The Practice of Suicide Assessment and Management by Marriage and Family Therapists

Abstract

Over 90% of mental health providers encounter suicidal clients. However, the majority of marriage and family therapists (MFTs) are not exposed to suicide-specific trainings within their clinical coursework. Due to the lack of consistent training protocols for suicide assessment and management among MFTs, this qualitative study identified common MFT responses to suicidal clients, including assessment of risk severity and intervention modalities. Responses were then compared to best practices for suicidal clients. Participants inconsistently adhered to best practices identified in the larger field of mental health, revealing the need for increased MFT training on suicide to ensure appropriate and effective care.     

Working with suicidal clients: The person‐centred counsellor's experience and understanding of risk assessment

Background: Client risk assessment within the person‐centred paradigm is traditionally seen as squarely opposed to its ethos. Aim: To determine how the person‐centred counsellor experiences and understands the issue of risk assessment within the confines of their work ethos. Method: Semi‐structured interviews with seven person‐centred counsellors using thematic analysis were conducted. Findings: Three main themes emerged following thematic analysis: The impact of the risk assessment process on self; The counsellor's experience of self, and The therapeutic process in relation to risk assessment. Discussion: The findings suggest that person‐centred counsellors conduct risk assessments taking a holistic approach involving not only individual risk predictors and characteristics of the client but also individual factors related to self.     

自杀“守门人”培训研究述评

在西方国家,自杀“守门人”培训被认为是最有效的自杀预防策略之一.自杀“守门人”培训的具体内容包括传授基础知识、识别自杀征兆、初步评估自杀风险和转介自杀高危个体等4个方面;研究发现自杀“守门人”培训对受训者的知识、态度和干预技能有显著的积极影响,但其对自杀率的影响仍需今后的研究详细探讨;目前的研究存在以下不足:1)随机对照研究少;2)难以评估培训对自杀率的真实影响;3)评价指标单一,缺乏统一的评估工具.未来的研究应弥补现有研究的不足,并重视自杀“守门人”培训的跨文化研究.     

Future Well-Being Among U.S. Youth Who Attempted Suicide and Survived

To what extent does a suicide attempt impair a person’s future well-being? We estimated the prevalence of future well-being (FWB) among suicide attempt survivors using a nationally representative sample of 15,170 youths. Suicide attempt survivors were classified as having high FWB if they reported (a) a suicide attempt at Wave I, (b) no suicidal ideation or attempts over the past year at Wave III (7 years after), and (c) a well-being profile at or above the top quartile of nonsuicidal peers. Seventy-five of 574 suicide attempt survivors (∼13%) met criteria for FWB at Wave III, compared to 26% of nonsuicidal peers. Wave I well-being levels, not depressive symptoms, predicted the likelihood of FWB at Wave III (OR = 1.23, 95% CI [1.05, 1.44], p < .05). In conclusion, a nonfatal suicide attempt reduced but did not preclude FWB in a large national sample. The observation that a segment of the population of suicide attempt survivors achieves FWB carries implications for the prognosis of suicidal behavior and the value of incorporating well-being into investigations of suicide-related phenomena.     

痛苦逃避和自我参照惩罚条件下脑电特征对自杀意念的分类效能

采用支持向量机的特征递归选择算法, 创新性采用三维心理痛苦量表和自我参照情感激励延迟任务, 建构自杀意念分类模型的重要特征集, 并比较自杀意念和抑郁的分类模型重要特征集差异。结果发现, 痛苦逃避是自杀意念分类模型的首位特征; 基于痛苦加工特征的自杀意念多模态分类模型效能优良。研究首次证实了在机器学习建构复杂的自杀意念分类模型中, 痛苦逃避及其相关脑电成分的重要性。拓展了结合心理痛苦三因素模型和机器学习算法对自杀预测的临床应用可行性。     

Integrating the Interpersonal Psychological Theory of Suicide Into the Depression/Suicidal Ideation Relationship: A Short-Term Prospective Study

We examined the hypothesis that depressive symptoms are associated with increased beliefs about perceived burdensomeness and thwarted belongingness identified in the interpersonal psychological theory of suicide and that these beliefs are associated with changes in suicidal ideation. Participants with clinical levels of depressive symptoms (n = 299) were selected from a larger group (n = 508) and completed measures of depressive symptoms, perceived burdensomeness and thwarted belongingness, and suicidal ideation twice over a period of 2 months. Results of a structural equation model found that depressive symptoms were associated with increases in burdensomeness and lack of belonging, which were associated with suicidal ideation. Moreover, this hypothesized integrated model demonstrated a significantly better fit than an alternative model that assumed burdensomeness and lack of belonging were associated with changes in depressive symptoms, which were associated with suicidal ideation. Our findings suggest that the well-established relationship between depressive symptoms and suicidal ideation is associated with changes in beliefs that one is a burden on others and lacks belonging. More generally, these results suggest that it may be fruitful to integrate theories of suicide risk to form a comprehensive model that can inform future research and clinical interventions.     

Escaping the World: Linguistic Indicators of Suicide Attempts in Poets

The purpose of this study was to determine features of language use in the texts of poets who committed suicide and to identify psychological factors contributing to depression and suicide. Texts of suicidal and non-suicidal poets were analyzed via the Linguistic Inquiry and Word Count program. ANOVA and logistic regression analysis revealed predictors of suicide: higher percentage of words self-oriented, expressed negative emotions, ambiguity, exclusion attitude toward reality, and lower percentages of words related to others, world entitativity, and experiencing the world. The data support hypotheses that suicide is facilitated by weak social bonds, egocentrism, helplessness, and visions of an unordered, uncertain, and unsafe world.     

Religiosity,spirituality, mental health,and mental health treatment outcomes in Australia: a systematic literature review

The relationship between religiosity and mental health is a relatively well-researched field within North America, covering numerous domains of religiosity, including: religion, spirituality, prayer, church attendance, church affiliation and belief in God or a higher power. Considering the Australian literature, there are few papers that explore these dimensions of religiosity and their relationship with health, and in particular, very little research into the field of religiosity and mental health. Using systematic literature review methods, this study explores the Australian research into relationships between religiosity, mental health, and treatment outcomes for psychiatric illness and suicidal behaviour.     

Between Hippocrates and God: Ugandan mental health professional's views on suicide

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 1. Quantitative outcome and process studies

Scope of review: The paper reports a meta‐review of 15 previous systematic reviews and meta‐analyses of the literature concerning the outcome of counselling and psychotherapy with people at risk of suicide; a meta‐analysis of 67 outcome studies in this area; and a narrative review of 17 studies of the therapeutic process. Publication time span: The literature reviewed was published between 1981 and 2008. Publication origin: The majority of the literature reviewed was by authors from the USA or the UK, but there were also authors from other European countries, Australia, Canada, India, and Sri Lanka. Findings: There is evidence of the effectiveness of dialectical behaviour therapy, cognitive‐behavioural therapy, and problem solving therapy, but also for other forms of therapy. Therapist and client variables, as well as the therapeutic relationship, appear to be related to treatment outcome. Conclusions: People at risk of suicide should have access to psychological interventions, including, but not necessarily limited to, those within the cognitive‐behavioural spectrum. Therapies for which there have been promising findings, but which are under‐researched, should be a research priority.