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Foundations for Conceptualizing and Treating Depression in Girls and Women
Published in Laura H. Choate, Depression in Girls and Women Across the Lifespan, 2019
Complete safety planning. While a full discussion of suicide assessment is beyond the scope of this chapter, it is important to be aware of the need for ongoing suicide risk assessment throughout treatment for any individual who is experiencing depression. As previously stated, there is a strong relationship between depression and suicide, largely due to feelings caused by depression—worthlessness, helplessness that she can do anything to change her situation, and hopelessness that things will ever get better for her. There is a need to assess for suicide risk throughout treatment, but it is particularly relevant when/if psychotropic medication is initiated. This increased suicide risk with medication initiation will be discussed later in this chapter and also in Chapter 2. Screening tools such as the Columbia Suicide Severity Rating Scale (C-SSRS; Columbia Lighthouse Project, 2019) can be used to assist with risk assessment. A safety plan should be established to help your client recognize the signs that suicidal thoughts are increasing, and outline the steps to take if she notes any of these signs (e.g., call a suicide prevention hotline, call a trusted friend, or other coping strategies).
Assessment of PTSD in the Context of Substance Use Disorders
Published in Anka A. Vujanovic, Sudie E. Back, Posttraumatic Stress and Substance Use Disorders, 2019
Finally, given the elevated risk for suicide (Harned, Najavits, & Weiss, 2006) and propensity for anger and aggression (Barrett, Mills, & Teesson, 2011; Hellmuth, Stappenbeck, Hoerster, & Jakupcak, 2012) in clients with comorbid PTSD/SUD, clinicians should assess risk of harm to self and others. With respect to suicide risk, the Columbia-Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011) is a widely used assessment of suicidal ideation and behavior. Across settings, the C-SSRS has demonstrated good convergent and divergent validity with similar scales of suicidal ideation, high sensitivity and specificity for suicidal behavior classifications, and sensitivity to change over time (Posner et al., 2011). For assessment of risk for violence toward others, the Historical-Clinical Risk Management–20 (HCR-20; Webster, Douglas, Eaves, & Hart, 1997; Webster, Eaves, Douglas, & Wintrup, 1995) has demonstrated strong psychometric properties. The recently developed third version of the HRC-20 (Douglas, Hart, Webster, & Belfrage, 2013) has shown strong predictive validity for violence at four to six weeks and six to eight months postassessment (Strub, Douglas, & Nicholls, 2014). Importantly, comorbid PTSD and depression have been found to predict heightened risk for suicide (Kimbrel et al., 2016). As such, we wish to emphasize the importance of assessing for comorbid depression. Appropriate measures include the brief self-report measure described above for screening purposes (PHQ-9; Kroenke et al., 2001) and the interview-based depression module of the SCID-5 (First, Williams, Karg, & Spitzer, 2015a, b), described below.
Special Considerations in Home Care
Published in Danielle L. Terry, Michelle E. Mlinac, Pamela L. Steadman-Wood, Providing Home Care for Older Adults, 2020
Luis Richter, Ami Bryant, William Gibson, Clair Rummel
Depending on the operating procedures of their agency, suicide screenings may be conducted by home care providers other than MH provider. At a minimum, suicidal ideation should be screened for during initial evaluations and at any point in treatment when warning signs are observed. Use of structured instruments to assist with screening are recommended (Corson, Gerrity, & Dobscha, 2004). Consider using one of the following: Beck Scale for Suicidal Ideation (BSS; Beck, Steer, & Ranieri, 1988).Beck Hopelessness Scale (BHS; Beck & Steer, 1988).Reasons for Living Inventory (RFL; Linehan et al., 1983).Columbia-Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011).Assessments specific to evaluating suicide in older adults may also be used: The Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006).Reasons for Living Inventory-Older Adults (RFL-OA; Edelstein et al., 2009).MH providers should carry materials needed for suicide risk screening, clinical risk assessments, and safety planning with them while in the field, as it is not always known when these materials will be needed.
Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) to Classify Suicidal Behaviors
Published in Archives of Suicide Research, 2018
Alejandro Interian, Megan Chesin, Anna Kline, Rachael Miller, Lauren St. Hill, Miriam Latorre, Anton Shcherbakov, Arlene King, Barbara Stanley
The monitoring of suicidal behaviors in clinical trials is a high priority. The Food and Drug Administration (FDA) recommended that suicidal ideation and behavior be prospectively monitored in all clinical trials, particularly those involving antidepressants (Food and Drug Administration, 2012). The FDA endorsed the Columbia-Suicide Severity Rating Scale (C-SSRS) as one of the instruments that can accomplish this task (Posner et al., 2011), resulting in widespread use of the C-SSRS. Despite the utility of the C-SSRS, there remain longstanding challenges when classifying suicidal behavior (Goldsmith, Pellmar, Kleinman, & Bunney, 2002). For example, assessing suicidal intent in self-injurious behavior is viewed as necessary, but also complicated due to varying definitions and inconsistencies in self-reported suicidal intent (De Leo, Burgis, Bertolote, Kerkhof, & Bille-Brahe, 2006; Freedenthal, 2007). Therefore, there is a need to ensure that the C-SSRS can be used with consistency and precision to classify even the most complex occurrences of suicidal behavior. The purpose of this paper is to describe key considerations we used in instances of difficult-to-classify suicidal behavior with the C-SSRS during the course of a clinical trial testing a suicide prevention intervention. Our descriptions are intended to aid users of the C-SSRS and to inform future development of suicide-behavior classification.
Depression and Intention to Seek Treatment Among Black and White Suicidal Military Members Who Are Not Engaged in Mental Health Care
Published in Military Behavioral Health, 2018
Jennifer M. Gómez, Nicholas P. Allan, Elizabeth J. Santa Ana, Tracy Stecker
The Columbia Suicide Severity Rating Scale (C-SSRS) is a widely used, validated measure of change in suicidal thoughts and behavior over time (Posner et al., 2011) that is validated for administration by telephone (Mundt et al., 2010). The C-SSRS was used to obtain information about participants' history of suicide attempts and ideation. Suicidal behavior included a history of actual, interrupted, or aborted suicide attempts. The C-SSRS measures suicidal ideation (SI) on a 6-point scale ranging from 0 (none) to 5 (active ideation with intent and plan). In the current study, SI was dichotomized (0 = none, 1 = present) and included present suicidal ideation and lifetime history of suicidal ideation.
Contributions of posttraumatic stress disorder (PTSD) and mild TBI (mTBI) history to suicidality in the INTRuST consortium
Published in Brain Injury, 2020
Lauren B. Fisher, Jessica Bomyea, Garrett Thomas, Joey C. Cheung, Feng He, Sonia Jain, Laura A. Flashman, Norberto Andaluz, Raul Coimbra, Mark S. George, Gerald A. Grant, Christine E. Marx, Thomas W. McAllister, Lori Shutter, Ariel J. Lang, Murray B. Stein, Ross D. Zafonte
The Columbia-Suicide Severity Rating Scale (C-SSRS) (72) is a gold-standard, clinician-administered scale that assesses presence/absence of lifetime suicidal ideation and suicidal behaviour. The C-SSRS shows good convergence with other measures of suicidality and excellent sensitivity and specificity for suicidal behaviour (i.e., actual, interrupted, or aborted suicide attempts) (72).