Psychological mechanisms of the development of suicidal ideation: Longitudinal cohort study

Introduction This study aimed to investigate the mechanisms of the development of suicidal ideation and its moderating and protective factors. Drawing on the Interpersonal-psychological theory of suicide, we proposed that disruptions to belongingness, in conjunction with tolerance of health risk, may influence the development of suicidal ideation above and beyond psychosocial changes such as disruptions […]

Employing a sequential multiple assignment randomized trial (SMART) to evaluate the impact of brief risk and protective factor prevention interventions for American Indian Youth Suicide

Background This study is built on a long-standing research partnership between the Johns Hopkins Center for American Indian Health and the White Mountain Apache Tribe to identify effective interventions to prevent suicide and promote resilience among American Indian (AI) youth. The work is founded on a tribally-mandated, community-based suicide surveillance system with case management by […]

Laws, risk management, and ethical principles when working with suicidal patients

Working with a suicidal patient is a high-risk enterprise for the patient who might die from suicide, the patient’s family who might lose a loved one, and the psychologist who is likely to feel extreme grief or fear of legal liability after the suicide of a patient. To minimize the likelihood of such patient deaths, […]

Disclosure of suicidal ideation in non-psychiatric clinical research: Experience using a novel suicide risk management algorithm in a multi-center smoking cessation trial

Background Clinical trials involving pharmacologic or behavioral treatments often assess depression and suicidal ideation for purposes of screening, baseline assessment of potential moderators or mediators of treatment, or as a study outcome, even if the primary condition under study is not a mental health disorder. Suicide risk management in the context of clinical research poses […]

Reporting ethical procedures in suicide prevention research: Current status and recommendations

Objective: Ethical concerns frequently arise in suicide prevention research regarding participant safety and confidentiality. Despite a substantial literature on managing and navigating ethical concerns in suicide research, little attention has been paid to the reporting of ethical procedures. Furthermore, standard procedures for reporting ethical risk management procedures have not been developed. Method: A review of the current […]

Managing suicidal risk: A collaborative approach. 3rd ed.

Now in an extensively revised third edition with 65% new material, this is the authoritative presentation of the Collaborative Assessment and Management of Suicidality (CAMS) therapeutic framework. CAMS provides proven tools to help clinicians of any orientation evaluate suicidal risk and develop a suicide-focused treatment plan. In addition to their clinical utility, the procedures used […]

Understanding the risks of recent discharge: The phenomenological experiences trying to survive while living under the proverbial “Sword of Damocles”

Background: Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and the period of time immediately following discharge after such hospitalizations appears to be a particularly high-risk time. Aims: This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better […]

Current practices of suicide risk management protocols in research

Background Participant safety is an important concern in mental-health-oriented research. Investigators conducting studies in the United States that include potentially suicidal individuals are often required to develop written suicide risk management (SRM) protocols. But little is known about these protocols. It is possible that such protocols could serve as templates for suicide risk management in […]

Anxiety sensitivity and intolerance of uncertainty: Transdiagnostic risk factors for anxiety as targets to reduce risk of suicide

Purpose of Review Suicide has a profound impact on individuals, families, and society. One prominent, if understudied, risk factor for suicide is anxiety. More than 70% of people with at least one suicide attempt meet diagnostic criteria for an anxiety disorder. There are several limitations to exploring the associations between anxiety and suicide using diagnosis-based […]

Suicide risk help-seeking among middle- to old-age adults: A systematic review

Background and Objectives Suicide has become a major public health concern worldwide and in the United States. Rates of suicide increase during the life course and are highest among middle- to old-age adults. Help-seeking represents a crucial coping mechanism that can mitigate suicide risk. Yet, less is known about suicide risk help-seeking, especially among these […]

A review of multidisciplinary clinical practice guidelines in suicide prevention: Toward an emerging standard in suicide risk assessment and management, training and practice

Objective: The current paper aims to: (1) examine clinical practice guidelines in suicide prevention across fields, organizations, and clinical specialties and (2) inform emerging standards in clinical practice, research, and training. Methods: The authors conducted a systematic literature review to identify clinical practice guidelines and resource documents in suicide prevention and risk management. The authors used PubMed, […]

Conducting research with individuals at risk for suicide: Protocol for assessment and risk management

Objective Suicide prediction, prevention, and intervention are urgent research areas. One barrier for research with high-risk populations is limited resources to manage risk in a research setting. We describe using the University of Washington Risk Assessment Protocol (UWRAP) to assess and manage suicide risk during phone-administered eligibility assessments in two clinical trials. Method Study 1 […]

The Narrative-Crisis Model of suicide and its prediction of near-term suicide risk

Despite decades of research, much remains unknown about the transition from chronic to imminent suicidal risk. In the context of COVID-19, this question is even more urgent. The present study tests a novel, stepwise model of this transition, termed the Narrative-Crisis Model. This model proposes that, in people with chronic risk factors, stressful life events […]

Military mental health professionals’ suicide risk assessment and management before and after experiencing a patient’s suicide

Objective This study examines the association between a patient’s suicide and the therapist’s suicide risk assessment (SRA) and suicide risk management (SRM) of patients, following the occurrence. Method SRA values range from “absence of suicidality” to “immediate suicidal intent to die”. SRM consists of therapists’ written recommendations. Rates of the various SRA and SRM values […]

Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management

Suicide prevention in psychiatric practice has been dominated by efforts to predict risk of suicide in individual patients. However, traditional risk prediction measures have been shown repeatedly in studies from high income countries to be ineffective. Several factors might contribute to clinicians’ preoccupation with risk prediction, which can have negative effects on patient care and […]

Suicide risk profiles and barriers to professional help-seeking among college students with elevated risk for suicide

Suicide is the second leading cause of death among college students, yet many students with elevated suicide risk do not seek professional help. This study identified suicide risk profiles among college students and examined these in relation to students’ perceived barriers to professional help-seeking. Data were obtained from college students (n = 1689) identified to be at […]

Suicide behavior results from the U.S. Army’s suicide prevention leadership tool study: The behavioral health readiness and suicide risk reduction review (R4)

Introduction The U.S. Army developed a new tool called the Behavioral Health Readiness and Suicide Risk Reduction Review (R4) for suicide prevention. A 12-month evaluation study with the primary objective of testing the hypothesis (H1) that Army units receiving R4 would demonstrate improved outcomes in suicidal-behavior measures following the intervention, relative to control, was then […]

Evaluating a recovery-oriented intensive outpatient program for veterans at risk for suicide

Background: Suicide is the 10th leading cause of death in the United States and suicide risk is elevated among military veterans. Risk for suicide is inherently transdiagnostic, complex, and multifaceted, which means a comprehensive psychotherapeutic approach to risk mitigation is required. Aims: Our aims were to summarize findings from an evaluation of an interdisciplinary, recovery-oriented intensive outpatient program […]

Real-world feasibility and acceptability of real-time suicide risk monitoring via smartphones: A 6-month follow-up cohort

Active and passive Ecological Momentary Assessment of suicide risk is crucial for suicide prevention. We aimed to assess the feasibility and acceptability of active and passive smartphone-based EMA in real-world conditions in patients at high risk for suicide. We followed 393 patients at high risk for suicide for six months using two mobile health applications: the MEmind […]

Safety planning: Why it is essential on the day of discharge from in-patient psychiatric hospitalization in reducing future risks of suicide

Individuals who suffer from mental illness are at an increased risk for suicide. That risk is substantially higher in the post-discharge period from psychiatric hospitalization. Safety planning intervention (SPI) is a common intervention tool that is utilized to mitigate the risk of suicide. Current research notes promising results of SPI use in the emergency department […]

Procedures for risk management and a review of crisis referrals from the MindSpot Clinic, a national service for the remote assessment and treatment of anxiety and depression

Background: The MindSpot Clinic (MindSpot) provides remote screening assessments and therapist-guided treatment for anxiety and depression to adult Australians. Most patients are self-referred. The purpose of this study was to report on the procedures followed to maintain the safety of patients and to examine the circumstances of urgent referrals to local services made by this remote […]

Alliance-focused safety planning and suicide risk management

Patients’ interpersonal vulnerabilities and problems represent major distal and proximal risk factors in the etiology of suicide. These can be triggered by the interpersonal demands of therapy and safety planning and impede the development of a strong therapeutic alliance, and thus, the effectiveness of safety planning. This article proposes that the principles put forth by […]

The European Human Rights system and the right to life seen through suicide prevention in places of detention: Between risk management and punishment

This paper analyses the shortcomings of European suicide prevention policy in places of detention, a topic that has been neglected in the European legal literature. Four interrelated characteristics of the suicide prevention policies developed by the European Court of Human Rights (ECtHR) are responsible for the failures of these policies. First, the risk-based approach relies […]