Suicidology: A Look Backward and Ahead

Using the metaphor of “a long run’ to describe our progress in suicidology, the author looks back to discuss important concepts that have become well established, such as clues to suicide, ambivalence, crisis services, suicide consultations, and psychological autopsies. An example is the psychological autopsy of Marilyn Monroe. Follow-up studies of crisis center clients have indicated that chronically suicidal clients are at the greatest risk of suicide. Recommendations for the long-term treatment of such patients are provided. Research on youth suicide is reported. Finally, the author looks ahead toward new developments in training and treatment.     

Psychologist suicide: Incidence, impact, and suggestions for prevention, intervention, and postvention

Psychologist practitioners are not immune to some mental health problems, including suicidality, for which they provide services. In the aftermath of two recent psychologist suicides, the American Psychological Association's Advisory Committee on Colleague Assistance (ACCA) initiated the formation of a conjoint ad hoc committee consisting of members from ACCA, the American Psychological Association (APA) Practice Directorate, and the Section on Clinical Emergencies and Crises (Section VII of APA's Division 12) to investigate the incidence of psychologist suicide and its impact on colleagues, students or interns, patients or clients, and the profession. The committee reviewed the extant empirical literature on suicide rates for psychologists, evaluated unpublished data on psychologist suicide provided by the National Institute of Occupational Safety and Health (NIOSH), interviewed colleague survivors, reviewed published case reports of the impact of therapist suicides, and linked their findings to the literature on professional distress, impairment, and self-care. The committee concluded that there is evidence suggestive of an elevated risk of suicide for psychologists in past decades. It further concluded that there is a need for further research to confirm if there is a heightened risk of suicide for psychologists in the present day, and to determine factors that might contribute to such risk. Accounts from colleague-survivors suggest that the impact of a psychologist's suicide can affect many people including family, colleagues, students, and patients or clients. This article offers suggestions for possible preventive approaches, for intervention with potentially at-risk colleagues, and for postvention efforts in the wake of a colleague suicide.     

Youth Suicide: The Knowledge and Attitudes of Australian Teachers and Clergy

This is the first study of the suicide-related knowledge and attitudes of teachers and clergy in Australia. These professional groups have been identified as “gatekeepers” who might serve as a first line of assistance for distressed young people. Such gatekeepers, along with medical and mental health professionals, have a vital role to play in the prevention of youth suicide, of which Australia has the highest rates in the world. This research confirmed that high numbers of teachers and clergy have been approached by suicidal young persons. However, their gatekeeping role may be compromised by a low level of knowledge about signs of suicide risk, which was found even among those who had taken courses in suicide or death and dying or who had personally known someone who suicided. Suicidal behavior was found to be generally regarded as unacceptable, especially by those with a high religious commitment. Further educational efforts about suicide risk identification and prevention seem to be needed for both teachers and clergy; it will be important for such education to take into account attitudinal issues and how these might affect communication with young suicidal people.     

Older Adults: The Next Suicide Epidemic?

Suicide rates historically and currently are highest by age among those over the age of 65. Predictions of markedly higher rates for future older adults have been advanced. Possible alternative factors that might produce lower risk among future elderly Americans are presented and it is argued that future trends are uncertain. Predictions of elderly suicide are made based on an assumption of stable rather than changing rates. Constant rates produce estimates of more than twice the current number of suicides and a proportionate increase in the number of suicides from one in five for the 1980s to one in three by the year 2030. The elderly are and likely will be a group with high suicide risk. Immediate efforts to lower elderly suicide risk and avert high future rates are recommended.     

Epilepsy and suicide

Although statistics dealing with the causes of death are often difficult to compare, in some cases they indicate that suicide rates are high among people suffering from seizures. The author considers this critically. At present the number of attempted suicides among this group is at least five times higher than among the average population. The author reports on his own findings, on factors indicating potential suicide victims, and on the possible prevention of suicide, particularly in connection with pharmaceutical treatment.     

Evaluation of the Recognizing and Responding to Suicide Risk Training

Changes in attitudes, confidence, and practice behaviors were assessed among 452 clinicians who completed the training, Recognizing and Responding to Suicide Risk, and who work with clients at risk for suicide. Data were collected at three time points. Scores on measures of attitudes toward suicide prevention and confidence to work with clients at risk for suicide improved over time. Clinical practice behaviors improved for assessing and formulating suicide risk, developing suicide prevention treatment plans, and responding to vignettes. Results suggest training can improve clinicians’ attitudes toward suicide, confidence to work with clients at risk for suicide, and, most importantly, clinical practice skills.     

Rescuers and the Rescued

ABSTRACT: There is a fairly widespread but unverified belief that persons working on certain taboo areas may be similar to the population they serve and drawn to such work by their own personal problems in these areas. Two groups, 51 suicide prevention volunteers and 31 suicide attempters, were compared with respect to demographic characteristics and for psychological attitudes and experiences pertaining to suicide, death, and mental status by means of a death questionnaire developed by Shneidman. Comparative analysis revealed substantial differences between volunteers and clients. Demographically, the volunteers were older, better educated, more affluent, and contained a greater proportion of Protestants. Psychologically, the volunteers were distinctly different in regard to suicide. In contrast to their clients, the volunteers reported greater emotional stability, much less fantasy about suicide, almost no actual suicide attempts, and a disinclination to consider suicide as a justifiable problem-solving option.     

The impact of the Samaritan centres on suicide in Scotland

A study of Scottish suicide rates from 1958 to 1981 showed no evidence for a preventive effect from the growth in the number of Samaritan centres.     

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,Attitudes, and Use of Crisis Hotlines among Youth At‐Risk for Suicide

Crisis hotlines have been central to suicide prevention efforts; however, utilization among youth remains low. A sample of at‐risk youth was surveyed about their awareness, utilization, and attitudes toward local and national crisis hotlines. Youth reported low rates of awareness and utilization, yet expressed a strong interest in phone hotlines (41% vs. 59% for new media categories combined). Youth reported stigma, but that help‐seeking could be positively influenced by peers and adults in their support system. Implications include making crisis services available across several mediums and the importance of engaging trusted others in youth suicide awareness campaigns and prevention efforts.     

Resilience Factors and Suicide Risk for a Sample of Transgender Clients

This study explored how individual- and community-based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross-sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens by way of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study.     

A Century of Suicide in Italy: A Comparison between the Old and the Young

This study analyzes suicide rates from 1887 to 1993 in the Italian population between the ages of 15 and 24 years old and over 65 years of age, based on official data published in the Health Statistics Year Book. The rates of death by suicide (per 100,000) subjects) are calculated for each year and for 10-year periods, as are the mortality rates relative to each method of suicide, standardized by gender. The latter analysis was possible starting from 1951 only, when it became customary to record method. The findings indicate an increase in the suicide phenomenon in the elderly population in Italy over the test period. Rates are at least 3 times higher for men than for women. The highest rates are reported for elderly men, but there appears to have been a greater proportional increase in the number of suicides committed by elderly women. The rise was statistically significant in both males and females. By contrast, a rather constant decrease in suicide rates in young people emerges from the beginning of the century through to the present date. This decrease is more marked in females, although suicide rates are lower for females than for males. Over the study period, substantial changes have come about in the suicide methods used by both young and old people. There was an increase in poisoning by care exhaust fumes, jumping from heights, hanging, and firearms.     

Samaritanism and Civil Disobedience

In this paper, I defend the existence of a moral duty to disobey the law and engage in civil disobedience on the basis of one of the grounds of political obligation—the Samaritan duty. Christopher H. Wellman has recently offered a ‘Samaritan account’ of state legitimacy and political obligation, according to which the state is justified in coercing each citizen in order to rescue all from the perilous circumstances of the state of nature; and each of us is bound to obey the law, as the state demands, because we each have a responsibility to help rescue others when this assistance is not unreasonably costly. Though Wellman recognizes that there can be reasons for disobeying the law and resisting injustice in otherwise legitimate states, he overlooks the possibility that at least some of these reasons could be Samaritan in nature, grounded in the duty to rescue people from peril. As I shall argue, the Samaritan duty supports obligations to disobey the law, when the law prohibits Samaritan rescues, and to engage in civil disobedience, when unjust laws and practices contribute to endangering people. The discussion proceeds as follows. After a brief overview of the Samaritan duty, I articulate my case for Samaritan duties to disobey the law, and duties to engage in civil disobedience when unjust laws, institutions, or practices enable what I call ‘persistent Samaritan perils’. I then examine and respond to several objections to my account: first, that the costs of law-breaking are unreasonable, and thus cannot be morally required; second, that individuals’ particular acts of protest and civil disobedience do not appear to make any difference to the rescue, and thus cannot be required; third, that I stretch the Samaritan duty beyond recognition; and fourth, that the Samaritan duty binds us to help people in need or peril anywhere, not particularly at home. I consider in conclusion the advantages and limits of my account of citizens’ Samaritan duties in the face of injustice.     

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.     

In a search for meaning: challenging the accepted know-how of working with suicide risk

This opinion piece considers the current predominance of assessment tools and strategies in working with people at risk of suicide, and questions their efficacy and how they are privileged in day to day mental health practice. While such tools and an evidence-based ‘scientific’ approach to assessment clearly has its place, the author instead asserts that the modus operandi of therapy – a discursive based exploration – has much more to offer and should be the primary intervention in understanding suicide potential. Helping the client to gain insight into the meaning of their suicidality helps position the client – and practitioner – in the best possible place to reduce risk.     

Styles of Suicide Intervention: Professionals' Responses and Clients' Preferences

As the rates of suicide in America continue to rise, suicide recently has been declared to be a national public health concern. The crisis intervention model, which has dominated the treatment of suicidal individuals in America since the 1950s, is currently believed to be the most effective model for suicide intervention. This study examined this belief by taking a more complex look at professionals' responses to suicidal clients both by investigating the existence of different ways in which professionals interpret the crisis intervention model. In one interpretation (the "fight" response), the professional takes power and agency away from the client and does what is perceived to be "best" for the client. An alternate interpretation, the "ideal" response, allows for a respectful engagement with the client. Professionals also can act contrary to the model (i.e., the "flight" response). In addition, based on the humanistic notion that clients are the experts of their own experience and that their voices are a very valuable part of evaluating the treatment process, this study investigated which response style clients report to be most helpful and most desired. The results suggest that while the typical response of mental health professionals to suicidal clients is most characteristic of the "fight" response style, clients overwhelmingly report that the contrasting "ideal" response style is most helpful. The findings are discussed along with implications for practice, research, and training.     

Suicide in nurses.

The worldwide English language literature on suicide in nurses is reviewed in this article. There is evidence from several countries that female nurses are at increased risk of suicide. Very little information is available about the specific causes. Increased risk in nurses has been statistically associated with smoking and negatively related to extent of caffeine consumption. Unlike some other high-risk occupational groups, it is unclear to what extent access to means for suicide contributes to nurses' risk. The methodological issues and specific needs of research concerning suicide in nurses are discussed.     

Predictive and concurrent validity of the Suicidal Ideation Questionnaire among American Indian adolescents

Suicide is currently the second leading cause of death for ages 15–24 years; reports indicate that 6–8% of American teens have attempted suicide. Rates of suicide and suicide attempts are at least as high, if not higher, for American Indian adolescents and young adults. The Suicidal Ideation Questionnaire (Junior High School Version) (SIQ-JR) could be used to identify young people who may be at risk for attempting suicide, since this questionnaire focuses on suicidal ideation, a major risk factor for suicide attempt. However, little is known about the predictive validity of the SIQ-JR, particularly in American Indian adolescent populations. A suicide attempt cluster at an American Indian boarding school provided the unique opportunity to examine the performance of the SIQ-JR in a group of American Indian high school students who had taken the SIQ-JR approximately 2 months prior to the outbreak of attempts. The SIQ-JR proved to be an excellent predictor of future suicide attempts when compared to other measures of distress: anxiety, depression, and alcohol use. The SIQ-JR is an effective screener for suicide risk in this American Indian adolescent population.     

The relationship between impulsivity and suicide among rural youths aged 15–35 years: a case–control psychological autopsy study

In China, the gender ratio of suicide rates did not match the Western patterns, which was higher for females than males. However, the rural men were at relatively high risk of suicide in Liaoning province. Impulsivity was an important factor of suicide behaviors, but there was a lack of studies in China. This research aimed to study the relationship between impulsive personality traits and suicidal behavior among Chinese rural youths. Suicides were consecutively sampled from six randomly selected counties in Liaoning Province in China. Between 2005 and 2007, a total of 162 suicide victims were enrolled in the study along with 162 community controls matched for age, gender, and location. The psychological autopsy method was used to collect data from informants knowledgeable about the selected suicide victims and controls. The results showed the suicide victims in the study were more likely to demonstrate dysfunctional impulsivity and less likely to demonstrate functional impulsivity compared with the controls. Mental disorders, acute negative life events, and dysfunctional impulsivity contributed to the risk of suicide; educational and functional impulsivity were protective factors. Suicide prevention efforts in rural China may address impulsivity.