MMPI ratings of suicide risk.

Among past attempts to use MMPI data to predict suicidal behavior, there has been a lack of research on the ability of clinicians to identify MMPI profiles of suicidal persons. In this study, the MMPI profiles of 20 male psychiatric patients who committed suicide and the MMPI profiles of 20 male patients who did not attempt or commit suicide were presented to six clinical psychologists with expertise in MMPI interpretation. The clinicians were asked to classify each MMPI profile as coming from a patient who did or did not later commit suicide, and to rate eight variables thought to be relevant to the assessment of suicide risk. Data analysis revealed that the clinicians could not identify suicide and nonsuicide patients from their MMPI profiles. Furthermore, the ratings of the eight suicide variable did not differentiate suicide and nonsuicide patients.     

An assessment of community suicide risk

The contributions of several core variables to the white suicide rates in 24 Florida counties were examined, and a prediction equation, using multiple linear regression, was developed. Age was found to be about 50% more important than divorce. With both age and divorce controlled, loneliness and insanity were found to be significant core variables (p less than .05). A prediction equation including age, crime rate, insanity, and alcoholism was found that accounted for 79% of the variation in the suicide rates across counties. The observed rates were divided by predicted rates to yield standardized mortality ratios. It is proposed that these ratios may serve to assess both the need for and the impact of community suicide prevention services by placing suicide rates in the context of relevant social conditions.     

How psychiatrists weigh risk factors when assessing suicide risk

The clinical assessment of suicide risk is a difficult task that the traditional literature contributes to in a limited way. This study aims to complement the traditional literature by determining the ranking of suicide risk factors by a group of 81 psychiatrists. Hopelessness was ranked the most important risk factor, followed by Suicidal Ideation, Previous Attempts, the Level of Mood and Affect, Quality of Relationships, Signs and Symptoms of Depression, and Social Integration. Less highly ranked risk factors are also noted. The significance of these findings is discussed with respect to the literature and commonly used textbooks of psychiatry.     

Youth suicide risk and sexual orientation

Using a broad suicide risk assessment (suicidal ideation, hopelessness, hostility) with 100 youth ages 17 to 19, this study examined the relationship between sexual orientation and youth suicide risk. Participants were compared across sexual orientation, as well as level of perceived external support, which may be a mitigating variable in suicide risk. The suicide risk demonstrated by sexual minorities in this study was no greater than that of their heterosexual peers. Youth who reported more external support demonstrated lower overall suicide risk and, specifically, lower levels of hostility, hopelessness, and suicidal ideation. The results indicated that suicide risk is not determined by demographic criteria alone, and may be influenced by psychosocial variables, such as support.     

Development and field-testing of a procedure for coached clients to assess rapport during trainees' counselling interviews

Procedures for using coached clients to assess the degree of rapport between client and counsellor, as experienced by the client during counselling interviews, were developed. Twenty-three interviews conducted by counsellor trainees were assessed at one-minute intervals by two coached clients using a five-point rating system. In addition, the Working Alliance Inventory was used to assess rapport at the end of the interview. Data indicated that the in vivo rating procedure of client-experienced rapport possessed good reliability and validity.     

Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey

Definitions and classification schemes for suicide attempts vary widely among studies, introducing conceptual, methodological, and clinical problems. We tested the importance of the intent to die criterion by comparing self-injurers with intent to die, suicide attempters, and those who self-injured not to die but to communicate with others, suicide gesturers, using data from the National Comorbidity Survey (n = 5,877). Suicide attempters (prevalence = 2.7%) differed from suicide gesturers (prevalence = 1.9%) and were characterized by male gender, fewer years of education, residence in the southern and western United States; psychiatric diagnoses including depressive, impulsive, and aggressive symptoms; comorbidity; and history of multiple physical and sexual assaults. It is possible and useful to distinguish between self-injurers on the basis of intent to die.     

Development of a tool to assess suicide risk factors in urban adolescents

Dramatic increases in the adolescent suicide rate over the past three decades have underscored the need for risk-assessment tools. The tools that do exist are oriented to older populations and their application to adolescents is questionable. A project was initiated at the University of Utah's Health Education Department to develop a pilot instrument to examine the differences between adolescents who have attempted suicide and other teenagers. Eighty-two subjects between the ages of 14 and 19 participated in the test of this instrument. Twenty-five subjects were identified by a physician or psychologist as having failed in a sincere suicide attempt within the previous 18 months. Fifty-seven nonsuicide attempters with similar demographic profiles served as a comparison group. An 86-item questionnaire was administered to both groups. Questions were generated from a review of the literature of the past three decades for problems associated with suicide in this population. Questions were sorted into three domains (family environment, social environment, and self-perceptions), with each domain having several subdomains. Statistical analysis revealed significant differences for each of the three domains and on 55 of 86 questions. The results were used to create a streamlined instrument for assessing suicide risk that can be administered in 20 minutes.     

An integrated approach to estimating suicide risk

It is ironic that if we had a perfect predictive instrument we would not be able to recognize it because it could never be validated by its critical outcome criterion. Though some exceptions could occur, we would be obliged to take all available measures to prevent a suicidal outcome in cases where suicide was predicted. After the crisis we could have no way of knowing with certainty whether the person would have suicided or not. Even if we accepted the reality that people are not either 0% or 100% likely to suicide, and developed a perfect scale to estimate degree of risk, we would still be unable to validate it in individual cases. If it indicated "moderate" risk of 2.5-5.0%, for example, and no intervention were offered, we would have to observe one suicide in every 20-40 persons assessed at this level of risk to demonstrate its validity. The key to assessment is obtaining information, primarily regarding present or anticipated pain and the threshold of pain tolerance in the individual involved. Since different persons communicate in a variety of ways--verbal, nonverbal, symbolic, metaphoric, etc., eclecticism in approach is essential. For some clinicians communication will be facilitated most by one style; for others, a different method would be most effective. Thus, the "best" approach is the one that works best given the unique characteristics of the persons involved and under the conditions existing at the time. My own bias is that every assessment, whatever the approach, must include some form of direct inquiry regarding suicidal intent, and that the final decision in this regard must be a subjective and intuitive judgment. Contrary to possible assumptions in the legal world, accurate assessment does not necessarily mean safety. It can serve as a guide to the degree of risk that may be involved in a treatment program, but even low risk management measures may have an adverse outcome without implications of negligence or carelessness. There has been no mention here of biological markers of suicide, which are of much current interest but still in an investigational stage. Similarly, rational suicide has not been mentioned, though our aging population and the status of AIDS are making this issue progressively more important. The principles involved in assessment of risk are the same as with other forms of suicide, however. Finally, we can only presume that more precise assessment will operate to reduce suicidal deaths.(ABSTRACT TRUNCATED AT 400 WORDS)     

Adolescent suicide risk: four psychosocial factors

Suicide is a leading cause of death among adolescents. This study examined the suicidal ideation, behavior, and attempt history of 100 adolescents ages seventeen to nineteen. Four psychosocial factors were found to be important for overall suicide risk: hopelessness, hostility, negative self-concept, and isolation. It is suggested that focusing on these four psychosocial factors would enhance suicide assessment and prevention efforts with adolescents.     

A comprehensive and concise assessment of suicide risk

Because suicide is one of the few fatal consequences of psychiatric illness and is a source of extraordinary stress for loved ones and the clinician, accurate assessment of suicidal risk is an essential aspect of the mental health profession. Innumerable individual differences, along with the low base rate of suicide, make assessment a challenging task in clinical practice that is both delicate and time consuming. In this article, the authors recommend examining and incorporating each patient's personal characteristics, dispositional factors, situational factors, and current presentation of symptoms into a unique individual picture of suicidal risk. This portrait of potential for suicidal behavior can, in turn, be used to evaluate risk and design a course of action. This thorough yet concise approach will likely reduce omissions in assessment, and hopefully lead to fewer false negatives and fewer deaths of suicidal patients.     

Use of case vignettes in suicide risk assessment

Thirty-three brief case histories of suicidal patients were given to 19 experienced crisis workers for 7-point ratings of short- and long-term suicide risk. The ratings revealed considerable variability, raising questions about the reliability of such global assessments of suicidality. The most consistently rated cases were selected to operationally define "mild," "moderate," and "high" risk. Thus, each level was "anchored" by several vignettes. It was hoped that these anchor points would lead to more uniform future ratings among crisis workers. The correlation between short- and long-term risk ranged from near zero for some vignettes to as high as .82 (median = .46), demonstrating the need to rate both separately. Long-term risk was more difficult to rate, as demonstrated by a larger number of cases judged to be unrateable because of "insufficient information" (94 vs. 53 rater-case combinations). When the anchor vignettes were provided as a guide to the same sample of crisis workers, their ratings of suicide risk, as expected, showed significantly improved consistency.     

Clinical assessment of suicide risk in depressive disorder

Efforts to identify clinical risk factors for complete suicide through the follow-up of depressed patients have yielded relatively few robust predictors. Those identified by at least three studies are (in order of decreasing frequency) suicidal plans/attempts, male sex, being single or living alone, inpatient status, and hopelessness. Because the best established of these predictors has only modest sensitivity and specificity, the need for other robust tools is clear. A rich body of research has identified two biological risk factors for suicide in depressive disorder: hypothalamic-pituitary-adrenal axis hyperactivity and deficits in serotonin function. Moreover, there is now considerable evidence that the dexamethasone suppression test and measures of serum cholesterol concentrations, respectively, may provide a clinically useful reflection of these two mechanisms. Observations that these measures appear to be additive, both with each other and with other clinical risk factors, indicate that a substantial improvement in the clinician's ability to assess suicide risk is possible.     

Assessing African American adolescents' risk for suicide attempts: attachment theory

The threat of separation from a parent theoretically increases the risk of adolescent suicide attempts. The present study evaluated this and other hypothesized risk factors in a sample of adolescent suicide attempters and nonsuicidal controls, using the Psychiatric Consultation Checklist (Lyon, 1987). Stepwise logistic regression was used to predict group membership. It was found that threat of separation from a parental figure, insomnia, neglect, substance abuse, suicidal ideation, and failing grades were the strongest predictors of suicide attempt. Ten predictor variables correctly identified 97% of suicide attempters and 86% of nonattempters. Unexpected findings included high levels of truancy, threatening others, and separation from a parent before the age of 12 among nonattempters.     

Schizophrenia--a high-risk factor for suicide: clues to risk reduction.

Suicide is the chief cause of premature death among schizophrenic persons. The lifetime incidence of suicide for patients with schizophrenia is 10% to 13% compared to a general population estimate of about 1%, and is quite close to that observed among those with major affective disorder. The magnitude of increased risk for suicide among schizophrenics peaks before middle age and declines thereafter, although schizophrenic persons tend to be at increased risk throughout the life span. Among psychiatric patients, schizophrenics are overrepresented among suicides, and often schizophrenics constitute the majority of inpatient suicides. It is important in evaluating suicide risk among schizophrenic persons to assess depression and suicidal ideation especially during index admission and during acute phases of the illness. It is noteworthy that schizophrenic persons often commit suicide as the overall level of psychopathology decreases during a nonpsychotic phase. Research has yielded salient risk factors for suicide in schizophrenic persons and "types" of especially vulnerable patients, even though statistical prediction of individual suicides has not proven effective.     

Axis I screens and suicide risk in jails: a comparative analysis

Mental health professionals conducting screenings in jail settings face formidable challenges in identifying inmates at risk for major depression and suicide. Psychologists often rely on correctional staff to provide initial appraisals of those inmates requiring further evaluation. In a sample of 100 jail detainees, the effectiveness of two specialized screens (the Referral Decision Scale and Mental Disability/Suicide Intake Screen or MDSIS) and one general screen (Personality Assessment Screener or PAS) was evaluated. For suicidal ideation, the MDSIS composite score evidenced promise (sensitivity = 1.00; specificity = 0.71). In ruling out major depression, the PAS Negative Affect subscale was useful for the inmate participants.     

Exposure to violence and suicide risk in adolescents: a community study

The prevalence of violence exposure is relatively unexplored in adolescents in European communities, and reports on the association between exposure to community violence and suicidal behavior are rare. The aim of this study was to investigate (1) the prevalence of community violence in a European urban adolescent sample, (2) the relationship between exposure to community violence and suicidal ideation/deliberate self-harm, and (3) the influence of depressive symptoms and aggressive behavior on this relationship. Self-report surveys were administered to a representative school-based sample of 1509 adolescents in Antwerp (Belgium). The prevalence rate of violence exposure was still high but lower than that reported in U.S. communities. Suicidal ideation and deliberate self-harm were both related to violence exposure. The gender-specific influence of depressive symptomatology and aggressive behavior on the association between exposure to violence and suicidal behavior suggests the need for further research.     

Subthreshold bipolar traits and suicide risk among undergraduates

Data from a sample of 500 undergraduate students showed that depression scores were more strongly correlated with suicide risk than were mania scores, uggesting that such traits should be routinely screened to evaluate suicide risk.     

Psychopathy, antisocial personality, and suicide risk

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist--Revised (PCL-R). Male prison inmates (N = 313) were assessed using the PCL-R and DSM-III-R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL-R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.