Introduction
Suicide is defined as a death brought on by intentional harm to oneself. Contrarily, a suicide attempt takes place when someone attempts suicide by harming themselves to take their own life, but they are not successful in doing so. Numerous variables can either raise or lower the likelihood of suicide.
Suicidal ideas and behaviors can be prevented by having access to a counseling center, in addition to the support of one’s family and community (Centers for Disease Control and Prevention [CDC], 2023). To properly assess and respond in circumstances where persons may be in danger of suicide, it is critical to know these risks along with protective variables. The essay will delve into the significance of understanding suicide risks and protective factors to effectively assess and respond to situations where individuals may be at risk of suicide.
Background on Suicide
Critical Terms Associated with Suicide Intervention
When discussing suicide intervention, several important concepts are frequently utilized. Suicidal purposes, suicide plots, suicide attempts, and suicidal thoughts are the four particular concepts that will be covered in this essay. The term “suicidal ideation” refers to contemplating suicide or engaging in suicidal behavior (Paladino, 2020).
A self-initiated concept that promotes self-harming behavior or a suicide attempt is referred to as a suicide plot. A self-directed, dangerous, nonfatal activity that is not meant to result in death is referred to as an attempt to commit suicide. A suicide attempt can cause harm or lead to death for the person attempting it. Lastly, suicidal purpose relates to evidence that the person who was hurt recognized the consequences of their actions and intended to end their own life at the exact moment of the injury.
It is inadvisable to use specific phrases when discussing suicide, such as suicidal gestures, suicidal threats, and suicidal threats, because they were considered inappropriate by the Centers for Disease Control and Prevention. The phrases “completed suicide, failed effort, nonfatal suicide, parasuicide, effective suicide, and suicidality” were declared inappropriate by the CDC (2021). It has been suggested that they be taken from written and verbal clinical evaluation reports, clinical practice, studies, and clinical teaching and training. To increase accuracy and reduce stigma, it is strongly urged that, as a helpful professional, suitable terminology be encouraged in one’s workplace, among other things (Paladino, 2020). In order to encourage accurate and courteous discourse concerning suicide inside clinical settings as well as outside them, professionals need to implement these suggested adjustments.
Risk Factors for Suicidal Behavior
The majority of individuals who attempt or complete suicide have certain risk factors that may increase their likelihood of doing so. A previous episode of depression, previous attempts at suicide, an addiction to alcohol or drugs, a family background of mental health problems or suicide, or experiencing harassment by someone they recognize or by others are some examples of these risk factors (Paladino, 2020). Understanding these risk factors is vital to devising effective preventive measures and providing appropriate support.
The existence of a quantifiable demographic, characteristic, behavior, or circumstance is referred to as a risk factor, such as gender, age, mental health condition, and history of suicide attempts. Risk factors are distant variables that cannot trigger or predict suicidal conduct, but they do have a positive relationship with attempts to commit suicide and suicide death (Edwards et al., 2021). Consider the client’s sociocultural background when examining general risk factors. Men in midlife and older, veterans, and former members of the armed forces must also understand the risk factors specific to different age groups. To successfully treat suicidal behavior across a variety of demographics and circumstances, clinicians and other professionals must include this thorough awareness of risk factors in their evaluation and intervention techniques.
Mental health disorders include anxiety-related disorders, alcohol or other drug use disorders, significant or persistent illnesses or pain, lack of access to healthcare, biological and genetic variables, and bipolar disorder. A broad spectrum of stresses and situations is considered an environmental variables that increase the risk of suicide (Edwards et al., 2021). Stressful life situations such as divorce, death, or financial hardship are among them.
Long-term stressors such as unemployment, intimidation, and an absence of social support are also significant. Cultural attitudes, experiences of prejudice, exposure to suicide, and availability of fatal tools further increase these risks. Historical elements include past attempts at suicide, a family background in suicide attempts, trauma or abuse history, a relative history of mental illness or drug misuse, and people who injure themselves, not suicidal.
Prevalence/Statistics within Various Populations
It is critical to comprehend the risk factors associated with various age and developmental stages, such as bullying and online harassment among adolescents. Suicidal thoughts and actions are common in some groups. LGBTQ persons face bias, judgment, and discrimination, which creates a stressful and hostile social setting that exacerbates mental health issues (Paladino, 2020). Male suicide deaths in the West are between three and four times higher than female suicide deaths.
Risks associated with serving in the military have grown, and they include pressures tied to deployment, watching someone get hurt or killed, firing a weapon, and being exposed to more warfare. Across all age categories, American Indians and Alaska Natives continue to have suicide rates that are more than fifty percent higher than those of the overall U.S. population. Comprehending the distinct risk factors associated with various demographic groups assists in customizing preventative and intervention strategies to cater to the particular requirements and obstacles encountered by these groups, thereby diminishing the frequency of suicide.
Suicide Risk Screeners and Assessment Tools
Difference Between Screening and Assessment
Screening is done to determine whether any dangers can be taken action on. It seeks to identify members of an ostensibly healthy group who are more susceptible to disease or other health issues (Ryan & Oquendo, 2020). It must thus be easy for front-line personnel to administer, suspect, and rule out patients who do not appear to be dangerous.
Unlike screening, assessment is a more comprehensive analysis that better defines the severity of the risk. Screening and assessment should work together to identify clinically actionable risks, with screening detecting them with sensitivity and assessing them along a severity spectrum (Ryan & Oquendo, 2020). It is unlikely that someone without specialized training in suicide evaluation and intervention will have attended more than one class, or, if they are lucky, one chapter in a textbook.
Instruments Used
Numerous research investigations have shown that a few of the warning indicators included in the acronym are linked to suicidal thoughts. The PHQ-9 is the nine-item depression module of the PHQ (Sun et al., 2020). Depression is one of the nine depressive signs that must be present for a minimum of “more than half the days” during the previous two weeks in order to be classified as major depression. To identify individuals who are at risk and monitor treatment outcomes, research on suicide avoidance and treatments needs a consistent technique for evaluating suicidal ideation. The Columbia-Suicide Severity Rating Scale (C-SSRS) was created to measure the intensity of suicide ideas and behavior.
Application to Case (Using PHQ-9 or C-SSRS)
Summary
The C-SSRS could serve as a valuable tool in dealing with Anna. She seems hopeless and has not only considered suicide in the past but also attempted to do so. According to the C-SSRS, Anna should immediately seek assistance, given her responses to questions 4 and 5 (Mayes et al., 2023). However, because Anna is still hopeful and eager to work on herself, she is prepared to begin implementing a safety plan.
To establish a strong rapport with Anna and further examine the problem, the counselor might ask her questions utilizing “her words” throughout their session. Whenever the counselor concludes that Anna has little possibility of recovery, they have to keep talking to her and thinking until they conclude that Anna is likely to pass away when she departs. When this is the case, the counselor should focus on hospital admission (Paladino, 2020). Clinicians may make critical decisions on urgent security measures and ongoing therapy preparation for patients at risk of suicide, such as Anna, with the use of structured evaluation instruments such as the C-SSRS.
Risk Factors, Protective Factors, Lethality, Plan, and Mandated Reporting Issues
Anna’s recent breakup with her boyfriend is the most significant environmental risk factor. This risk factor is what first caused her to consider suicide (Paladino, 2020). Her possession of a gun, her perception of herself as having no assistance system, and her perception that she alienated her friends are further environmental factors that contribute to risk. Anna should take into account several protective elements, such as social, cultural, and communal protective variables, to help her avoid suicide.
The development of Anna’s adapting and problem-solving abilities illustrates a successful individual component. The counselor had to concentrate on this to assist Anna. Anna can participate in regular, excellent physical and behavioral medical procedures from a community perspective. Lastly, Anna may sell the pistol to distance herself from the weapon she was considering using to carry it out, which would be a protective social measure.
Relational theories of culture can assist the client in managing suicidal thoughts when used in conjunction with appropriate suicide evaluation and therapy. An essential component of suicide intervention is the counselor’s ability to determine if a client needs to be hospitalized and to evaluate their lethality (Paladino, 2020). Anna is at extremely high risk of suicide, based on the C-SSRS, yet during the meeting, she begins to exhibit signals of optimism.
Safety Plan Creation
It is critical to maintain composure while simultaneously treating a client’s admission of suicidal thoughts with seriousness. A client’s decision to disclose their suffering and suicidal thoughts is a clear cry for assistance (Paladino, 2020). They are attempting to communicate in hopes that someone can relate to their situation. Now is the time to listen to them with empathy, show sympathy, and determine how severe their suicidal ideas are. Ann’s scenario is best suited to the Stanley and Brown Safety Plan, which uses an organized approach to safety planning.
Conclusion
In conclusion, the first stages in doing an effective evaluation and care when a person may be contemplating suicide are determining their suicide risk and protective factors. It can be accomplished by using a comprehensive risk-factor assessment that considers environmental stressors, mental health conditions, and demographics to develop interventions and preventive measures tailored to the specific needs of various groups. It is important to recognize the role protective variables play in suicide intervention, including social support networks, adaptive coping mechanisms, and communal or cultural influences that foster inner strength and promote recovery.
References
Centers for Disease Control and Prevention. (2021). Risk and protective factors.
Centers for Disease Control and Prevention. (2023). Facts about suicide.
Edwards, A. C., Ohlsson, H., Mościcki, E. K., Crump, C., Sundquist, J., Lichtenstein, P., Kendler, K. S., & Sundquist, K. (2021). On the genetic and environmental relationship between suicide attempt and death by suicide. The American Journal of Psychiatry, 178(11), 1060–1069.
Mayes, T. L., Carmody, T., Rush, A. J., Nandy, K., Emslie, G. J., Kennard, B., Forbes, K., Jha, M. K., Hughes, J. L., Heerschap, J. K., & Trivedi, M. H. (2023). Predicting suicidal events: A comparison of the Concise Health Risk Tracking Self-Report (CHRT-SR) and the Columbia Suicide Severity Rating Scale (C-SSRS). Psychiatry Research, 326.
Paladino, D. A. (2020). Suicide prevention and intervention. In T. Duffey & S. Haberstroh (Eds.), Introduction to Crisis and Trauma Counseling (pp. 137-163). Wiley.
Ryan, E. P., & Oquendo, M. A. (2020). Suicide risk assessment and Prevention: Challenges and opportunities. Focus/Focus (American Psychiatric Publishing. Online), 18(2), 88–99.
Sun, Y., Fu, Z., Bo, Q., Mao, Z., Ma, X., & Wang, C. (2020). The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry, 20(1).