Intervention Styles With Suicidal Callers at Two Suicide Prevention Centers

Callers to suicide prevention centers are mainly helped by volunteers trained to face these crisis situations. This study evaluated this process of intervention in order to better understand the nature of the interventions and their determinants. A total of 617 calls with suicidal clients were classified with a 20-category rating instrument, the Helper's Response List. Cluster analysis determined that the 617 intervention profiles could match one of two styles: nondirective (“Rogerian”-391 calls) or directive (226 calls). Further analyses indicated that the particular style of intervention was related more to the characteristics of the callers themselves than to characteristics of volunteers.     

A Follow-up Study of 53 Suicides Known to a Suicide Prevention Center

ABSTRACT: The operation of the Cleveland Suicide Prevention Center is reviewed, and 53 known suicides during the Center's first four years of operation are discussed. A suicide rate of 288 per 100,000 suggests that persons contacting the Center represented a high suicide risk group. Of the suicides, 57 percent were women. This high proportion of females was statistically significant when compared to the smaller percentage of female suicides for Cuyahoga County, Ohio. Of the persons who committed suicide, 26 percent initiated direct contact with the Center themselves, and none recontacted the Center just prior to death. The question is raised whether contact initiated by another may in itself be suggestive of greater suicidal risk. Some of the practical problems in evaluation and referral are discussed.     

Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: Evaluation of Caller Risk Profiles and Interventions Implemented

Crisis lines are settings where identifying individuals at imminent risk of suicidal behavior and intervening to keep them safe are critical activities. We examined clinical characteristics of crisis callers assessed by telephone crisis helpers as being at imminent risk of suicide, and the interventions implemented with these callers. Data were derived from 491 call reports completed by 132 helpers at eight crisis centers in the National Suicide Prevention Lifeline network. Helpers actively engaged the callers in collaborating to keep themselves safe on 76.4% of calls and sent emergency services without the callers' collaboration on 24.6% of calls. Four different profiles of imminent risk calls emerged. Caller profiles and some helper characteristics were associated with intervention type. Our findings provide a first step toward an empirical formulation of imminent risk warning signs and recommended interventions.     

A Two-Year Follow-up of Suicide Prevention Center Patients*

ABSTRACT: A random sample of Los Angeles Suicide Prevention Center patients was selected for follow-up about two years after their prior contact with the Center. Of 417 patients sought, 184 were located and interviewed at follow-up. Sixteen had died and nine had committed suicide. The deaths were studied in depth by interviewing survivors (by means of a psychological autopsy). Results of the psychological autopsies uncovered two apparent suicides who had been certified as natural deaths (included in the total of nine). Interviews with the 184 follow-ups yielded longitudinal information about the onset, duration, and recurrence of suicidal states.     

Follow‐up with Callers to the National Suicide Prevention Lifeline: Evaluation of Callers’ Perceptions of Care

Continuity of care for suicidal individuals engaged with a variety of health and mental health care systems has become a national priority, and crisis hotlines are increasingly playing a part in the risk management and continuum of care for these individuals. The current study evaluated a national initiative to have crisis centers in the National Suicide Prevention Lifeline network provide follow‐up care to suicidal callers. Data were obtained from 550 callers followed by 41 crisis counselors from 6 centers. Two main data sources provided the information for the current study: a self‐report counselor questionnaire on the follow‐up activities completed on each clinical follow‐up call and a telephone interview with follow‐up clients, providing data on their perceptions of the follow‐up intervention's effectiveness. The majority of interviewed follow‐up clients reported that the intervention stopped them from killing themselves (79.6%) and kept them safe (90.6%). Counselor activities, such as discussing distractors, social contacts to call for help, and reasons for dying, and individual factors, such as baseline suicide risk, were associated with callers’ perceptions of the impact of the intervention on their suicide risk. Our findings provide evidence that follow‐up calls to suicidal individuals can reduce the perceived risk of future suicidal behavior.     

Effects of Different Telephone Intervention Styles with Suicidal Callers at Two Suicide Prevention Centers: An Empirical Investigation

To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of Rogerian nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.     

Evaluation of a Suicide Prevention Center by Sampling the Population at Risk*

ABSTRACT: At present there are no clear guidelines for assessing the effectiveness of suicide prevention and crisis centers. This report focuses on one readily available source of data, specifically that segment of the population at risk made up of persons admitted to the inpatient service of a mental health center due to depressive and/or suicidal states, including suicide attempts. To determine the role of the suicide prevention center in providing services to this group, 575 persons meeting these criteria were interviewed. The findings included the following: (a) 11 percent had utilized suicide prevention center services, with 59 percent of these experiencing substantial benefit; (b) 20 percent stated they were unaware of the center; (c) 8 percent expressed the view that calling the center would be inappropriate because a suicide attempt was not imminent; and (d) 26 percent indicated an inclination to call the center in the event of subsequent difficulties. Experience suggests that response to a crisis (intervention) as well as response to low lethality callers with “everyday problems” (prevention) constitute valid functions of a suicide prevention and crisis center. Preoccupation with short-term goals, such as reducing the apparent suicide rate, should not dominate the conceptualizing of program evaluation methods.     

Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: The Importance of Active Engagement,Active Rescue,and Collaboration Between Crisis and Emergency Services

In 2012, the SAMHSA‐funded National Suicide Prevention Lifeline (Lifeline) completed implementation of the first national Policy for Helping Callers at Imminent Risk of Suicide across its network of crisis centers. The policy sought to: (1) provide a clear definition of imminent risk; (2) reflect the state of evidence, field experience, and promising practices related to reducing imminent risk through hotline interventions; and (3) provide a uniform policy and approach that could be applied across crisis center settings. The resulting policy established three essential principles: active engagement, active rescue, and collaboration between crisis and emergency services. A sample of the research and rationale that underpinned the development of this policy is provided here. In addition, policy implementation, challenges and successes, and implications for interventions to help Lifeline callers at imminent risk of suicide are detailed.     

Suicide Prevention in a Treatment Setting

Reducing the suicide rate through treatment depends on the development of new knowledge and new technology with emphasis on early intervention and continuing lowintensity contact for many troubled suicidal people, rather than the current preoccupation with detecting and hospitalizing the “highest risk.” I anticipate that sophisticated interactive computer programs will be effective in improving screening and case finding, thus bringing many more suicidal persons into contact with primary care physicians and outpatient mental health services for the purpose of relieving psychological pain. Computer programs will be invaluable in improving training for both primary care providers and outpatient mental health workers. Improved communication networks will prove to be useful resources for maintaining continuity of care and consultation, which is important in long-term treatment. Other technical developments include simplifying and making explicit various treatment approaches, in both psychotherapy and drug therapy, so that research can proceed to clarify what type of treatment helps which type of suicidal patient.     

The Relationship between Coping Strategies and Perceived Stress in Telephone Intervention Volunteers at a Suicide Prevention Center

This study examines stress perceived by telephone intervention volunteers at a suicide prevention center before their shift, during the most high-urgency call, and after the shift. Eighty of the 82 active volunteers completed questionnaires concerning stress, coping strategies, motivations for volunteer work, and experiences with suicide. Stepwise multiple regression analysis indicated that only one variable, the amount of experience in telephone intervention with suicidal persons, predicted stress level before the shift; volunteers with more experience tended to be less stressed. Stress during the most urgent call was related first to the level of urgency of the call, then to the total length of all calls received, followed by the coping mechanisms of magical thinking, detachment, and feeling personally responsible. Stress after the shift was related first to the total amount of time spent on calls, then to the number of other persons present during the shift. Stress after the shift was also negatively related to amount of education and having realistic expectations about interventions. Magical thinking was positively related to stress, and the mechanism of positive thinking was negatively related. A high proportion of volunteers had attempted suicide, had previous thoughts about suicide, and had known persons who attempted or died by suicide. These findings are discussed as to their implications for the selection and training of volunteers in suicide prevention.     

Suicide Prevention from a Public Health Perspective

The public health approach to health problems provides a strong framework and rationale for developing and implementing suicide prevention programs. This approach consists of health-event surveillance to describe the problem, epidemiologic analysis to identify risk factors, the design and evaluation of interventions, and the implementation of prevention programs. The application of each of these components to suicide prevention is reviewed. Suggestions for improving surveillance include encouraging the use of appropriate coding, reviewing suicide statistics at the local level, collecting more etiologically useful information, and placing greater emphasis on analysis of morbidity data. For epidemiologic analysis, greater use could be made of observational studies, and uniform definitions and measures should be developed and adopted. Efforts to develop interventions must include evaluating both the process and the outcome. Finally, community suicide prevention programs should include more than one strategy and, where appropriate, should be strongly linked with the community's mental health resources. With adequate planning, coordination, and resources, and the public health approach can help reduce the emotional and economic costs imposed on society by suicide and suicidal behavior.     

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.     

An Integrative Suicide Prevention Program for Visitor Charcoal Burning Suicide and Suicide Pact

An integrative suicide prevention program was implemented to tackle an outbreak of visitor charcoal burning suicides in Cheung Chau, an island in Hong Kong, in 2002. This study evaluated the effectiveness of the program. The numbers of visitor suicides reduced from 37 deaths in the 51 months prior to program implementation to 6 deaths in the 42 months post‐implementation period. The number of visitor suicide pacts decreased from 7 pacts (15 individuals) to 1 pact (2 individuals). No statistically significant differences in the numbers of visitor suicide attempts and resident suicides were observed in the two time periods. No statistically significant changes in visitor suicides during the study period were observed on the comparison islands. The consistency and timing of reduction in visitor suicides correlated with the development and delivery of the integrative program on the intervention island, suggesting a causal association between program delivery and reduction of visitor suicides. The possibility of displacement seems small because there was no increase in visitor suicides on the comparison islands during the study period. This integrative approach in preventing target‐specific suicides may serve as an example for other communities to develop suicide prevention programs that make use of the existing local resources.     

Mobilizing Schools for Suicide Prevention

ABSTRACT: Experience in providing consultation and survivor counseling to school personnel following student suicides led to the development of a program of prevention through training school personnel. The goal of the program was to increase the ability of resource persons available to adolescents—teachers, counselors and school nurses—to recognize signs of suicidal depression and to respond effectively to suicidal students. This report describes that program, the reaction of the participants and the observations of the project staff, and comments on the feasibility of this approach as a means of helping to prevent suicide among adolescents.     

Suicide across the Life Span: Pathways to Prevention

As reflected in a recent series of highly visible suicide awareness and prevention activities, the call for a comprehensive suicide prevention strategy has never been stronger, nor more unified. Using the framework provided by the transactional model of human development, the author illustrates the central implications that a developmental perspective has for suicide prevention, emphasizing the need to consider multiple pathways to prevention, to place renewed emphasis on prevention strategies that have their impact earlier in the life course and earlier in the course of mental disorder, and to collaborate with prevention specialists and advocates in related fields.     

The Effectiveness of Suicide Prevention Centers

The presence of suicide prevention centers in a state in 1970 was negatively associated with changes in the suicide rate from 1970 to 1980 in the USA, indicating a preventive effect from suicide prevention centers. This effect, though weak, was consistently found for most demographic subgroups of the population and when a strong social correlate of suicide rates (divorce rates) was taken into account by means of multiple regression analysis.