Interviewing suicide "decedents": a fourth strategy for risk factor assessment

Serious Suicide Attempts

BACKGROUND

Suicidal behavior comprises a diverse set of behaviors with significant differences among several behavioral categories. One noteworthy category includes individuals who have made serious suicide attempts, epidemiologically very similar to those completing suicide. This behavioral category is important, since interviewing survivors of a potentially lethal incident of self-harm enables a detailed investigation of the psychological process leading to the suicidal act.

AIM

To achieve a consensus definition and operational criteria of serious suicide attempts.

METHOD

We reviewed studies that included the term serious suicide attempt or related terms (e.g., highly lethal), with a focus on the variety of operational criteria employed across studies.

RESULTS

More than 60 papers addressing various types of serious suicide attempt were explored. We found a large variety of operational definitions, reflecting the lack of consensus regarding terminology and criteria related to the term.

CONCLUSION

We undertook the challenge of developing an integrative and comprehensive set of criteria of serious suicide attempt and suggest a definition comprising three key dimensions: medical lethality, potential lethality of the method used, and severity of the objective circumstances of the suicide intent. Clinicians and researchers are strongly encouraged to consider using the term serious suicide attempt with its attendant components.

Improving care for depression and suicide risk in adolescents: innovative strategies for bringing treatments to community settings

This article reviews the literature on interventions and services for depression and suicide prevention among adolescents, with the goals of placing this science within the context of currently changing health care environments and highlighting innovative models for improving health and mental health. We examine the challenges and opportunities offered by new initiatives and legislation designed to transform the US health and mental health care systems; summarize knowledge regarding the treatment of depression and suicidality/self-harm in adolescents; and describe innovative models for partnering with health systems and communities. This review demonstrates that treatment models and service delivery strategies are currently available for increasing evidence-based care, particularly for depression, and concludes with recommendations for future research and quality improvement initiatives aimed at inspiring additional efforts to put science to work, bridge science and community practice, and develop strategies for partnering with communities to improve care, mental health, and well-being among adolescents.

Attachment patterns in medically serious suicide attempts: the mediating role of self-disclosure and loneliness

Although the study of medically serious suicide behavior is an important strategy for understanding the nature of suicide, little is known about its underlying psychological mechanisms. This gap is addressed here by applying insights from attachment theory to severe suicidal behavior. The results show that both anxious and avoidant attachment patterns predict medical lethality. Path analysis indicated that interpersonal difficulties mediated the paths between insecure attachment patterns and lethality of suicide attempts. These results suggest that the psychological mechanisms of medically serious suicide behavior involve high levels of mental pain amplified by insecure attachment patterns and interpersonal difficulties. Implications for prevention and therapeutic intervention strategies are discussed.

Dependency and self-criticism as predictors of suicidal behavior

Individuals have been theorized to develop anaclitic and introjective depression to the extent that they may be characterized as dependent and self-critical, respectively (e.g., Blatt, 1990). Blatt's theory was applied to suicidal behavior to determine if suicidal behavior could also be reliably broken down into two distinctive types, with respect to a number of parameters. Sixty-four undergraduate students who had attempted suicide were interviewed, and the lethality of their attempts was assessed with the Risk-Rescue Rating scale (Weisman & Worden, 1972). Participants were also administered an Intent and Precipitating Events scale, a modified version of the BDI-II, and the Depressive Experiences Questionnaire (DEQ). Self-critical individuals showed greater intent to die and greater lethality in their suicide attempts than did dependents. Self-critics were also more likely to attempt in response to an intrapsychic stressor, with the explicit motivation to escape. In contrast, dependents were more likely to attempt in response to an interpersonal stressor, with the motivation to communicate some form of unhappiness. Implications for suicide prediction and treatment are discussed, with special reference to the importance of identifying different suicidal subtypes.