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Joseph H. Obegi PsyD
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SCREENING FOR SUICIDALITY Fearlessly Asking Fearsome Questions
© JOSEPH H. OBEGI |
BAROMETER MODEL
Adapted from Millner et al. (2016) and Harris et al. (2015)
MORBID THOUGHTS “I wish I could disappear.”
WISHES TO DIE "I wish I was dead.”
INTERNAL DEBATE “Maybe I should kill myself.”
PLANNING “How and where should I kill myself?”
DECISION “I should kill myself.”
ACTION Preparations, attempt
INEN
T T
O D
IE
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© JOSEPH H. OBEGI |
ASKING QUESTIONS
McCabe et al. (2017)5
No thoughts of harming yourself?
Thoughts of killing yourself at all?
Any suicidal thoughts?
Have your ever thought of not living?
Questions That May Discourage Patients
© Joseph H. Obegi 9-27-2017
© JOSEPH H. OBEGI |
NEGATIVE RESPONSE BIAS
McCabe et al. (2017)
Negatively Phrased Questions Elicit Denials of SI
In this study, psychiatrists in England had a strong tendency to ask questions that encouraged patients to deny SI. They asked negatively framed questions more often and these questions were more likely to result in denials (66% resulted in
“No” responses) than positively framed questions (43% resulted in “No” responses).
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30
40
50
Negatively phrasedquestions
Positively phrased questions
no suicidal thoughtssuicidal thoughtsnarrative
66%
43%
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© JOSEPH H. OBEGI |
ASKING QUESTIONS
Ganzini et al. (2013)7
Repetitive, checking the box approach
Shameful, sign of weakness
Lack of connection with the provider
Barriers to Disclosure
© JOSEPH H. OBEGI |
ASKING QUESTIONS
Adapted from Shea (1999) and Ganzini et al. (2013)9
Rapport (eye contact, warm-up, explanations)
Direct and understandable
Provide a rationale for asking
Start low on the barometer then go up
Normalizing
Shame attenuation
Gentle assumptions
Tips for Asking about Suicidal Ideation
© Joseph H. Obegi 9-27-2017
© JOSEPH H. OBEGI |
Past month and lifetime
Suicidal behavior
SI characteristics
Adaptable to different settings
Barometer model built-in
C-SSRS
Semi-structured interview
Includes questions and follow-up prompts
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Inquires about 5 different types of SI
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Community, healthcare, inpatient, ER
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Frequency, duration, controllability and more
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Attempts, aborted or interrupted attempts, lethality, and self-harm,
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Inquires are two different time periods for suicidal ideation and behavior
10Posner et al. (2009)
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Myth?
17© JOSEPH H. OBEGI |
“Talking about suicide could give them the idea.”
It’s already on their mind.
They are often relieved to talk about it.
Suicide Hotlines work
Treatment for suicidal thoughts work
CONTACT ME
18© JOSEPH H. OBEGI |
Address
2055 Anderson Road Davis, CA 95616
Joseph H. Obegi PsyD
Web www.joeobegi.com
Phone & Email [email protected]
530.302.7304
http://tinyurl.com/sutterscreening
© Joseph H. Obegi 9-27-2017
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REFERENCES
Ganzini, L., Denneson, L. M., Press, N., Bair, M. J., Helmer, D. A., Poat, J., & Dobscha, S. K. (2013). Trust is the basis for effective suicide risk screening and assessment in veterans. Journal of General Internal Medicine, 28(9), 1215-1221.
Harris, K. M., Syu, J.-J., Lello, O. D., Chew, Y. L. E., Willcox, C. H., & Ho, R. H. M. (2015). The ABC’s of Suicide Risk Assessment: Applying a Tripartite Approach to Individual Evaluations. PLoS One, 10(6), e0127442.
McCabe, R., Sterno, I., Priebe, S., Barnes, R., & Byng, R. (2017). How do healthcare professionals interview patients to assess suicide risk. BMC Psychiatry, 17(1), 122. Millner, A. J., Lee, M. D., & Nock, M. K. (2017). Describing and Measuring the Pathway to Suicide Attempts: A Preliminary Study. Suicide and Life-Threatening Behavior, 47(3), 353-369.
Posner, K., Brent, D., Lucas, C., Gould, M., et al. (2009). Columbia-Suicide Severity Rating Scale (C-SSRS) Lifetime Recent - Clinical Version. The Research Foundation for Mental Hygiene.
Shea, S. C. (2002). The practical art of suicide assessment: A guide for mental health professionals and substance abuse counselors. Hooboken, NJ: Wiley.
© Joseph H. Obegi 9-27-2017
