Suicide Risk Assessment and Risk Formulation Part I: A Focus on Suicide Ideation in Assessing Suicide Risk

The main procedure used by clinicians to determine whether an individual may be at risk of suicidal behaviors is the suicide risk assessment (SRA). The purpose of the SRA is to identify risk and protective factors that then provide the data for the formulation of suicide risk. The suicide risk formulation (SRF) assigns a level of suicide risk that ideally leads to triage and treatment deemed appropriate for that level of risk. Some of the problems with the SRA are explored here, with an emphasis on addressing the over reliance on communicated suicide ideation, and recommendations are made for improvements. Part II of this article (Berman & Silverman, 2013, also appears in this issue of STLB) examines the process of an SRF and, similarly, makes recommendations to improve clinical practice toward the desired end of saving lives.     

Suicide on Railroad Rights‐of‐Way: A Psychological Autopsy Study

Findings from 55 psychological autopsies of decedents who perished on U.S. railroad rights‐of‐way between October 1, 2007, and September 30, 2010 are reported. Described are distal, proximal, and contextual factors of risk; understandings of why these suicides occurred on railroad rights‐of‐way; and opportunities for prevention of similar suicides. International comparisons of suicides on railroad rights‐of‐way are made to highlight distinct findings regarding U.S. cases. Decedents studied exhibited considerable predisposing risk for suicide, with a high prevalence of severe mental disorders and substance abuse. In addition, a number of acute risk factors were commonly observed, notably suicide ideation, hopelessness, anxiety, and anger. In the context of that acute risk, associated situational variables and a relative absence of protective factors are described.     

Suicide Prevention in Adolescents (Age 12–18)

The epidemiology of adolescent suicide is summarized with particular emphasis on temporal trends by age and gender. “First-generation” prevention programs, as reviewed and critiqued by the Centers for Disease Control and Prevention, are then examined. In the absence of compelling empirically based behavioral outcome data, selective targeted “second-generation” prevention efforts are then described across the primary-secondary-tertiary continuum. These efforts are focused toward targets of individual predisposition, the social milieu, or proximal agents associated with high risk for suicidal behaviors. Finally, with an eye toward the future, current obstacles and unanswered questions are explored as they relate to opportunities and hopes for change in effecting reduced rates of these behaviors.     

A critical look at our adolescence: notes on turning 18 (and 75)

Within the contexts of both the American Association of Suicidology's (AAS's) history and the history of associating suicidologists, an integrative identity based on the tenets of science is urged for the AAS. Two propositions are made: first, that we must promote and adopt more discriminative, standardized terminology; second, that we must promote and implement standards of informational competency for professionals and paraprofessionals alike.     

Suicide and the Standard of Care: Optimal vs. Acceptable

ABSTRACT: The accepted standard of care in the treatment of suicidal patients is discussed from the perspectives of the law, malpractice insurance claims, the mental health professions, and the ideal. A review of decisions of professional liability in suits for wrongful death provides guidelines for what the court considers to be adequate care. Out of court settlements further connote accepted standards of reasonable care. Although attention to potential malpractice issues is necessary and appropriate, what appear to result are an acceptance of minimal standards and the practice of defensive care. It is argued that by demanding more optimal standards the consequent quality of care not only serves the patient best but provides the best legal protection as well.     

Dyadic death: murder-suicide.

Twenty homicide-suicides, drawn from death records of three major eastern United States cities, were analyzed in comparison to prior studies and samples of homicide offenders and suicide victims. Results indicated a lower incidence for this event than reported previously and several distinguishing characteristics of the murderer who subsequently commits suicide. Two primary types, from the perspective of ego fusion, are discussed.