A test of the effectiveness of a list of suicide warning signs for the public

In this study we examined the effect that reading a list of warning signs for suicide has on beliefs about suicide, including the belief that one can recognize a suicidal crisis. All participants read two sets of warning signs (with only the experimental group reading the suicide warning signs) and then answered questions concerning beliefs related to three health problems. Results indicate that participants who read the suicide warning signs reported greater abilities to recognize if someone is suicidal but did not report stronger beliefs that suicidal individuals are partly to blame, nor did they report lower likelihoods of befriending suicidal individuals. Results suggest that reading the list of warning signs may be effective in increasing the public's ability to recognize suicidal crises without creating or magnifying stigmatizing beliefs about suicidal individuals.     

Exposure to a Mnemonic Interferes with Recall of Suicide Warning Signs in a Community‐Based Suicide Prevention Program

The incremental impact of adding a mnemonic to remember suicide warning signs to the Air Force Suicide Prevention Program (AFSPP) community awareness briefing was investigated with a sample of young, junior‐enlisted airmen. Participants in the standard briefing significantly increased their ability to list suicide warning signs and improved consistency with an expert consensus list, whereas participants in the standard briefing plus mnemonic demonstrated no learning. Both groups demonstrated positive changes in beliefs about suicide. Results suggest that inclusion of the mnemonic in the AFSPP briefing interfered with participants' ability to learn suicide warning signs, and that increased confidence in the perceived ability to recognize suicide risk is not related to actual ability to accurately recall warning signs.     

Warning signs for suicide on the Internet: a descriptive study

The issue of suicide warning signs on the Internet is considered. In addition to reviewing some of the relevant conceptual issues about warning signs, a random sample of Internet sites was selected and reviewed. Warning signs were grouped and agreement across sites was examined, with results confirming broad disparity in what is presented to the public. The implications of a lack of consensus on warning signs for suicide are discussed.     

Risk Factors,Warning Signs,and Drivers of Suicide: What Are They,How Do They Differ,and Why Does It Matter?

Research investigating suicide attempts and deaths by suicide has yielded many specific risk factors and warning signs for future suicidal behaviors. Yet, even though these variables are each valuable for suicide prevention efforts, they may be limited in their applicability to clinical practice. The differences among risk factors, warning signs, and “drivers,” which are person‐specific variables that lead individuals to desire death by suicide, are highlighted. The scarce evidence on drivers is described and specific recommendations for conducting future drivers‐focused research and targeting them in clinical practice are suggested.     

Warning signs for suicide: theory, research, and clinical applications

The current article addresses the issue of warning signs for suicide, attempting to differentiate the construct from risk factors. In accordance with the characteristic features discussed, a consensus set of warning signs identified by the American Association of Suicidology working group are presented, along with a discussion of relevant clinical and research applications.     

Suicide coverage in U.S. newspapers following the publication of the media guidelines

A nationally representative sample of 968 local and national newspapers was examined to determine whether the 2001 U.S. media guidelines were followed in articles published in 2002-2003, and featuring individual cases of suicidal behavior (N = 157). We found that, during this period of time, U.S. newspaper suicide coverage did not consistently reflect the influence of the media guidelines. On the positive side, only 19% of stories included inappropriate imagery. On the negative side, suicide stories often detailed suicide method (56% of stories) and location (58%), and rarely provided information about warning signs and risk factors (1%), the roles of depression (4%) and alcohol (2%), and prevention resources (6%). Our findings, together with previous evidence, suggest the need for sustained dialogue with the media about suicide reporting.     

Emotional Impact of a Video‐Based Suicide Prevention Program on Suicidal Viewers and Suicide Survivors

In light of continuing concerns about iatrogenic effects associated with suicide prevention efforts utilizing video‐based media, the impact of emotionally‐charged videos on two vulnerable subgroups—suicidal viewers and suicide survivors—was explored. Following participation in routine suicide education as a part of the U.S. Air Force Suicide Prevention Program's video‐based community briefing, a sample of young active duty airmen demonstrated small decreases in positive emotional states and larger decreases in negative emotional states, especially among suicidal females. No evidence of iatrogenic effects were observed among suicidal or survivor subgroups when compared to controls. Results support the use of video‐based media as a safe educational strategy that might actually serve to decrease emotional distress among vulnerable subgroups.     

A test of the validity of the IS PATH WARM warning signs for suicide

The 10 warning signs for suicide, encapsulated in the mnemonic IS PATH WARM, did not differentiate between genuine suicide notes and those written by people simulating a suicidal crisis or between notes written by completed suicides and those written by attempted suicides.     

Awareness of Suicide Risk and Communication Between Health Care Professionals and Next‐of‐Kin of Suicides in the Month Before Suicide

Based on psychological autopsy data, the study compared awareness of suicide risk in the deceased among next‐of‐kin (NOK ) and health care professionals (HCP s), and communication between these two groups in the month before death. The NOK s had significantly more knowledge about the decedent's suicide warning signs than the HCP s (90.5% vs. 44.6%). Contact between NOK and HCP was initiated more often by the family than the HCP s (29.4% vs. 5.9%). The study found communication gaps between HCP s and NOK and stresses the need for suicide prevention strategies strengthening communication between these two groups.     

Mechanisms behind hazard perception of warning signs: An EEG study

Warning signs are the most effective way to alert people to hazards in the industries, architecture, and transportation. To better understand how these warning signs prompted hazard, this study investigated the intrinsic mechanism of hazard perception of warning signs, including warning words (low versus high hazard levels) and surrounding shapes (upright triangle versus circle). We recruited 18 participants and recorded electroencephalogram (EEG). We found that a combination of high-hazard-level words and an upright triangle shape significantly elicited more negative N300 and increased theta-band (3–8 Hz) synchronization, but reduced beta-band (15–30 Hz) desynchronization. The N300 component represented the emotional arousal strength, theta oscillations reflected the engagement of retrieval of emotional experiences from episodic memory, and beta oscillation connoted the semantic encoding. Thus, these findings suggested that a high-hazard-level combination had the ability to obtain high priority in cognitive processing. The EEG pattern changes allowed us to assess whether the hazard perception of warning signs was high or low, which could be an accurate indicator to better evaluate the design of warning signs.     

The Process of Suicide Risk Assessment: Twelve Core Principles

Suicide risk assessment requires counselors to determine client risk factors, warning signs, and protective factors. The content of suicide assessment has received attention in the literature. The guiding principles of the process of suicide assessment, however, have not yet been articulated. This article contains 12 core process principles that highlight the broader overarching philosophical tenets that guide suicide risk assessment. The principles serve as a complement to the current focus on content in suicide assessment.     

The nature of intrusive memories after trauma: the warning signal hypothesis

Individuals who had experienced a range of different traumas were asked to describe the quality and content of their intrusive memories. Visual intrusions were the most common, and thoughts were uncommon. Intrusion quality varied little with type of trauma. Intrusive memories commonly consisted of stimuli that were present immediately before the traumatic event happened or shortly before the moments that had the largest emotional impact (i.e., when the meaning of the event became more traumatic). It is suggested that intrusive memories are about stimuli that through temporal association with the trauma acquired the status of warning signals, i.e., stimuli that if encountered again would indicate impending danger. This explains why intrusive memories are accompanied by a sense of serious current threat. The warning signal hypothesis may be useful in guiding therapists in identifying the moments with the largest emotional impact that will need reprocessing in treatment, and in educating patients about the nature of reexperiencing symptoms.     

Suicidal Behavior and Problems with Emotion Regulation

We examined in two independent samples whether: (1) difficulties with emotion regulation predict suicide ideation and (2) depressed adults with a history of attempting suicide report and exhibit more emotion dysregulation compared to healthy and depressed controls. Difficulties with emotional clarity and relationship status were significant predictors of suicide ideation (Study 1). In Study 2, when compared to controls, depressed attempters reported significantly more difficulties with emotional clarity and emotional impulsivity. Attempters had significantly more difficulty than controls returning to heart rate baseline following a stressful task. Problems with emotions are therefore differentially connected to suicidal behaviors.     

Suicide Prevention in Australian Aboriginal Communities: A Review of Past and Present Programs

A review of Aboriginal suicide prevention programs were conducted to highlight promising projects and strategies. A content analysis of gray literature was conducted to identify interventions reported to have an impact in reducing suicidal rates and behaviors. Most programs targeted the whole community and were delivered through workshops, cultural activities, or creative outlets. Curriculums included suicide risk and protective factors, warning signs, and mental health. Many programs were poorly documented and evaluations did not include suicidal outcomes. Most evaluations considered process variables. Results from available outcome evaluations suggest that employing a whole of community approach and focusing on connectedness, belongingness and cultural heritage may be of benefit. Despite the challenges, there is a clear need to evaluate outcomes if prevention is to be progressed.     

A School-Based Suicide Risk Assessment Protocol

Suicide remains the third leading cause of death among young people in the United States. Considering that youth who contemplate suicide generally exhibit warning signs before engaging in lethal self-harm, school-based mental health professionals can play a vital role in identifying students who are at risk for suicidal behavior. Nevertheless, the assessment of vulnerable children and adolescents is a challenging undertaking, with many variables considered relevant to the determination of a student's suicide risk level. This article introduces school-based mental health professionals to the Student Suicide Risk Assessment Protocol, an evaluation tool developed by the author to aid in the determination of student suicide potential, assist with the selection of appropriate interventions, and allow for documentation of school personnel's actions taken to mitigate a student's suicide risk.     

Is emotional content obtained from parafoveal words during reading? An eye movement analysis

An eye-movement-contingent display change technique was employed to study whether adult readers extract semantic information from parafoveal words during reading. Three types of parafoveal preview conditions were contrasted: an emotional word, a neutral word, and an identical word condition. To have a maximally effective parafoveal manipulation, high-arousal emotional words (sex- and threat-related and curse words) were used as parafoveal previews. Readers' eye fixation patterns around the target word revealed no evidence for parafoveal semantic processing. Furthermore, the pupil size showed no signs for an emotional response triggered by an emotional word previewed parafoveally. These results are consistent with the view that, as a rule, only the fixated word is processed to a semantic level during reading.     

Teachers' knowledge of facts and myths about suicide

Suicidal behavior is a serious public health concern that has prompted the development of prevention strategies, which include increasing community members' knowledge about suicide. Given that teachers are in a key position to recognize and respond to suicidal behavior, this study examined teachers' knowledge about suicide to identify how they need to be educated relative to its prevention. 82 Canadian school teachers from middle and high schools were administered a revised version of the 32-item Facts on Suicide Quiz to examine their knowledge of suicide. Analysis indicated that general information about suicide was limited, while knowledge of clinically relevant information about suicide, e.g., "Suicide rarely happens without warning," was relatively high.     

Impact of Client Suicide on Psychologists in Australia

Objective

This research aimed to assess the frequency and impact of client suicides on psychologists in Australia.

Method

Participants were 178 psychologists who completed an online self‐report questionnaire concerning the frequency of occurrence and impact of client suicide.

Result

Fifty six (31.5%) participants reported one or more client suicides. Psychologists with more years of experience reported more client suicides. Participants who had experienced a client suicide reported a range of emotional, cognitive and behavioural reactions as well as professional impacts. Ratings of responsibility, preventability and predictability of a client suicide were associated with emotional and/or professional impacts. Beneficial coping responses included talking to supervisors and colleagues, recognising the psychologist is not responsible and having increased acceptance of a client suicide.

Conclusions

The findings have important implications for training, workplace practices and research.     

The role of death romanticization in the dynamics of suicide

Suicide is an emotional, complex event, the causes of which are not well understood. Hence, the subject of suicide cannot be adequately treated in an objective, simplified, scientific discussion without ignoring its essentially personal nature. In an attempt to add some insights into the personal dimension of suicide to analytical theory considered in the following pages, subjective, spontaneous thoughts, both philosophical and indulgingly emotional, have been included. The subjective thoughts have been separated from the theoretical discussions and will be found in the sections labeled with a letter a (e.g., iii a and v a) following the theory sections to which they most closely relate. A reading of these extra sections is extraneous to the understanding of the suicidal theory presented here, and they have been included only for the reader's interest.     

Phenomenology of bibliotherapy in modifying teacher punitiveness

The authors examined the phenomenology of bibliotherapy and its effects in changing preservice teachers' punitive attitudes toward children. Participants (N = 29) were enrolled in a university course (Introduction to Emotional Disturbance). Five books by Torey Hayden, autobiographical accounts of teaching and building relationships with students with emotional and behavioral disorders, were read and discussed within the framework of group bibliotherapy. Participants completed a self-report rating form measuring their tendency toward punitiveness during the first and last weeks of the 15-week semester. Participants also completed a questionnaire measuring the bibliotherapeutic impact of reading Hayden's texts, and they kept journals about the experience of reading Hayden. Comparison of the group's pre- and post-measures on punitiveness showed a small, albeit significant decrease in punitiveness; decreased punitiveness was associated with the therapeutic impact of reading Hayden. Phenomenological analysis of the participants' journal entries revealed that the structure of the experience of reading Hayden was one of identification with the protagonist, leading to emotional and cognitive learning.