Running head: ASSESSING SUICIDE AND SUICIDAL BEHAVIOR 1

Assessing Suicide and Suicidal Behavior

Allyson Lindsey

Seton Hall University

ASSESSMENT 2

I. Precipitants or Stressors

Precipitants or stressors, as they relate to clients with suicidal thoughts, ideations or attempts,

will invariably be different for every client - no two people are the same. That statement rings

true even of clients who are diagnosed with the same disorder. Stressors among clients vary,

respectively, from the seemingly mundane day-to-day stress (e.g. caring for children, work) to

those which have significant implications for the client’s well-being, welfare, or life, generally

speaking (e.g. financial problems, family instability, interpersonal relationship issues, death of a

family member) (Bryan & Rudd, 2006, pg. 191). Precipitants and stressors are also seen as a

byproduct of a preexisting medical conditions, wherein the client experiences a myriad of

symptoms related to their illness, which has the potential to compound the already existing

stress. A client who has escalating precipitants or stressors which cause instability or significant

change of behavior, no matter how seemingly insignificant, should be assessed for suicide, and

suicidal behavior as a precaution.

II. Predisposition to Suicide

Empirical data provides support that offspring of parents who have depression are more likely

to develop suicidal behaviors, ideation, thoughts, or to commit suicide (Gureje, Oladeji, Hwang,

Chiu, Kessler, Sampson, & ... Kovess-Masféty, 2011, pg. 1230). Genetic studies also show a

strong genetic predictability of suicide and suicidal behaviors for children of parents who have a

history of impulse-control or anxious arousal issues (Gureje, et al, 2011, pg. 1230). Gureje et al

(2011) state that although there is a genetic component to an increased risk of suicide and

suicidal behavior in families where suicide and suicidal behaviors “run” in the family there are

still unanswered questions pertaining to “how the risk is transmitted…” (pg. 1222).

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According to the National Institute of Mental Health (NIMH), men are at a greater risk for

suicide and suicidal behaviors; nearly four times as many males as females die by suicide, the

seventh leading cause of death for males (2013). Suicide is also the third leading cause of death

for youth, aged 15 to 24 years (NIMH, 2013). In ages 15 to 19 years, nearly five times as many

males as females die by suicide and from 20 to 24 years, nearly six times as many males as

females die by suicide (NIMH, 2013). Older individuals have the same tragic statistics; of ages

65 and older, 14.3 in every 100,000 people die by suicide (results from the 2007 Centers for

Disease Control online statistics query). Non-hispanic whites, mostly men, make up the majority

of the statistic with 13.5 of the 14.3 (per 100,000) (NIMH, 2013). While gender is an important

risk factor for suicide and suicidal behavior, marital status and sexual orientation are also

significant, specifically among the gay, lesbian, bisexual, and transgendered (GLBT)

communities (Bryan & Rudd, 2006, pg. 191).

III. Presence of Hopelessness

“Hopelessness refers to a cognitive style characterized by a tendency to make negative

attributions about the causes, consequences, and self-implications of future events” (Beck,

Brown & Steer, as cited in Ribeiro, Bodell, Hames, Hagan, & Joiner, 2013, pg. 208). Generally,

negativity is due to one’s overall longitudinal outlook on life, and the feeling that life offers only

negative outcomes in a never-ending repetition of negative outcomes, which for the person

experiencing such a lack of positivity, is the unfortunate inability to ‘look upward’ (Ribeiro, et

al, 2013, pp 208-209). Hopelessness is often linked to depression and is one of the leading risk

factors of suicide and suicidal behaviors.

ASSESSMENT 4

IV. Assessment

General Guidelines

The thought of assessing a client for suicide or suicidal behaviors appears a daunting task; in

fact one article calls it “one of the most anxiety-provoking tasks for professionals” (Freda, 2010,

pg. 7). Freda (2010) suggests starting an assessment with simple questions (e.g. “How often do

you have thoughts of hurting yourself?”) that require specificity in answers – the more detailed

responses, the better (pg. 7). Freda (2010) follows with additional questions gaged to assess the

client’s strengths, limitations and their coping skills (e.g. “Who can you turn to for help?”) (pg.

7). She also suggests interview questions to open discussions on death, suicide, the client’s

future, and their reasons for living (Freda, 2010, pg. 7).

Assessing Precipitants and Stressors. In an effort to evaluate suicide and suicidal behaviors a

verbal self-report is often vital to predicting at-risk clients. On other occasions, when a self-

report is insufficient, such as when working with adolescents or children, observing their

behavior(s) becomes essential in the treatment of symptoms (and sometimes, coexisting

symptoms) (Freda, 2010, pg. 6). Understanding that even the most seemingly insignificant

stressors in the life of an adolescent can become critical (Freda, 2010, pg. 6). Stressors cannot be

measured as ‘typical’ since the value of the stressor differs amongst individuals, ages, genders,

etc. Interpersonal relationships, family conflict and cultural issues among others are factors to

consider when assessing suicidal behaviors. Interaction with family members, specifically for

children and adolescents are essential for determining the client’s support system as well as to

provide any historical information of mental illness or medical problems within the client’s

immediate family (Freda, 2010, pp 6-7).

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Assessing a Predisposition to Suicide. Assessing a predisposition to suicide should involve a

thorough intake interview wherein the counselor gathers a brief history of the client’s

background and any medical conditions, mental health issues and family life. Taking into

consideration the reasons for the client’s reasons for seeking mental health counseling, assessing

the client as ‘normal’ while also looking for risk factors which may point to the potential for

suicide and suicidal behaviors. Such risk factors could include depression, alcohol or substance

abuse or misuse, disruptive or unusual behaviors, impulsivity, and anxiety (NIMH, 2013).

Chronic or terminal medical conditions or a history of mental illness is also an important risk

factor to note during the intake interview (NIMH, 2013).

Assessing feelings of hopelessness. Hopelessness is often defined by ever present negative

thoughts and emotions, but is often compounded by the idea that the future is devoid of

possibility (Sisask, Varnik, Kolves, Konstabel, & Wasserman, 2008, pg. 431). In assessing

hopelessness, counselors often use the Beck Hopelessness Scale, a 20-item self-report inventory

developed by Dr. Beck, which aids counselors in the assessment of a client’s feelings and

attitudes about his/her future (Sisask et al, 2008, pg. 431). The inventory engages the client with

simple questions that have multiple choice “true/false” answers. Beck’s questions are simple but

vary (e.g. “I never get what I want so it’s foolish to want anything”); it is designed to provide

counselors with an overall “hopelessness score” (Beck & Weissman, 1974, pg. 862).

While there are numerous questionnaires and inventory scales designed to quantify a client’s

feeling of hopelessness, despair or depression, in an effort to assess for suicide and suicidal

behaviors, most are used in clinical research settings rather than in an office. Beck’s Depression

Scale is another self-report inventory however, others such as the Beck Suicide Intent Scale and

the Pierce Suicide Intent Scale are most often used for research studies on suicide (Sisask et al,

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2008, pg. 432). Observation of client behaviors, along with a thorough interview and possible

inventory for hopelessness, depression, etc. is key when assessing a client for the possible risk of

suicide.

VI. Conclusion

There is much to learn about suicide, suicidal behaviors and suicidal ideation. Freda had it

right when she suggested that predicting risk is difficult (Freda, 2010, pg. 7). Freda also

mentioned that despite the various tests, inventories and self-report measures, the best tool for a

counselor assessing clients who discuss suicide, suicidal ideation, or who exhibit suicidal

behaviors, is the clinical interview.

ASSESSMENT 7

References

Beck, A. T., Weissman, A. (1974). The measurement of pessimism: The hopelessness scale.

Journal of Consulting and Clinical Psychology 42(6), 861-865. Retrieved from

http://web.elastic.org/~fche/mirrors/www.jya.com/2012/10/beck-hopelessness.pdf

Bryan, C. J., & Rudd, M. D. (2006). Advances in the assessment of suicide risk. Journal of

Clinical Psychology: In Session 62(2), 185-200. Retrieved from

http://myweb.shu.edu/courses/1/2013_FALL_CPSY6103...

Gureje, O., Oladeji, B., Hwang, I., Chiu, W., Kessler, R., Sampson, N., & ... Kovess-Masféty, V.

(2011). Parental psychopathology and the risk of suicidal behavior in their offspring: results

from the World Mental Health surveys. Molecular Psychiatry, 16(12), 1221-1233.

doi:10.1038/mp.2010.111

National Institute for Mental Health. (2013). Suicide in the U.S.: Statistics and prevention (NIH

Publication No. 06-4594). Bethesda, MD: Science Writing, Press, and Dissemination Branch.

Retrieved from http://www.nimh.nih.gov/health/publications/suicide-in-the-us

Ribeiro, J. D., Bodell, L. P., Hames, J. L., Hagan, C. R., & Joiner, T. E. (2013). An empirically

based approach to the assessment and management of suicidal behavior. Journal Of

Psychotherapy Integration, 23(3), 207-221. doi:10.1037/a0031416

Sisask, M., Varnik, A., Kolves, K., Konstabel, K., & Wasserman, D. (2008). Subjective

psychological well-being (WHO-5) in assessment of the severity of suicide attempt. Nordic

Journal Of Psychiatry, 62(6), 431-435. doi:10.1080/08039480801959273