management tasks include the development and implementation of specific plans and identification and training of specific personnel to perform risk management activities [1,2].Guidance regarding the detection of suicidal threat can be found in the suicide literature, which characterizes risk across numerous domains [3]. Socio-demographic risks for suicide include age, gender, and ethnicity, with white men and older adults accounting for disproportionately high rates of completed suicides [4]. Distal suicide risk factors such as mental and medical illnesses represent relatively stable backdrops against which SI or suicidal behavior occurs [5]. For example, existing research indicates that suicide risk is elevated among persons with mental illness generally [6] and particularly among those with mood disorders [7], substance abuse/dependence problems [8], anxiety and posttraumatic stress disorder [9-11], self-reported physical illness [7,12], and chronic pain [13]. Psychosocial issues can be conceptualized as more proximal suicide risk factors, which exist on their own or in concert with distal risks. More proximal or transient fac...

show abstract

Predictors of Prospectively Examined Suicide Attempts Among Youth With Bipolar Disorder

Goldstein

Ha²,

Axelson³

et al. 2012

Arch Gen Psychiatry

148

123

View full text Add to dashboard Cite

Context Individuals with early onset of bipolar disorder are at high risk for suicide. Yet, no study to date has examined factors associated with prospective risk for suicide attempts among youth with bipolar disorder. Objective To examine past, intake, and follow-up predictors of prospectively observed suicide attempts among youth with bipolar disorder. Design We interviewed subjects, on average, every 9 months over a mean of 5 years using the Longitudinal Interval Follow-up Evaluation. Setting Outpatient and inpatient units at 3 university centers. Participants A total of 413 youths (mean [SD] age, 12.6 [3.3] years) who received a diagnosis of bipolar I disorder (n=244), bipolar II disorder (n=28), or bipolar disorder not otherwise specified (n=141). Main Outcome Measures Suicide attempt over prospective follow-up and past, intake, and follow-up predictors of suicide attempts. Results Of the 413 youths with bipolar disorder, 76 (18%) made at least 1 suicide attempt within 5 years of study intake; of these, 31 (8% of the entire sample and 41% of attempters) made multiple attempts. Girls had higher rates of attempts than did boys, but rates were similar for bipolar subtypes. The most potent past and intake predictors of prospectively examined suicide attempts included severity of depressive episode at study intake and family history of depression. Follow-up data were aggregated over 8-week intervals; greater number of weeks spent with threshold depression, substance use disorder, and mixed mood symptoms and greater number of weeks spent receiving outpatient psychosocial services in the preceding 8-week period predicted greater likelihood of a suicide attempt. Conclusions Early-onset bipolar disorder is associated with high rates of suicide attempts. Factors such as intake depressive severity and family history of depression should be considered in the assessment of suicide risk among youth with bipolar disorder. Persistent depression, mixed presentations, and active substance use disorder signal imminent risk for suicidal behavior in this population.

show abstract

Warning Signs for Suicide: Theory, Research, and Clinical Applications

Cited by 434 publications

References 16 publications

Warning signs for suicide within a week of healthcare contact in Veteran decedents

Warning signs for suicide within a week of healthcare contact in Veteran decedents

Suicide risk management: development and analysis of a telephone-based approach to patient safety

Predictors of Prospectively Examined Suicide Attempts Among Youth With Bipolar Disorder

Contact Info

Product

Resources

About