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.     

The emotional impact and ease of recall of warning signs for suicide: a controlled study

In light of concerns about potential iatrogenic effects of information about suicide, in the current study we examined the emotional impact of reading a list of warning signs for suicide in comparison to comparable lists for heart attacks and diabetes. All participants read two sets of warning signs, with the experimental group reading the suicide warning signs. Results confirm no difference in emotional impact across groups, along with providing evidence that warning signs for suicide are as easy to recall after exposure as warning signs for heart attack. Implications for pubic health campaigns are discussed.     

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.     

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.     

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.     

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.     

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.     

Identifying Potential Mass Shooters and Suicide Terrorists With Warning Signs of Suicide,Perceived Victimization,and Desires for Attention or Fame

In the United States and Europe, the distinction between public mass shooters and suicide terrorists no longer seems particularly meaningful. A number of public mass shooters have considered using bombs and claimed to be sacrificing themselves for an ideological cause, and many suicide terrorists have attacked without organizational support, using firearms, for what appear to be largely personal reasons. Previous research has also documented several common factors in these offenders’ lives, including (a) suicidal motives and life indifference, (b) perceived victimization, and (c) desires for attention or fame. These factors are not always easy for observers to recognize in advance, so mental health professionals, the public, and law enforcement officials might need help from experts to more successfully identify at-risk individuals. This article reviews the evidence of each factor, provides a list of specific warning signs, and offers recommendations for future research. Ultimately, an evidence-based approach to prevention could help save both the lives of many potential victims and the lives of the would-be attackers themselves.     

Suicide Prediction

ABSTRACT: Methodological problems intrinsic to suicide prediction are discussed. The research on suicide predictive signs derived from attributes of the suicidal person, his behavior, and his surroundings, and on predictive instruments is reviewed. The results of these researches are equivocal, in that neither single signs, standard psychological tests, specially devised tests, clinical judgments, nor scales are found to be able to predict suicide at useful levels. Scales are shown to offer the best predictive potential, but to date their construction has not been systematic. It is proposed that scales might be better constructed and prediction improved if investigators were to consider the focus, duration, inclusion-exclusion, interactions and subgroupings, and generalizability of suicidal indices.     

Suicide Risk and MMPI Scores,Especially as Related to Anxiety and Depression*

ABSTRACT: Thirty-seven depressive patients were examined, nine of whom had attempted to commit suicide. An MMPI profile and check list was compiled on each patient in order to assess the risk of suicide. It was demonstrated that anxiety and depression are correlated with an increased risk. The specific type of fear is not important; it appears together with social maladjustment, is compressed, and then finds its expression in the cry for help that a suicidal tendency represents.     

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.     

SHORES: A Practical Mnemonic for Suicide Protective Factors

Guidelines for addressing and managing client suicide risk include discussing and conceptualizing protective factors. Counselors should be able to recall and discuss suicide protective factors that are applicable across client populations. SHORES, a suicide protective factors mnemonic that is supported by the literature, has applications for risk assessment and crisis intervention across settings, preventative care, strengths‐based management, and counselor training. A case example and discussion serve to illustrate the wide‐ranging application of SHORES in counseling practice.     

The Association Between Gun Ownership and Statewide Overall Suicide Rates

An extensive body of research has demonstrated an association between gun ownership and suicide that extends beyond the effects of a range of covariates. We aimed to expand on extant research by examining the extent to which gun ownership predicts statewide overall suicide rates beyond the effects of demographic, geographic, religious, psychopathological, and suicide‐related variables. By extending the list of covariates utilized, considering those covariates simultaneously, and using more recent data, we sought to present a more stringent test. Gun ownership predicted statewide overall suicide rates, with the full model accounting for more than 92% of the variance in statewide suicide rates. The correlation between firearm suicide rates and the overall suicide rate was significantly stronger than the correlation between nonfirearm suicide rates and the overall suicide rate. These findings support the notion that access to and familiarity with firearms serves as a robust risk factor for suicide. Therefore, means safety efforts aimed at reducing accessibility and increasing safe storage of firearms would likely have a dramatic impact on statewide overall suicide rates.     

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.     

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.     

Suicide Signs on the Rorschach

This paper reviews the literature concerning the assessment of suicide using the Rorschach and updates the important developments since Goldfried, Stricker, and Weiner's comprehensive review of the literature in 1971. Special attention is given to those indicators which show the most support in the literature and are most efficient to use. The presence or absence of any of these signs in a patient's record should not be taken to signify the presence or absence of suicidal ideation. However, the presence of even one of these indicators does provide a warning to the clinician, indicating that further exploration in this area may be warranted. Knowledge of the many suicidal indicators on projective tests places the clinician in a better position to predict such destructive behavior and intervene appropriately.     

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.     

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.     

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.