Understanding suicidal ideation and assessing for risk

The UK government's health strategy, The Health of the Nation , included a target for reducing the population suicide rates by 15% over an 8-year period [Department of Health (1992), London: HMSO]. This thrust has been carried forward in subsequent work embodied in the ninth standard of the National Service Framework for Mental Health [Department of Health (1999), London: HMSO] and Safety First: FiveYear Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness [Department of Health (2001), London: HMSO]. A crucial aspect in reducing suicide rates is the accurate assessment of those who may be at risk to enable appropriate interventions to take place.While any person who wants to end his or her own life may find a way to do so, it is most important for the clinician to approach any potential suicide with the conviction that it is possible to prevent at least some suicides. This paper outlines best practice regarding the exploration and assessment of suicidal ideation and suicidal potential.     

Prospective predictors of suicidality: defeat and entrapment lead to changes in suicidal ideation over time

Theoretical perspectives into suicidality have suggested that heightened perceptions of defeat and entrapment lead to suicidality. However, all previous empirical work has been cross-sectional. We provide the first longitudinal test of the theoretical predictions, in a sample of 79 students who reported suicidality. Participants completed self-report measures of suicidal ideation, depression, defeat, and entrapment at two time points, approximately 12 months apart. People higher in defeat became more suicidal over time (β= .45), with baseline levels of suicidality and depressive symptoms controlled. The current results support the posited role of perceived defeat in driving suicidal ideation.     

Body image and suicidal ideation in adolescents

Data from 231 adolescents (mean age = 15.7, SD = 1.39) were collected from a public school setting in the United States. Participants completed several measures, including those assessing depression, hopelessness, past suicidal behavior, body image, and current suicidal ideation. It was hypothesized that depression, hopelessness, past suicidal behavior, and body image (a risk factor seldom examined) would significantly predict current suicidal ideation and that there would be gender differences for body image. Regression analyses indicated that all risk factors including body image were significant predictors of current suicidal ideation for the whole sample. For both males and females, body image offered a unique contribution to the measurement of suicide ideation above and beyond the other risk factors, with body attitudes/feelings being the strongest predictor. Results encourage the inclusion of body image as a variable in risk models for adolescent suicidal ideation, as it likely accounts for additional variance above and beyond traditional risk factors.     

Suicidal ideation versus suicidal obsession: a case report

This case report illustrates the relationship between stress and obsessive-compulsive disorder (OCD) by describing an unusual case of OCD sequelae following a suicide attempt. The patient is a 29-year-old married woman who suffered a major depressive episode without OCD and tried to commit suicide by drinking household cleaner. Following the attempt, violent obsessive thoughts of harming herself and others emerged along with avoidance behavior. After exposure therapy, there was a decrease in her obsessive thoughts, less anxiety, and no avoidance behavior. This report highlights not only the existence of "posttraumatic obsession" but also the importance of accurate interpretation of suicidal preoccupation, leading to the diagnosis of OCD rather then suicidal ideation secondary to depression.     

Predicting suicidal ideation in high school students.

In a sample of 77 high school students, current suicidal ideation was predicted by depression, music preferences, and reasons for living scores.     

Cognitive behavioral therapy reduces suicidal ideation in schizophrenia: results from a randomized controlled trial

Patients with schizophrenia are at high risk of suicide. Cognitive behavior therapy (CBT) has been shown to reduce symptoms in schizophrenia. This study examines whether CBT also changes the level of suicidal ideation in patients with schizophrenia compared to a control group. Ninety ambulatory patients with symptoms of schizophrenia resistant to conventional antipsychotic medication were randomized to CBT or befriending. They were assessed using the Comprehensive Psychopathological Rating Scale, including a rating of suicidal ideation at baseline, post intervention, and after 9 months. Post-hoc analysis revealed that CBT provided significant reductions in suicidal ideation at the end of therapy, and sustained at the follow-up. Further research is required to substantiate these findings and determine the process and mechanisms through which this reduction is achieved.     

Suicidal behaviour and suicidal ideation in adolescents: A problem for counsellors in education

Some of the research findings on the prevalence, causes and possible prevention of suicidal behaviour and suicidal ideation in adolescents, including students, are reviewed. Both completed and attempted suicide (parasuicide) in teenagers is increasing. A number of factors appear to be associated with suicidal behaviour: cultural factors such as those arising from the stresses of discrimination; disorganised and unstable family life, especially that which involves the child in early separation from a parent; sexual imbalances in educational institutions; and an increase in anomie which is associated in the young with a variety of self-indulgent behaviour. Some data on suicidal ideation in a sample of English adolescents are reported, with suggestions for using such questionnaire data for identifying teenagers in need of counselling.     

Racial differences in self-disclosure of suicidal ideation and reasons for living: implications for training

Racial differences in suicidal self-disclosure and reasons for living were investigated in 2 separate studies. In Study 1, a random sample of archival client and therapist intake data from a university counseling center for 1 year was examined, and results indicate that ethnic minority clients do not self-disclose suicidal ideation as readily as their nonethnic minority peers. In addition, a significantly higher number of ethnic minority clients were deemed "hidden ideators" because their suicidal ideation only became evident when a counselor performed a suicide risk assessment. Only 1 of the 36 ethnic minority clients with suicidal ideation in the sample voluntarily self-disclosed this ideation at intake without an assessment by the therapist. Study 2 used the Reasons for Living Inventory (RFL) and compared African American and European American college students from an introductory psychology course. The RFL is a useful instrument to compare potential race differences in reasons people report for choosing not to kill themselves, because it does not require respondents to self-disclose (or to have) current suicidal ideation. The results from Study 2 indicate European Americans report fewer reasons for choosing not to kill themselves than their African American peers and that African Americans scored significantly higher than European Americans on the moral objections and survival and coping beliefs subscales of the RFL. Implications for training counselors in suicide risk assessment, prevention, and treatment with ethnic minorities are discussed.     

Prevalence of suicidal ideation in patients with atopic dermatitis

The prevalence of suicidal ideation in patients with mild, moderate, and severe atopic dermatitis between the age of 15 to 49 years were 0.21%, 6%, and 19.6%, respectively. In addition, the prevalence of homicide-suicidal ideation in mothers or fathers of patients (aged 0-14 years) with mild, moderate, and severe atopic dermatitis were 0.11%, 0.35%, and 3.28%, respectively. These results indicate that patients with atopic dermatitis or even parents of patients with atopic dermatitis have high prevalence of suicidal ideation.     

College students' intentions to seek help for suicidal ideation: accounting for the help-negation effect

Prior research has identified a negative association between suicidal ideation and help-seeking, a phenomenon called "help-negation." Help-negation has been documented to occur for both professional and nonprofessional sources of help. In this study help-seeking attitudes, stigma concerns, and perceptions of social support were examined as possible mediators of help-negation. Data were collected from a nonclinical sample of college undergraduates at a midwestern university (N = 321). Findings provided partial support for the mediation hypotheses. Help-seeking attitudes and stigma were significant predictors of help-seeking intentions (β = .34 and β = -.17, p < .05, respectively), but did not mediate help-negation for professional sources. Perceptions of social support, on the other hand, fully mediated help-negation for nonprofessional sources (β = .27, p < .05).     

Building social support for adolescents with suicidal ideation: implications for school guidance and counselling

This study involved interviews with 13 adolescents with high levels of suicidal ideation. It aimed to understand how these adolescents perceived their family, school and peer relationships, and how they perceived these systems as their support. Comparison between adolescents with severe and mild suicidal ideation showed that the family, school and peers could act as effective support systems in times of stress. A close interpersonal relationship was the key factor in unlocking these support systems. The school as a support system was highlighted. Implications for school guidance and counselling to strengthen the social support of adolescents and adolescents' resiliency were discussed.     

Randomized controlled trial of a brief problem-orientation intervention for suicidal ideation

Empirical evaluations suggest that problem orientation, the initial reaction to problems, differentiates suicidal youth from nonchnical controls and nonideating psychiatric controls. One promising area for intervention with suicidal youth relates to enhancing this specific coping skill. Nonclinical participants (N = 110) with active suicidal ideation were randomly assigned to receive a brief problem-orientation intervention or a control procedure. The current study evaluated the benefits of a brief prevention intervention based on the Problem-Solving Therapy model. Exposure to a brief video intervention regarding problem solving and coping skills was sufficient to elicit significant decreases in suicidal ideation and depression, but the intervention did not elicit improvements in problem orientation or other problem-solving abilities. These findings provide preliminary support for a brief, video-based problem-solving and coping skills module. However, considerable work in developing secondary prevention interventions remains.     

Gender differences in adolescent coping behaviors and suicidal ideation: findings from a sample of 73,238 adolescents

Suicide among adolescents is an emerging global public health problem as well as a socioeconomic problem. Stress-coping strategies have been shown to be associated with suicidal ideation. We examined coping behaviors related to suicidal ideation and gender differences in adolescents using the data from the 2010 Korea Youth Risk Behavior Survey (ages 12–19 years; N = 73,238). Logistic regression analysis was used to evaluate associations between suicidal ideation and specific coping behaviors while controlling for potentially confounding variables. In both male and female groups, the coping behavior “drinking alcoholic beverages” and “smoking cigarettes” were positively associated with suicidal ideation. “Watching TV,” “playing online/mobile games,” and “sleeping” were negatively associated with suicidal ideation in both groups. In males, “engaging in sports” was negatively related to suicidal ideation. In females, “venting by talking to others” and “eating” were negatively related to suicidal ideation. The results indicate that there are gender differences in the effects of coping behaviors on adolescent suicidal ideation, and that developing adaptive coping strategies may function to reduce suicidality. Future studies are needed to examine whether improving coping skills can reduce suicidal ideation in a gender-specific manner.     

Complicated grief and suicidal ideation in adult survivors of suicide

While the prevalence of complicated grief has been demonstrated to be elevated in survivors of suicide, the association between complicated grief and suicidal ideation among adult survivors of suicide has not been explored. The purpose of the present study is to examine the association between complicated grief and suicidal ideation in suicide survivors. The Inventory of Complicated Grief and the Beck Depression Inventory were administered to 60 adult survivors within 1 month of a death by suicide of a family member or significant other. Complicated grief was associated with a 9.68 (CI: 1.036, 90.417) times greater likelihood of suicidal ideation after controlling for depression, suggesting that syndromal complicated grief heightens vulnerability to suicidal ideation. Clinicians may provide more comprehensive assessments by recognizing the possibility of suicidal ideation in those with complicated grief.     

Psychological and family factors associated with suicidal ideation in pre-adolescents

To assess the psychological and family factors associated with suicidal ideation in pre-adolescent children, we studied a sample of 361 students, average age 9 years old. Two groups were formed, on the basis of the presence (n = 34) or absence (n = 44) of suicidal ideation. Suicidal ideation was assessed with the Children's Depression Inventory and the Children's Depression Rating Scale-Revised. Depression, hopelessness, self-esteem, and perceived family environment were compared in both the suicidal ideation and the control groups. Students with suicidal ideation generally presented greater depressive symptoms and hopelessness, and lower self-esteem and family expressiveness, although there were differences both between sexes, and when the variable depression was controlled. Identifying these risk factors in pre-adolescents may have an impact on prevention of suicidal behavior at higher risk ages.