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.     

Predicting Persistence of Nonsuicidal Self‐Injury in Suicidal Adolescents

Prospective predictors of persistent nonsuicidal self‐injury (NSSI) were examined in adolescents admitted to an inpatient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Seventy‐one (77%) participants reported NSSI at baseline, and 40 (56%) persisted at the 6 month follow‐up. Those who endorsed automatic positive reinforcement (APR) as the predominant reason for NSSI were more likely to persist in NSSI. Depression over follow‐up, but not at baseline, also predicted persistence. These results suggest that helping high‐risk adolescents to identify alternative ways of generating emotion(s) to counter the effects of APR that may accompany NSSI should be a high priority treatment target.     

Chaplains' Engagement with Suicidality among Their Service Users: Findings from the VA/DoD Integrated Mental Health Strategy

Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users were examined. An online survey was used to collect data from 440 VA and 1,723 Department of Defense (DoD) chaplains as part of the VA/DoD Integrated Mental Health Strategy. Differences were noted for demographics, work setting characteristics, encountering suicidality, and self‐perceived preparation for dealing with suicidality. Compared to DoD chaplains, VA chaplains encounter more at‐risk service users, yet feel less prepared for dealing with suicidality.     

Effect of Problem‐Solving Therapy on Depressed Low‐Income Homebound Older Adults' Death/Suicidal Ideation and Hopelessness

Previous study findings of psychotherapy's effect on suicide prevention have been inconsistent. This study reports the results of secondary analyses of outcome data from a short‐term depression treatment on reducing death/suicidal ideation among 158 low‐income homebound adults aged 50+. The treatment, in‐person or telehealth problem‐solving therapy (PST), compared with telephone support call, has been found effective in reducing depressive symptoms and disability among participants. Compared with support call participants, tele‐PST participants, but not in‐person PST participants, exhibited lower ideation ratings across the follow‐up period. Effect sizes at 36 weeks were 0.31 for tele‐PST and 0.17 for in‐person PST. Hopelessness mediated the effect of tele‐PST but not in‐person PST; however, in‐person PST also alleviated hopelessness, which led to lower ideation. Clinical implications of the findings are discussed.     

Spirituality as a 1‐Year Prospective Predictor of Violence Perpetration and Drug Use Among Youth at Continuation High Schools1

This paper presents the results of a 1‐year prospective study of violence perpetration, drug use, and spirituality among continuation high school youth. Spirituality was found to predict later violence perpetration and drug use as a single predictor. However, it failed to predict violence or drug use in models that also entered 6 other variables; particularly, baseline levels of violence and drug use, and morality of drug use. It is possible that current measures of spirituality predict later violence perpetration and drug use as a result of tapping attitudes about morality. Controlling for baseline spirituality, male gender, low morality of drug use, violence perpetration, and drug use predicted later spirituality. Spirituality appears to be affected by drug use and violence, but not the converse. The protective influence of spirituality is not supported, at least as currently measured.     

Zur Dynamik der Interaktion in der Supervision

The manifold functions of a supervisor in following the course of complex processes together with the trainee, are: ? to keep the goals of the supervision in view, ? to establish a teaching alliance and to support the wish and ambitions of the candidate to learn, ? to build a platform for the complex interactions with the trainee with regard to the dynamics of the training situation and keeping in mind the institutional influences, ? to lay down the setting for the work, ? to explore and to reflect how transference and counter-transference influence the interaction between patient and analyst as well as between trainee and supervisor, ? to examine these interactions together focussing continuously on the interaction between candidate and patient, and to encourage the candidate to do the same on his own, ? to continuously formulate hypotheses about the core conflict, the transference phenomena and resistance of the patient, ? to explore and reflect on the cooperative work.