Assessing and Managing Risk With Suicidal Individuals

The University of Washington Risk Assessment Protocol (UWRAP) and Risk Assessment and Management Protocol (UWRAMP) have been used in numerous clinical trials treating high-risk suicidal individuals over several years. These protocols structure assessors and treatment providers to provide a thorough suicide risk assessment, review standards of care recommendations for action, and allow for subsequent documentation of information gathered and actions taken. As such, it is a resource for providers treating high-risk populations across multiple contexts (e.g., primary care, outpatient psychotherapy, emergency department). This article describes both the UWRAP and UWRAMP. Taken together, these assessment and risk management tools include (a) assessment questions for gathering information to determine the level of risk, (b) action steps that can be taken to ensure safety, and (c) a companion therapist note where providers document their assessment and actions.     

Workaholic Tendencies and the High Potential for Stress Among Co-Workers

The dangers associated with excessive time at work do not apply equally to all people. Attempts to specify how much is too much have often referenced underlying motives as a factor in whether time at work is excessive and, therefore, likely to lead to undesirable outcomes. The literature on workaholism separates joy in work and perfectionism as two contrasting characteristics, either of which can lead to long hours at work. This study categorized subjects on those two characteristics to examine how the differences might relate to stress among coworkers. In line with suggestions of earlier studies, the joy/perfectionism difference was not linked to standard demographic breakdowns. However, tendencies toward one or the other did correspond to perceptions that may affect the quality of personal interaction in the workplace and, therefore, the level of stress among coworkers.     

Family Protection and Prevention of Alcohol Use Among Hispanic Youth at High Risk

Research regarding prevention strategies for Hispanic youth stress the importance of family interventions because of the particular importance of family as a protective factor within the Hispanic community. Starting in 1995, the Center for Substance Abuse Prevention conducted the National Cross-Site Evaluation of High Risk Youth Programs, a 5-year drug and alcohol prevention study with a sample of approximately 10,500 youth, including nearly 3,000 Hispanic youth. Youth were surveyed regarding their alcohol use patterns and risk and protective factors, with several measures of family relationships, including family connectedness, family supervision, and parental attitudes toward their child's alcohol use. Analyses indicate that family factors are highly linked to alcohol use among Hispanics, particularly among Hispanic females. Longitudinal growth curve analyses indicate that improving the connections that young Hispanic females have to their parents can have positive long-term effects on delaying or reducing their alcohol use. This evaluation was conducted under the direction of Dr. Soledad Sambrano, Ph.D. of the Center for Substance Abuse Prevention under contract #2777-95-5002 with EMT Associates, Inc. and ORC Macro. The views expressed herein represent the opinions and analyses of the individual authors and may not necessarily reflect the opinions, official policy, or position of the U.S. Department of Health and Human Services, the Public Health Service, the Substance Abuse and Mental Health Service Administration, or the Center for Substance Abuse Prevention.     

The Impact of Religiosity on Suicidal Ideation Among Youth in Central Mexico

Although over 100 years of research has been dedicated to understanding the connection between religiosity and suicide, many questions still remain. This is especially true among adolescent populations in countries outside the US. In 2008, over 700 students attending eight alternative high school centers in central Mexico completed a health survey designed to provide a comprehensive overview of their physical, mental, spiritual, and emotional health. This article reports on the findings of a secondary analysis study of those data and focuses on the protective influence of religiosity on suicidal ideation. The findings of this study are discussed in light of the network theory’s assertion that there is a belonging aspect to religion, and also to the idea that in religiously homogeneous communities of Mexico, religion can have a protective effect on the suicidal ideation of its members.     

Predicting Perceived Risk of Crime: a Multilevel Study

With a sample of Italians selected from 71 Italian counties (N = 1,868), we performed two multilevel analyses aimed at predicting the perceived risk of crime at local (i.e., in the participants' county of residence) and at societal (i.e., in the context of Italian society) levels. A significant proportion of the variation in local risk perception was at the county level. The following individual variables predicted higher levels of this variable: indirect victimization, the perception of social and physical disorder, being a woman, being poorly educated, and being an older person. Among the ecological predictors, the crime rate and unemployment rate predicted higher levels of local crime risk perception, while the immigrant rate did not. Perceived risk of crime at the societal level did not show significant variation at the county level. Education, being a man, trusting people, and adhesion to post‐materialistic values predicted lower levels of societal crime risk perception, while number of sons/daughters and exposure to television news increased it. The limitations and possible development of this study are discussed.     

Disclosure of HIV Status Among Female Youth With HIV

Minority female youth are significantly affected by the HIV epidemic. The purpose of this pilot study was to explore sexual behavior practices, disclosure of HIV status, attitudes about disclosure, and knowledge of HIV disclosure laws among female youth with HIV (YWH). Findings suggest that the majority of YWH studied have been sexually active since their HIV diagnosis, although the nature and extent of sexual activity varied. Rates of nondisclosure to sexual partners varied based on the type of question asked, but at least some of the YWH in this sample reported sexual activity with a partner who was unaware of the participant’s HIV status. YWH appear to be more likely to disclose before, as opposed to after, sexual activity. Although most YWH believe disclosure to sexual partners is important for a variety of reasons, many reasons exist for nondisclosure, including fear of rejection and limited communication skills. The majority of YWH in this sample were aware of the potential legal ramifications of nondisclosure although fear of legal repercussions was not the most important factor related to disclosure. These findings favor the implementation of HIV disclosure interventions over the enactment of HIV criminalization laws as a strategy for reducing HIV transmission.     

Efficacy of the Theory of Reasoned Action in Predicting AIDS-Related Sexual Risk Reduction Among Gay Men1

This study evaluates the utility of a social psychological theory, Ajzen and Fishbein's (1980) Theory of Reasoned Action, in explicating attitude-behavior relationships concerning the practice of “safer sex” in a sample of 297 gay men. As the theory predicts, results indicate that a positive attitude toward “safer sex” and a belief that important, influential referents encouraged such behavior covaried with intention to practice sexual behaviors that minimize risk of infection with Human Immunodeficiency Virus (HIV). In turn, intention predicted levels of sexual risk-taking and employment of HIV-risk reducing strategies. Results provide support for the theory of reasoned action as a viable model of attitude-behavior relationships in AIDS-related risk reduction behaviors of gay men.     

Appraisal of Suicidal Risk Among Adolescents and Young Adults Through the Rorschach Test

The aims of this study are to investigate suicidal behaviors among adolescents and young adults and to test an index composed using Rorschach test responses related to an increased risk of suicide. Using a cross-sectional design, 4 groups were studied (according to criteria of the Columbia Classification Algorithm of Suicide Assessment [Posner, Oquendo, Gould, Stanley, &; Davies, 2007 Rierdan, J. 1978. Suicide and transparency responses on the Rorschach: A replication. Journal of Consulting and Clinical Psychology, 46: 1162–1163.  [Google Scholar]]): A group with suicidal ideation (n = 30), a group with parasuicidal behavior (n = 30), a group with near-lethal suicide attempts (n = 26), and a control group (n = 30). Responses to the Rorschach test yielded 6 potential indicators of suicidal behavior (scored according to Exner's Comprehensive System and the Suicidal Index for Adolescents; Silberg &; Armstrong, 1992 Stengel, E. 1975. Suicide and attempted suicide , 2nd ed., New York, NY: Aronson.  [Google Scholar]). Rorschach scores including at least 4 of these 6 indicators selected 69% of the people who had committed serious suicide attempts. The Rorschach Suicidal Index reached an acceptable reliability and was related to other criteria of suicide risk, such as the Beck Depression Inventory (BDI; Beck, Ward, Mendelsohn, Mock, &; Erbaugh, 1961 Beck, A. T., Ward, C. H., Mendelsohn, M., Mock, J. and Erbaugh, J. 1961. An inventory for measuring depression. Archives of General Psychiatry, 4: 561–571. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) and Linehan Reasons for Living Inventory (RFL–I; Linehan, Goodstein, Nielsen, &; Chiles, 1983 Menninger, K. 1938. Man against himself, New York, NY: Harcourt. [Crossref] , [Google Scholar]). Moreover, the Rorschach Suicidal Index showed incremental validity over the BDI and the RFL–I to predict suicidal behavior. A path analysis additionally showed that low social support was an important mediator between the Rorschach Suicidal Index and the number of suicide attempts committed by participants.     

Perceived Maternal Parenting Styles,Cultural Values,and Prosocial Tendencies Among Mexican American Youth

The present study aimed to extend research on parenting and positive development of Latino youth. Participants were 207 Mexican American adolescents (M age = 10.9 years, SD = 0.83 years; 50% girls) who completed measures of their parents' supportive and firm parenting, their own endorsement of respect and traditional gender role values, and their tendency to engage in six forms of prosocial behaviors. Maternal nativity was also considered as an initial predictor of parenting, adolescents' cultural values, and adolescents' prosocial behaviors. Overall, the results demonstrated that maternal nativity was associated with traditional gender roles and specific forms of prosocial behaviors. Parenting dimensions were differentially associated with respect and traditional gender role values and prosocial behaviors. Cultural values, in turn, were associated with multiple forms of prosocial behaviors. Gender differences in the processes were also explored.     

The Relations of Pro-Drug-Use Myths With Self-Reported Drug Use Among Youth at Continuation High Schools1

Drug-use myths, questionable beliefs regarding the effects of drug use, may help to explain why people engage in self-injurious drug-use behavior. While clinicians and applied social researchers have used this concept of drug-use myths extensively when developing substance abuse prevention or cessation programs, drug belief-type myth measures have not been investigated empirically. The present study examined the internal consistency and discriminant validity of a drug-use myth measure among 362 continuation (alternative) high school youth and found it to be discriminable from demographic, drug use, and other psychosocial measures. Controlling for its relations with its correlates, social desirability, perceived friends' drug use, ethnicity items, and gender, the myth measure remained significantly associated with 4 drug-use measures. Future research regarding drug use myths as predictors of drug use is encouraged based on these results.     

The Moderating Role of BIS/BAS Personality Tendencies in the Relationship between General Strain and Crime

This article extends general strain theory by examining the role of the behavioral approach systems (BAS) and behavioral inhibition systems (BIS) in moderating the relationship between exposure to social strain and criminal behaviors. Analyses revealed that BIS and BAS operate differently in the prediction of crime. Those low in chronic strains experienced increases in arrests at higher BAS scores. For those exposed to medium and high levels of stress, a higher level of BAS-drive was associated with a decreased probability of arrest. In contrast, there is a positive association between lifetime traumas and arrest, and the magnitude of this relationship increases at each succeeding level of BAS scores.     

Emergency Department Youth Patients With Suicidal Ideation or Attempts: Predicting Suicide Attempts Through 18 Months of Follow‐Up

This prospective study of suicidal emergency department (ED) patients (ages 10–18) examined the timing, cumulative probability, and predictors of suicide attempts through 18 months of follow‐up. The cumulative probability of attempts was as follows: .15 at 6 months, .22 at 1 year, and .24 by 18 months. One attempt was fatal, yielding a death rate of .006. Significant predictors of suicide attempt risk included a suicide attempt at ED presentation (vs. suicidal ideation only), nonsuicidal self‐injurious behavior, and low levels of delinquent symptoms. Results underscore the importance of both prior suicide attempts and nonsuicidal self‐harm as risk indicators for future and potentially lethal suicide attempts.     

Social Functioning Mediates the Relation Between Symptoms of Depression,Anxiety, and Suicidal Ideation Among Youth

Journal of Child and Family Studies - In order to accurately identify youth at risk for suicide, it remains crucial to explore the interplay of risk factors that predict suicidal behavior. Thus,...     

Examining the Validity of the Structured Assessment of Violence Risk in Youth (SAVRY) for Predicting Probation Outcomes Among Adjudicated Juvenile Offenders

The current study examined the ability of the Structured Assessment of Violence Risk for Youth (SAVRY), a standardized risk assessment instrument, to predict probation outcomes among a sample of 158 adjudicated juvenile offenders placed on probation. Traditionally, the SAVRY has been used to measure violence risk among adolescents after release from custody. More recently, a delinquency risk measure based on SAVRY responses was developed, which could be useful for other types of outcome. This study examined the predictive validity of both summary risk ratings (SRR) for probation outcomes, including the reason for terminating probation and length of time on probation. A number of bivariate analyses and Cox regression models provided preliminary support for the ability of the nonviolent delinquency SRR, and modest support for the violence SRR, to predict probation outcomes. The implications for use of the SAVRY SRRs during juvenile justice system decision‐making and recommendations for future research are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

Assessment of Suicidal Youth in the Emergency Department

Accurate evaluation of suicidal adolescents in the emergency department (ED) is critical for safety and linkage to follow‐up care. We examined self‐reports of 181 adolescents who presented to an ED with suicidal ideation (SI) or a suicide attempt (SA). Parents also completed self‐reports. Results showed fair agreement between parents and youth on the reason for the ED visit (e.g., SI vs. SA) and greater agreement between independent judges and youths than between judges and parents. In accordance with accepted definitions of suicide attempts (e.g., Crosby, Ortega, & Melanson, 2011; O'Carroll, Berman, Maris, Moscicki, Tanney, & Silverman, 1996, p. 237; Posner, Oquendo, Gould, Stanley, & Davies, 2007, p. 1035; Silverman, Berman, Sanddal, O'Carroll, & Joiner, 2007, p. 248), most youth with SA as the reason for the ED visit reported some intent to die associated with the attempt. Finally, youth presenting to the ED with SA did not differ clinically from youth presenting with SI, and almost half of youths with SI reported past suicide attempts. These results highlight the need to emphasize adolescents' reports in clinical decision making, suggest adolescents' defined suicide attempts similarly to published definitions, and show that assessment of past SAs, as well as present suicidal thoughts and behaviors, is critical in determining future risk.     

Street Youth,Gender, Financial Strain,and Crime: Exploring Broidy and Agnew's Extension to General Strain Theory

General strain theory posits that adversive circumstances experienced by youths increase the likelihood of criminal behavior. Broidy and Agnew argue that while the underlying process identified in the general strain model will be applicable to both male and female crime different models of strain may be required to highlight gender differences in the underlying process. Utilizing a “high risk” sample of 400 homeless street youths the study examines how socioeconomic strain in the forms of homelessness, monetary dissatisfaction, and relative deprivation may be differentially linked to property and violent crime depending on gender. The conditioning effects of deviant attitudes, deviant peers, attributions, self-efficacy, and self-esteem are also examined. The results reveal few gender differences in the main effects of the different types of strain on crime. There are, however, gender differences in the way the conditioning variables impact the link between forms of strain and crime.