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.     

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.     

Survey of the Use of Crisis Intervention Centers by the Black Population*

ABSTRACT: In an attempt to determine the extent to which crisis centers meet the needs of black communities, questionnaires were sent to 12 centers. Responses were received from six. Only two centers, in Nashville and Washington, D.C., had statistics of callers identified by race. The findings from these two centers indicate that there are differences between the white and black callers with regard to age, marital status, and type of problem. As an example, the typical black male caller was older and more concerned about his job and financial problems than were white males. This kind of information suggests a need for expanded services within the crisis center framework, possibly for a more preventive approach. More data gathering concerning the black community using crisis centers is urged in order better to identify the needs of this population and the methods to be used for meeting those needs.     

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 the 113Online Suicide Prevention Crisis Chat Service: Outcomes,Helper Behaviors and Comparison to Telephone Hotlines

Recognizing the importance of digital communication, major suicide prevention helplines have started offering crisis intervention by chat. To date there is little evidence supporting the effectiveness of crisis chat services. To evaluate the reach and outcomes of the 113Online volunteer‐operated crisis chat service, 526 crisis chat logs were studied, replicating the use of measures that were developed to study telephone crisis calls. Reaching a relatively young population of predominantly females with severe suicidality and (mental) health problems, chat outcomes for this group were found to be comparable to those found for crisis calls to U.S. Lifeline Centers in 2003–2004, with similar but not identical associations with specific helpers' styles and attitudes. Our findings support a positive effect of the 113Online chat service, to be enhanced by practice standards addressing an apparent lack of focus on the central issue of suicidality during chats, as well as by the development of best practices specific for online crisis intervention.     

Temporal Fluctuations in Suicide Calls to a Crisis Intervention Service

Suicide-related calls received by a crisis intervention center were analyzed for temporal variations. The overall number of calls, calls concerning personal suicidal ideation, and calls concerning third-person suicide potential varied by both month and day of the week. Ideation calls and calls involving a suicide attempt varied by day of the month. Month and day of the week variation in third-person calls paralleled variations in completed suicides. Fluctuations were large enough to be useful in scheduling crisis center staff. The possibility that third-person calls represent a greater suicide threat than first-person calls is discussed.     

Managing Elder Suicide: A Profile of American and Canadian Crisis Prevention Centers

Suicides among older adults in the United States and Canada in the last decade have accounted for an increasing share of all suicides. In both countries the use of firearms among older adults has steadily increased. Despite these trends, little is known about the extent to which crisis centers are prepared to prevent elder suicide. A survey of AAS-listed crisis prevention centers examined the training, knowledge, and current practices relevant to elder suicide among personnel in 321 crisis prevention centers in both countries. Results revealed insufficient training, a lack of familiarity with recent suicide trends, and limited outreach to older adults.     

Measuring Associations of the Department of Veterans Affairs' Suicide Prevention Campaign on the Use of Crisis Support Services

Campaigns have become popular in public health approaches to suicide prevention; however, limited empirical investigation of their impact on behavior has been conducted. To address this gap, utilization patterns of crisis support services associated with the Department of Veterans Affairs' Veterans Crisis Line (VCL) suicide prevention campaign were examined. Daily call data for the National Suicide Prevention Lifeline, VCL, and 1‐800‐SUICIDE were modeled using a novel semi‐varying coefficient method. Analyses reveal significant increases in call volume to both targeted and broad resources during the campaign. Findings underscore the need for further research to refine measurement of the effects of these suicide prevention efforts.     

Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline

We examined the impact of the implementation of Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's national network of crisis hotlines. Data were derived from 1,507 monitored calls from 1,410 suicidal individuals to 17 Lifeline centers in 2008–2009. Callers were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by ASIST‐trained counselors. Few significant changes in ASIST‐trained counselors' interventions emerged; however, improvements in callers' outcomes were linked to ASIST‐related counselor interventions, including exploring reasons for living and informal support contacts. ASIST training did not yield more comprehensive suicide risk assessments.     

Evaluation of Crisis Intervention Programs and Personnel: A Summary and Critique*

ABSTRACT: Many of the suicide prevention centers that developed throughout the country during the last decade have evolved into general crisis intervention services. At the same time, they have stimulated the development of a wide variety of agencies that utilize nonprofessional volunteers who, primarily through telephone contact, provide helping services to people in crisis. This paper presents a critique of three particular problem areas relating to the use of volunteer personnel, along with a summary of research aimed at providing new technologies for their solution. Methods have been developed for rating on-the-job performance of crisis intervention workers, based upon criteria that are thought to have general application to crisis intervention centers. Efforts to describe personality characteristics of volunteers are reported, along with suggestions for the direction of additional investigations. Finally, the issue of assessing the outcome of crisis intervention cases is summarized. A four-phase conceptualization of the crisis intervention process is proposed, and appropriate measures of outcome at each point in the process are suggested. The overall significance of this type of research is discussed in terms of the need for standards by which to evaluate crisis intervention services.     

Resolving Ethical Dilemmas in Suicide Prevention: The Case of Telephone Helpline Rescue Policies

The ethical basis of suicide prevention is illustrated by contrasting helpline emergency rescue policies of the Samaritans and the AAS and the U.S. National Suicide Prevention Lifeline network. We contrast moralist, relativist, and libertarian ethical premises and question whether suicide can be rational. Samaritans respect a caller's right to decide to die by suicide; U.S. helplines oblige emergency intervention during an attempt even against the caller's will. We analyze the effect of emergency rescue when there is high suicide risk but an attempt has not been initiated. We examine links between values and actions, needs for empirical evidence to guide practice, and propose vigorous dialogue about values in the gray zone of moral practice.     

Youth Suicide Prevention: A Survey and Analysis of Policies and Efforts in the 50 States

State-level initiatives directed at youth suicide prevention since 1980 were analyzed. During 1992 and 1996, each governor was surveyed regarding his or her state's efforts in youth suicide prevention. Questions pertained to legislation, a mandated or recommended school-based suicide prevention curriculum, funding, a special advisory council, a state plan, the development and dissemination of materials, and assessment. Several states sent examples of their prevention activities, which were reviewed to determine the extent to which they represent conceptually and/or empirically grounded preventive intervention strategies. The number of suicides, suicide rates, and percentage change in rate for youth 15–19 years old were reported by state for the periods 1979–1981 and 1992–1994. The results of a repeated measures 2 × 5 ANOVA revealed that while changes in suicide rates over time were statistically significant, there was no relation between these changes and any of the variables studied. Suggestions for future research on state-level initiatives are presented.     

The Opinions of GP's Patients About Suicide,Assisted Suicide,Euthanasia, and Suicide Prevention: An Italian Survey

A survey about opinions on end‐of‐life issues of a population represented by 1,171 people in the waiting room of general practitioners' surgeries was conducted in a province of northern Italy. Most subjects did not consider suicide as a reasonable option even in cases of a serious and incurable disease. Moreover, subjects did not consider euthanasia as a possible option either; however, they did express an opposite attitude when considering euthanasia in a third‐person perspective. People with a personal history of suicidal behavior appear to present as a different population, overall expressing more open attitudes.     

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.     

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence‐based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population‐level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability‐centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population‐level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence‐based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.