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Practice Guidelines for the Assessment of Risk for Violent Behaviors during the Psychiatric Evaluation
Published in Kunsook S. Bernstein, Robert Kaplan, Psychiatric Mental Health Assessment and Diagnosis of Adults for Advanced Practice Mental Health Nurses, 2023
Kunsook S. Bernstein, Robert Kaplan
Suicide assessment is an essential first step in helping APMHNs estimate a client's risk for suicide. After that assessment has been conducted, a determination can be made as to an appropriate treatment setting, and an individualized treatment plan can be formulated that addresses specific modifiable risk factors, including any need for heightened observation. A suicide assessment protocol is composed of the following steps: (1) gathering information related to a client's risk and protective factors, and the warning signs for suicide; (2) gathering information related to the client's suicidal ideation, planning, behaviors, desire, and intent; and (3) the clinical decision-making that is subsequently applied to create a formulation of risk.
Risk and protective factors
Published in Lorraine Bell, Helping People Overcome Suicidal Thoughts, Urges and Behaviour, 2021
Risk factors are often confused with warning signs of suicide, and frequently suicide prevention materials mix the two into lists of “what to watch out for”. Warning signs indicate an immediate risk of suicide, whereas risk factors indicate someone is at heightened risk for suicide, but little or nothing about immediate risk (Rudd et al 2006) (Table 1.1).
Substance Use Disorder, Intentional Self-Harm, Gun Violence, and HIV/AIDS
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
The warning signs for suicide are complex, and most individuals at risk or displaying signs do not attempt suicide. However, displays of suicidal ideation should be recognized and considered an emergency with immediate medical attention sought for the individuals. Individuals talking about suicide or death often, or expressing extreme feelings of hopelessness, shame, guilt, pain, or being a burden, can be indicative of suicidal intentions. If the person voices that they have a plan for suicide, such as researching a method or obtaining lethal weapons, it should be considered an emergency situation. Actions such as reckless behaviors, or demonstrations of extreme mood swings or changes in sleeping and eating patterns, should not be dismissed. Additionally, activities such as getting affairs in order, giving away possessions, and/or saying goodbye to family and friends should be met with significant concern in the absence of a terminal illness.41 Asking the person if they are having thoughts of doing harm to themselves or taking their life, though difficult, is the first step to be taken, as well as alerting other appropriate resources and support people. For individuals with a terminal illness, discussing wishes for the end of life should be encouraged (see Chapter 7 and Appendix 1), and patients eligible for MAiD, where legal, should be supported in their decisions (see Appendix 2).
Variable Circumstances of Suicide Among Racial/Ethnic Groups by Sex and Age: A National Violent-Death Reporting System Analysis
Published in Archives of Suicide Research, 2021
Bina Ali, Ian Rockett, Ted Miller
Our study builds on previous research indicating that suicide risk varies as a function of sex and age for diverse racial/ethnic groups (Leavitt et al., 2018; Stone & Crosby, 2014; Y. Wong et al., 2017). Findings of this study underscore the importance of affordable, effective, and tailored approaches to prevent suicide among high-risk subgroups. Enhanced social support, access to health services, development of life skills, and development of interpersonal social-emotional learning can promote overall health and healthy relationships. Social barriers, such as public stigma and lack of culturally competent care, often prevent individuals from accessing adequate health care (Wong, Collins, Cerully, Seelam, & Roth, 2017). Health care providers potentially contribute to health disparities through their actual or perceived perceptions of racial/ethnic patients, male/female patients, and older/younger patients, which relate to their diagnostic and treatment decisions (Leresche, 2011; Motov & Khan, 2008). Education and training on cultural sensitivity to health care providers may help address disparities across diagnostic and treatment. The American Association of Suicidology provides education materials and information on the warning signs of suicide (American Association of Suicidology, 2018), which may help reduce suicide stigma and identify individuals at risk of suicide.
Isolating the Association of Sleep, Depressive State, and Other Independent Indicators for Suicide Ideation in United States Teenagers
Published in Archives of Suicide Research, 2019
Lynn M. Whitmore, Tyler C. Smith
Possible warning signs for suicide include low self-esteem; hopelessness; talking about self-harm, death or dying; experiencing the loss of a significant family member or friend; changes in personality, behavior, or affect; a fear of losing control; and changes in sleep patterns (APA, 2017). Suicide risks vary with age, sex, ethnic group, and life events, and include environmental, social, and psychological factors, with mental illness (e.g., depression, bipolar disorder, or substance abuse disorder) being the leading risk factor (APA, 2017; Cash & Bridge, 2009). Suicide rates tend to be higher among young men, but suicide ideation and attempts are higher in young women; suicide rates in Native American and Caucasian youths are also typically higher than in other races (Cash & Bridge, 2009). Physical or sexual abuse, bullying, same-sex sexual orientation, or having parents with suicidal tendencies or mental illness are also risk factors for teenage suicide (Cash & Bridge, 2009). Internet use can augment or disrupt suicide ideation (Daine et al., 2013; Mitchell, Wells, Priebe, & Ybarra, 2014), and even offer guidance and instruction for suicide attempts (Biddle, Donovan, Hawton, Kapur & Gunnell, 2008; Recupero, Harms, & Noble, 2008).
Evaluation of an avatar-based training program to promote suicide prevention awareness in a college setting
Published in Journal of American College Health, 2018
Benjamin A. Rein, Daniel W. McNeil, Allison R. Hayes, T. Anne Hawkins, H. Mei Ng, Catherine A. Yura
Previous applications of in-person gatekeeper training programs in college settings have demonstrated effectiveness. One study trained college students, faculty, and staff to act as gatekeepers through an in-person program that included a PowerPoint™ presentation, a question-and-answer component, and a role-play scenario.16 One month after training, participants reported being more knowledgeable about facts concerning suicide prevention, warning signs of suicide, how to ask someone about suicide, persuade them to get help, and actually get them help. Participants also reported being more likely to ask others about suicidality if they are concerned about them, believed that asking about suicide was more appropriate, and demonstrated greater knowledge of the local resources.16 At three months after training, participants' scores had not decreased significantly in any category.16 In another application of an in-person gatekeeper-training program, school personnel participated in a 1-hour training with a certified trainer. After training, participants scored significantly higher on a quiz evaluating their knowledge of warning signs, how to raise concerns, and refer at-risk individuals for help.17 Participants also reported higher self-evaluations of their knowledge on suicide, indicated greater likelihood of questioning an individual about suicide and intervening, believed that suicide is more preventable, and thought that their efficacy in assisting a suicidal person had improved.17 Readers are referred to a special issue of New Directions for Student Services which addresses the issue of college suicide, and provides a review of suicide prevention approaches used in higher education.18