Suicide Risk Assessment and Prevention

Description

This book explores suicide prevention perspectives from around the world, considering both professionals’ points of view as well as first-person accounts from suicidal individuals. Scholars around the globe have puzzled over what makes a person suicidal and what is in the minds of those individuals who die by suicide. Most often the focus is not on the motives for suicide, nor on the phenomenology of this act, but on what is found from small cohorts of suicidal individuals. This book offers a tentative synthesis of a complex phenomenon, and sheds some light on models of suicide that are less frequently encountered in the literature. Written by international experts, it makes a valuable contribution to the field of suicidology that appeals to a wide readership, from mental health professionals to researchers in suicidology and students. Preface Contents About the Editor Contributors Part I: Models of Suicide 1 Models of Suicide and Their Implications for Suicide Prevention Sociological Models Individual Models Physiological Models Intrapsychic Models Intrapersonal Models Why Are Models of Suicide Important? Preventing Completed Suicide The Societal Approach The Individual Approach Comment Preventing Attempted Suicide Final Comment: Is Suicide Prevention Needed? References 2 Neurobiological Approach to the Study of Suicide Introduction Explanatory Neurobiological Models of Suicidal Behaviour The Neuroscience of Suicidal Behaviour Molecular Neuroscience Cognitive Neuroscience Systems Neuroscience Neurobiology for Suicide Prevention Discussion References 3 The Journey Back from Suicide References 4 Suicide as Syndemic Culture Intersectionality Syndemic Theory Culture and Suicide Cultural Variations Methodology in Research Syndemic Case Study The Situation Location Details Assessment War Paths The Syndemic Physiological Factor: High Altitude Effects Physiological Factor: Psychiatric Disorders Cultural Factor: Cowboy Culture Swiss Cheese Model Current Events and the Future Summary References 5 Risk and Protective Factors for Suicide from a Cultural Perspective Introduction Theoretical Perspective: The Social Constructionism Methodology Analysis Results: Categories and Subcategories Resulting Categories Die Feelings Loneliness Sadness Rage Despair Guilt Emptiness Fear Anxiety Negative Self-Concept Social Support Lack of Love Domestic Violence Precariousness Silence Discussion Conclusions of This Study Limitations of This Study References 6 Protective Factors in Suicidal Behavior Decision-Making and Behaviour Resilience Mental Health Social Factors Reasons for Living Summary References 7 Unmet Needs in the Management of Suicide Risk The Formulation of Suicide Risk Understanding the Suicidal Mind Critical Appraisal of Psychiatric Disorders in the Context of the Suicidal Scenario Communication of Suicidal Intentions Unlocking the Suicidal Mind by a Proper Understanding of the Subjective Experience Conclusions References 8 Reasons for Living as a Strength-Based Approach to Suicide Prevention Introduction A Brief History A Holistic Approach to Suicide Prevention Problem-Focused Approaches Emotional Pain Hopelessness Entrapment Interpersonal Difficulties Emotion Dysregulation Personality Traits Strength-Based Approaches Resilience Meaning and Purpose Quality of Life Psychological Well-being Reasons for Living as a Strength-Based Approach Overview of the Subscales Survival and Coping Beliefs Responsibility to Family Child-Related Concerns Fear of Suicide Fear of Disapproval Moral Objections Adaptive Approach to Suicide Prevention Reasons for Living by Age Older Adult College Students Yong-Adult Adolescent Gender Differences Reasons for Living Translations and Adaptations Sweden Italy Latinx China India Summary References 9 Prevention-Oriented Risk Formulation Introduction The Background: From Prediction to Prevention Initial Motivations A New Approach Prevention-Oriented Risk Formulation More Enduring Factors More Dynamic Factors Risk Formulation Updates and Modifications Prevention-Oriented Risk Assessment for Violence Scientific Basis Practical Basis Process Conclusions and Future Directions The Gold Coast Achievement Rapid Implementation of Prevention-Oriented Risk Formulation Developing and Implementing an Integrated Formulation What Comes Next References 10 The Narrative Crisis Model of Suicide: A Novel and Empirically Grounded Diathesis-Stress Model of Suicide Introduction The NCM´s Raison D´être The Narrative Crisis Model of Suicide: A Dynamic Diathesis-Stress Multistage Model Long-Term Risk Factors Stressful Life Events The Suicidal Narrative The Suicide Crisis Syndrome Empirical Validation of the NCM Contrasting the NCM with Other Models of Suicide Stress-Diathesis Models Ideation-to-Action Models Conclusion References 11 Clinician Emotional Response to Patients at Risk of Suicide: A Review of the Extant Literature Effect on Clinicians Suicide Risk Assessment Models Countertransference Negative Countertransference Phenomena Positive Countertransference Phenomena Mixed Countertransference Phenomena Individual Differences Among Clinicians Effect of Countertransference on Outcomes in Therapy Countertransference and Therapeutic Alliance Awareness and Training Diagnostic Value of Countertransference Clinical Implications Future Directions Conclusion References 12 How to Ask About Suicide Introduction A Focus on Suicide Ideation How to Ask About Suicide How Is Suicide Ideation Addressed in Research Scales? How Is Suicide Ideation Addressed in Clinical Enquiry? Why Are Clinicians Hesitant to Ask About Suicide Ideation? Issues to Consider in Deciding How to Ask ``the Ask´´ How to Ask ``the Ask´´ When to Ask the Ask Is the Presence of Suicide Ideation Predictive of Future Suicidal Behavior? Conclusion References 13 Collaborative Assessment and Management of Suicidality Approach The Collaborative Assessment and Management of Suicidality (CAMS) Approach Case Example The CAMS Philosophy of Care Empathy Collaboration Honesty/Transparency Suicide-Focus Using the Suicide Status Form (SSF) to Guide Clinical Care The First Session of CAMS Assessment Treatment Planning Interim Sessions of CAMS Assessment Focus of Care Treatment Plan Update Case Example Interim Care Final Session of CAMS Assessment Outcome Disposition Case Study Outcome Disposition Empirical Support for CAMS SSF-Focused Studies Correlational Clinical Trials Randomized Controlled Trials of CAMS Other and Ongoing CAMS-Related Research Conclusions and Next Steps for CAMS References 14 Differentiation of Suicidal Behavior in Clinical Practice Introduction The Context of Development The Benefits of Clinical Differentiation of Suicidal Behaviours The Hypothetic Four-Type Model of Entrapment (H4ME) SUICIDI-2: An Instrument to Classify Entrapment Validation Strategy of the H4ME Discussion Conclusion References 15 Postdiction in the Psychological Autopsy: A Clue or Algorithm Introduction Suicide How Do We Study Suicide? A Model of Suicide The Psychological Autopsy The State of Indiana vs. Bei Bei Shuai The Evidence My Testimony Therefore Dr. Virginia Apgar and Formula The Algorithm That Postdicts Conclusion Cross-References Appendix 1 Thematic Guide for Suicide Prediction References 16 Suicide and Trauma Suicide and Trauma: Risk, Identification, and Treatment Suicide Risk Comorbid Psychiatric Diagnoses Impulsivity Gender Age Occupation Social Support Ethnic Minority Status The COVID-19 Pandemic Identification Treatment of Suicidality and Posttraumatic Symptoms Treatment of Acute Suicide Risk Stabilization Trauma-Focused Treatment Conclusion References 17 Suicide and Psychotic Depression Symptomatology Biological Symptoms Functional Impairments and Cognition Psychotic Depression vs. Non-psychotic Depression Treatment Antidepressants Antipsychotics Ketamine Electroconvulsive Therapy Suicide Role of Delusions and Hallucinations Conclusion References 18 Indirect Self-Destructive Behaviors Introduction Overview and Background of Indirect Self-Destructive Behaviors Eating Disorders Substance Use Recklessness and Impulsive Behaviors Self-Neglect Conclusions References 19 Promoting Healthy Development and Preventing Suicide Across the Life Span: Individuation and Attachment in Matched Biblical... Introduction A Two-Axis Model of Healthy Development Versus Pathological Fixation Bidimensionalizing Erikson Within-Stage Dynamics Between-Stage Dynamics Stage 4 - School Age: From Inferiority to Industry Healthy Developmental Integration Potentially Suicidal Disintegration Stage 5 - Adolescence: From Identity Confusion to Identity Healthy Developmental Integration Potentially Suicidal Disintegration Stage 6 - Early Adulthood: From Isolation to Intimacy Healthy Developmental Integration Potentially Suicidal Disintegration Stage 7 - Middle Adulthood: From Stagnation to Generativity Healthy Developmental Integration Potentially Suicidal Disintegration Stage 8 - Older Adulthood: From Despair to Integrity Healthy Developmental Integration Potentially Suicidal Disintegration Stage 9 - The Oldest-Old: From Incapacitation to Generational Continuity Healthy Developmental Integration Potentially Suicidal Disintegration An Application to Ancient Narratives: Preventing Suicide and Valorizing Life in Biblical Versus Graeco-Roman Narratives Feeling Isolated and Ignored: Treating the Ajax Syndrome with the Elijah Intervention The Ajax Syndrome The Elijah Intervention Feeling One´s Life Is Without Meaning: Treating the Zeno Syndrome with the Job Intervention The Zeno Syndrome The Job Intervention Feeling Exiled from One´s Home or Homeland (as a Refugee or Outcast): Treating the Coriolanus Syndrome with the David Interven... The Coriolanus Syndrome The David Intervention Feeling One Is Unable to Be Oneself with Others: Treating the Narcissus Syndrome with the Jonah Intervention The Narcissus Syndrome The Jonah Intervention Feeling One Is Alone and Unsupported in One´s Life Mission: Treating the Oedipus Syndrome (171) with the Moses Intervention (1... The Oedipus Syndrome The Moses Intervention Feeling Abandoned by One´s Child Leaving the Family Nest and Building His/Her Own Life: Treating the Phaedra Syndrome with the... The Phaedra Syndrome The Rebecca Intervention Feeling Doomed by a Dysfunctional Family of Origin: Treating the Antigone Syndrome with the Ruth Intervention The Antigone Syndrome The Ruth Intervention Conclusion References 20 The Impact of Stigma on the Risk of Suicide Introduction The concept of Stigma Stigma and Psychiatric Disorders Stigma and Suicidal Behavior References 21 The Role of Resilience in Suicide Prevention and for Recovery After Suicide Attempt: Learning from 80 Years of Resilience R... Introduction Learning from Resilient Survivors and the Contribution This Can Make to Suicide Prevention The Evolution of Research on Resilience Longitudinal Studies of Resilience: What Determines Someone´s Trajectory in Life? Resilience as Dynamic and Always Evolving Post-Traumatic Growth Can those Who Are Not Resilient at the Time of Greatest Vulnerability Build Resilience? Building Resilience in Individuals to Better Prepare Them for Life´s Adversities Choosing How We Respond to Distress, Trauma, and Depression Working with Neuroplasticity: Great Cause for Optimism Positive Psychology Conclusion References 22 Learning from the Lived Experience of Resilient Survivors of Suicidality and Suicide Attempt: The Role of Self-Managing Rec... Introduction The Decision to Live What Resilience Factors Did These Resilient Survivors Draw On? The Process of Recovery Phases of Recovery Stabilization Cocooning Keeping it Simple and Having Some Structure Knowing When to Re-Engage Beginning the Proactive Steps of Recovery Finding Anchors to Strength Reaching Out: Building Connection Reaching Out for Support Moving from Stabilization into Rebuilding The Awakening of Curiosity and Determination: Becoming Proactive They Exercised Some Domain/s of Intelligence Analytical Intelligence Emotional Intelligence Building Positive Connections Self-Care Insight Applied to Developing Resilience Spiritual Intelligence Moving Through Rebuilding and Consolidating Strength Becoming Engaged: Developing Altruism Through Volunteerism Decided to Become a Better Person Opening Up New Options: Moving Toward Flourishing Managing Setbacks: Reality-Checking Became Indomitable Choosing Happiness Sustaining Resilience Summary References Part II: Suicide Prevention Across the Life Span 23 Treatment Approaches with Suicidal Adolescents Treatment Approaches with Suicidal Adolescents Introduction Review of Recent Meta-Analyses Psychotherapy Treatment Approaches Individual CBT Approaches Individual CBT + Parent/Family Involvement CBT + Pharmacotherapy Dialectical Behavior Therapy Family Therapy Basic Family Therapy Attachment-Based Family Therapy (ABFT) Integrated Family Therapy Brief Family-Based Therapy Parent Training Safety Planning Other Psychotherapies Multisystemic Therapy (MST) Developmental Group Therapy Mentalization Therapy Brief Integrated Interventions Used in Inpatient Settings Technology as an Aid in Treatment Rapid Acting Treatments for Severe Suicidal Ideation: Ketamine Conclusions References 24 Suicide Prevention Among Elderly Introduction Epidemiological Data Risk Factors Physical Illness and Cognitive Impairment Psychiatric Illness, Suicidal Ideation, and Personality Factors Psychosocial Factors: Adverse Life Events and Transitions Protective Factors Prevention of Late-Life Suicide Universal Prevention Interventions Selective Prevention Interventions Indicated Prevention Interventions Gender Differences in Late-Life Suicide Intervention New Frontiers for the Prevention of Suicide in Old Age Conclusions References 25 Suicide and Older Adults: The Role of Risk and Protective Factors Introduction/Purpose General Suicide Rates in the United States Suicide in Older Adults Suicide and Gender Identity Suicide, Race, and Ethnicity Suicide and Education/Occupation/Socioeconomic Status Risk Factors Psychiatric Illness Physical Health Social Connectedness and Support Functional Capacity Access to Means Protective Factors Screening/Assessment, Prevention, and Treatment Strategies for Suicide in Older Adults Screening and Assessment Prevention Treatment Conclusion References 26 Preventing Suicide in Boys and Men Suicide in Boys and Men Masculinity, Seeking and Receiving Help, and Suicide Suicide Prevention Interventions Universal/Selective Interventions That Encourage Help-Seeking Through a Focus on Masculinity Indicated Interventions That Ensure That When Boys and Men Do Seek Help, It Meets Their Needs Addressing Research Gaps: Advancing Knowledge by Answering Critical Research Questions Our Research Program The Interventions The Randomized Controlled Trials The Modeling Exercises Strengths and Weaknesses of Our Approach A Final Comment References 27 The Workplace: Our Most Crosscutting and Under-Leveraged System in Suicide Prevention and Suicide Crisis Response Why Should Workplaces Care About Suicide Prevention? Global Models of Workplace Suicide Prevention Guidelines Upstream Midstream Downstream Conclusion Appendix References 28 Suicide Risk Among Psychiatric Patients Introduction Case Definition: Who Is a Psychiatric Patient? Suicides in Psychiatric Hospitals Suicides Among Depressive Patients Suicide Deaths in Unipolar Depression Temporal Variations in Suicide Risk During Hospitalization and After Hospital Discharge Risk Factors for Suicide Among Subjects with Depression Prevention of Suicides Among Depressive Psychiatric Patients Suicides Among Patients with Type I or II Bipolar Disorder Suicide Deaths in Bipolar Disorder Risk Factors for Suicide in Bipolar Disorder Role of Lithium Treatment in Suicide Prevention Suicides Among Patients with Schizophrenia Does Clozapine Treatment Prevent Suicides Among Subjects with Schizophrenia? Discussion Role of Gender Previous Attempts as Indicators of High Risk Role of Illness Severity Limitations of the Available Studies Future Prospects of Research References 29 Suicide in Doctors Introduction Suicide Risk Assessment Overall Perspective General Hypothesis and Specific Risk Factors for Completed Suicide Psychiatric Diseases Risk Factors Sex Risk Factor Race and Ethnicity Risk Factor Age Risk Factor Medical Specialty Risk Factor Civil Status Risk Factor Career Risk Factor Burn-Out Suicide Prevention Patient Barrier Embarrassment Time and Cost Personality Traits Medical Knowledge Provider Barrier Confidentiality Quality of Care System Barrier Structural Issue Cultural Issues Limitations Conclusion References 30 Suicidal Risk Across the Life Span Introduction In Utero and Perinatal Influences Cognitive Development Behavioral and Emotional Development Social and Interpersonal Development Conclusion Cross-References References Part III: Social Aspects of Suicide 31 The Aftermath of a Suicide: Social Media Exposure and Implications for Postvention Background Finding Out Widespread Rumor and Speculation Mass Exposure Romanticization Negative Comments Implications for Postvention Conclusion References 32 Print Media and Suicide Historical Recollections and a Current Issue Many Studies Have Concluded That Media Could Be Considered Responsible for the Increase of Suicide [11, 12] Therefore, What Can Be Done? There Is a Need to Improve the Relationship Between Mental Health Professionals and Suicidologists with Media Professionals Another Point The Education of Media Is Essential. But Is It Possible? Last Interesting Point: ``Is It a Fact of Modern Society?´´ However, Reporting Suicide Can Help to Prevent Future Suicide Conclusion References 33 Suicide Prevention in Female Sex Workers Introduction Suicide Prevention in Sex Workers Suicidal Behaviors in Indoor Sex Workers Suicidal Behaviors in Street Sex Workers Common Risk Factors Suicidal Behavior Prevention Suicidal Behavior Prevention in Sex Workers Training on Suicidal Behaviors to Harm Reduction Services Training on Suicidal Behaviors for Sex Worker´s Peers Providing Emotional Support Services Referral to Health Services in Situations of Suicidal Crisis References 34 Zero Suicide: The Movement to Safer Suicide Care in Health Care Introduction Zero Suicide Model Emerges As Part of National Strategy for Suicide Prevention A Set of Recommendations for Safer Care The Zero Suicide Model Defining the Elements of the Zero Suicide Model Early Adopters and Outcomes Implementation Resources Zero Suicide Training Suicide Care As a Public Health Initiative Within Health Care Creating a Movement An International Declaration Integrating Lived Experience Into System Design Future Directions: From Grants Supporting a Mental Health Initiative to Installing Suicide Care As a Core Activity of Health S... Conclusion References 35 Suicide Prevention: Turning Inward for Direction Self-Disclosure: Part 1 Is Suicide Preventable? Is There Any Value in Suicide Risk Factors Turning Inward: Because We Have To What Does It Mean to Turn Inward for Direction? Self-Disclosure Part 2: Looking in the Mirror What I Saw? What Is This Going to Do for me? References 36 Life Skills Dynamic Meditation for Suicide Prevention Introduction Life Skills Dynamic Meditation Self-Awareness Empathy Critical Thinking Creative Thinking Decision-Making Problem-Solving Effective Communication Interpersonal Relationship Coping with Emotions Suicide Prevention in India What Is Stress? What Is Attitude? What Is Dynamic? What Is Meditation? What Is Depression? What Are the Warning Signs of Suicide? What Can you Do if Someone Seems Suicidal? 37 Complex Trauma and Suicide: An Integrative Interpersonal Approach The Interpersonal Theory of Suicide Toward an Interpersonal Understanding of Suicide Research on the Interpersonal Theory of Suicide Complex Trauma and Suicide Trauma and Complex Trauma Complex Trauma and Suicide An Integrative Interpersonal Approach to Complex Trauma and Suicide Interpersonal Theory Interpersonal Dynamics of Complex Trauma and Suicide Discussion References 38 Suicide and Suicidal Ideation During the COVID-19 Pandemic Previous Evidence from Infectious Disease-Related Public Health Emergencies What Do We Know About the Suicide Rates During the Pandemic? What Do We Know About Suicidal Ideation During the Pandemic? Next Steps and Conclusions: Mitigating Suicide Risk References 39 Population Density and Suicide Risk Introduction Population Density and Suicide: What Is the Evidence of a Link? Has the Relationship Between Population Density and Suicide Changed Over Time? Are There Differences by Sex? Are There Age Effects? Race and Ethnicity Possible Mediators Implications for Prevention Further Research Conclusions References Part IV: Suicide in Different Cultures 40 Suicide in South Asia Introduction Epidemiology of Suicide in South Asia: A Brief Overview Women and Young People as Vulnerable Groups in South Asia Potential Risk Factors for Suicide in South Asian Women Gender Inequality and Violence Poor Marital and Family Relationships Childlessness Depressive Disorders Potential Risk Factors for Suicide in South Asian Youth Aspirational Disappointments ``Modern´´ Addictions: The Role of Smartphones, Gaming, and Social Media Bullying Alcohol and Drug Use Suicide Prevention Crisis Helplines Suicide Intervention Studies National Suicide Prevention Strategy Future Directions Summary References 41 Cultural Considerations in Suicide Research and Practice Introduction Updated Suicide Statistics and Influence of Culture Suicide: A Major Public Health Concern Ethnic and Racial Suicide Statistics Through the Lens of a US Versus International Comparison Suicide Through a Culturally Informed Lens: What Are the Issues? The Murky Waters of Epidemiology Rates Misclassification of Death Misidentification of Cultural Identity Differentiating Between Types of Suicide Psychiatric Versus Nonpsychiatric Suicide Gaps in Culturally Responsive Suicide Training Impact of Training Gaps Culturally Responsive Suicide Prevention Practice Traditional Models of Suicide and Cultural Responsivity Cognitive/Cognitive Behavioral Models Psychodynamic Models Interpersonal Models Limitations of Traditional Models Population Norms ``Classic´´ Versus Cultural Factors Language Availability The Cultural Theory and Model of Suicide Updates The Cultural Assessment of Risk for Suicide (CARS) Conclusions and Recommendations References 42 The Roles of Culture, Race, and Ethnicity in Suicide Introduction Evidence for the Link Between Suicidality and SES Demographic Moderators of the Link Between Suicidality and SES Possible Mediators of Suicidality and SES Relation Suicide among Racial and Ethnic Groups White Americans Black/African American Asian Americans Native Hawaiian/Pacific Islander American Indian/Alaska Native Suicidality and the Latinx Community Demographics Sociocultural Factors Culturally Competent Suicide Assessment and Intervention Cultural Meanings of Suicide Frequency of Suicidal Ideation across Cultural Groups Method of Facilitating Suicide Risk and Protective Factors Reporting of Suicide and Help-Seeking Behavior Summary and Conclusions References 43 Suicide Among Indigenous Populations Within the United States Background Current Issues Suicide Within Indian Country Risk Factors Protective Factors Clinical Implications Cultural-Driven Initiatives Cultural Competency and Cultural Humility Youth Ethics Discussion References 44 Cultural Adaptation for Suicide Prevention Cultural Adaptation for Suicide Prevention References 45 Culturally Adaptive Suicide Assessment Utilizing Resilience and Reasons For Living Introduction Culturally Adaptive Suicide Assessment Overview of the Conventional Suicide Assessment Commonly Used Suicide Risk Assessments Limitations of Conventional Suicide Assessment Cultural Understanding of Suicide Risk Cultural Adaptation Defined Hidden Ideation Cultural Risk Factors Cultural Protective Factors Suicide Assessments That Formally Consider Cultural Identity Cultural Assessment of Risk for Suicide (CARS) Measure Collaborative Assessment and Management of Suicidality (CAMS) Resilience Defining Resilience Related Concepts Theoretical Foundations Reasons for Living Background Reasons for Living and Suicide Assessment Reasons for Living and Cultural Identity Resilience and Reasons for Living as a Framework for Cultural Suicide Assessment Internal Sources of Resilience Moral Objections External Sources of Resilience Responsibility to Family Fear of Social Disapproval Closing References 46 Sexual Minority Suicide Rates of Suicidality Intersectionality Ethnic Minorities Gender Sexual Minority Youth Religion/Spirituality Understanding the Why of Sexual Minority Suicidality: Explanatory Frameworks The Minority Stress Model [49] The Psychiatric Model of Suicide [47] The Interpersonal Theory of Suicide [38] The Cultural Theory and Model of Suicide [8] Adapting Clinical Practice: Integrated Affirmative Therapy Assessing Sexual Minority Suicide Risk Managing Sexual Minority Suicide Risk (Safety Planning) Long-Term Treatment of Sexual Minority Suicide Risk Case Study: ``James´´ Implications for Policy and Public Health Conclusion References 47 Understanding Suicide Among Gender Minorities Introduction Gender Identity Development Suicide Theories Prevalence Rates Risk Factors Veterans and Suicide Disparities and Risk Factors Implications for Clinicians Conclusion References 48 Voices from the Black Rainbow: The Inclusion of the Aboriginal and Torres Strait Islander LGBQTI Sistergirl and Brotherboys... Introduction Literature Review Methodology Survey Aim and Method Strengths Limitations Number of Respondents Identity Age Gender Identity Sexuality Location Environment Suicide Help Seeking Workshop Social and Emotional Well-Being (SEWB) Discussion Outcomes Intersectionality Conclusions Future Directions Appendices: The Survey Echoes of the Forgotten Mob - Indigenous LGBQTI Voices in Suicide Prevention Survey References 49 Prevention of Suicide in Latin America Introduction Mental Illness and Suicide in Latin America Suicide Epidemiology in Latin America Mental Health Plans and Programs in Latin America National Suicide Prevention Programs in Latin America Conclusion References 50 Psychological First Aid in Suicide Crises Introduction What Is PFA Scope of PFA Goals of PFA Rationale of PFA Suicide Crises and PFA Training in PFA Effectiveness of PFA PFA for First Responders and Frontliners Ethical Concerns Conclusions References 51 Community-Based Interventions in Suicide Prevention Introduction Persisting Patterns Controversies Over Definitions Multifactorial Etiology Suicide and Social Exclusion Suicide and Anomie Suicide and Ageism Beskow´s Contributions The Concept of Security Suicide Prevention and Safe Communities Community Interventions to Repair Societies Injury and Intent Suicide Prevention Interventions Within the Framework of Safe Communities Levels of Attention and Levels of Prevention: Two Different Concepts The Role of the Media Toward a Comprehensive Model of Suicide Prevention Identify Populations and Individuals at Risk and Provide Better Life Opportunities Lonely and Socially Excluded Elderly Adolescents: Behavioral Changes and Substance Abuse COVID-19 Pandemic and Communities at Risk Suicide in Physicians: A Silent Epidemic? Suicide Prevention: Medical Approach Improve Epidemiological Surveillance Systems Suicide Prevention in the Secure Communities Model Before the Suicide Episode During the Suicide Episode After the Suicide Episode Community Interventions Conclusions and Proposals References 52 Suicide Prevention for Underserved Populations and Community Mental Health Introduction Suicide and Ethno-Cultural Minorities Suicide Rates Shared Challenges Acculturation Seeking Help Suicide Prevention Suicide and Gender and Sexual Minorities Parental Relationships Peer Relationships During Adolescence The Influence of Educational Systems Culturally Adapted Treatment Considerations for Community Mental Health Client-Therapist Cultural Matching Cultural Competency Role of Community Mental Health in Suicide Prevention Among Cultural Minority Groups: Promises, Challenges, and Recommendations Challenges and Recommendations Gatekeeper Training and Community Awareness Programs Recommendations Community-Based Participation Recommendation Training Community Health Professionals Recommendations Research, Program Evaluation, and Funding Recommendations Linkages Between Systems of Care Recommendation Cultural Appropriateness and Diversity Orientation Recommendations Conclusion References 53 Suicidal Self-Burning in Women and Men Around the World: A Cultural and Gender Analysis of Patterns and Explanations Introduction Terminology Quality of the Data Cultural Context, Patterns, and Explanations of Suicidal Self Burning in Countries Where Women Have Higher Rates of Suicidal S... Iran Iraq Afghanistan Tajikistan and Uzbekistan India Sri Lanka Africa Cultural Context, Patterns, and Explanations of Suicidal Self-Burning in Countries Where Men Have Higher Rates of Suicidal Sel... China Vietnam Africa Eastern Europe Discussion A Gender Lens on Similarities and Differences in Patterns and Explanations of Women´s and Men´s Suicidal Self-Burning Across C... Implications of a Gender Lens for Theory, Research, and the Prevention of Women´s and Men´s Suicidal Self-Burning Across Cultu... Progress in Theory, Research, and the Prevention of Women´s Suicidal Self-Burning Across Cultures Requires More Attention to S... Progress in Theory, Research, and the Prevention of Men´s Suicidal Self-Burning Across Cultures Requires More Attention to Psy... Conclusions References 54 The Crises in Suicide Among Members of the Military Special Operations Community Military Special Forces Psychological Training Suicide Risk Factors Stigma Protective Factors Resilience Hardiness and Mental Toughness Interventions/Future Directions Conclusion References 55 Suicide in Jails and Prisons Epidemiology Risk Factors Characteristics of the Phenomenon Prevention Training of Prison Staff Screening Procedures and Patient Observation Communication Between Staff Members Creation of a Positive Prison Environment Connections with Mental Health Services In Cases of Attempted Suicide Debriefing Conclusions References Part V: Treatments and Preventive Actions 56 Bridging the Global Mental Health Gap Introduction Main Text Global Efforts to Bridge the Mental Health Gap Suicide Global Suicide Prevention Efforts National Strategies Interventions with Strong Evidence Interventions with Weak Evidence Interventions with Insufficient Evidence Summary References 57 Suicide Prevention in Emergency Department Settings Introduction Epidemiology Prevalence of Suicide Behaviors Based on ED Data Methods of Suicide Attempts as Reported in ED Data Psychiatric Disorders Among Those Who Attempt Suicide Interventions Systematic Reviews and Meta-analyses in the ED Setting ACTION-J Study Attempted Suicide Short Intervention Program (ASSIP) Study Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) Study ED-SAFE 2 US National Survey in EDs Pediatrics and Adolescent Population Prevalence Screening Tool: Ask Suicide-Screening Questions (ASQ) The Suicidal Teens Accessing Treatment After an Emergency Department Visit (STAT-ED) Study Conclusion References 58 Suicide Prevention Education for Health Care Providers: Challenges and Opportunities Introduction The Role of Health Care Providers in Suicide Prevention Barriers to Increasing Health Care Providers´ Capacity for Suicide Prevention Overview of Trainings for Health Care Providers on Suicide Prevention Strengths and Limitations of Different Educational Approaches Recommendations for Strengthening Provider Education on Suicide Prevention Conclusions References 59 Nursing Care of the Suicidal Patient Introduction Nursing and Caring The View of the Human Being The Vulnerable Human Being The View of Health Health and Suffering The View of Environment Safer Supportive Environments Documentation and Communication The View of Caring The Caring Approach and the Caring Relationship Sympathy-Expressing Nursing Acceptance Establishing Nursing Understanding-Acquiring Nursing Competence-Manifesting Nursing Barriers for Rapport Structures for Caring Approaches Brief Admission Support to Nurses Developing Caring Competence Postvention Widening the Perspectives References 60 Psychological Treatment of Suicidal Individuals Introduction Psychodynamic Therapies Have Developed in Significant Ways over the Past 120 Plus Years Historical Background Psychodynamic Therapies Are Now Delivered in Different Ways Mentalization-Based Therapy (MBT) for Adults and Adolescents Transference-Focused Psychotherapy (TFP) Good Psychiatric Management (GPM) for Borderline Personality Disorder Survey and Discussion of the Evidence Base for the Effectiveness of Psychodynamic Psychotherapy in the Treatment of Suicidal P... Clinical Contributions Empathic Engagement of the Suicidal Patient´s Internal Subjective Experience The Emotional Dynamics of the Therapeutic Relationship Active Stance Therapeutic Alliance Sustaining Hope: The Role of Hopelessness Conclusion References 61 Treatment of Suicidal Behavior for Inpatients Introduction Indication for Admission Involvement of Carers Open or Locked Ward? Voluntary or Detained? Restrictions of Liberty Rescinding of Detentions Characteristics of Suicidal Patients in an Inpatient Unit Treatment on Admission Phased Treatment and Safety Plan on Acute Ward Application of Phased Treatment and Safety Plan Discharge Characteristics of Suicides in Mental Health When to Admit and When Not to Admit Intensive Home Treatments Finally References 62 Anti-suicidal Properties of Lithium Treatment Introduction Lithium´s Suicide Preventive Effect: More than 20 Years of Evidence Observational Studies and RCTs in Patients with Mood Disorders Ecological Studies Other Studies Possible Mechanism Practical Aspects Indications and Contraindications Initiating Lithium Lithium Level and Monitoring Side Effects Discussion Conclusion Cross-References References 63 Pharmacological Treatment of Suicidality in Affective and Psychotic Disorders Introduction Pharmacological Crisis Intervention Pharmacological Long-Term Treatment Empirical Studies on the Anti-suicidal Effect of Antidepressants and Neuroleptics Antidepressants Functions of Antidepressants (Ads) Possible Side Effects of Ads ([44]*) Studies on the Anti-suicidal Effectiveness of Antidepressants, Neuroleptics, Tranquillizers, Ketamine, and Electroconvulsive T... Studies on Anti-suicidal Effectiveness of Antidepressants Studies for Anti-suicidal Effectiveness of Lithium and Mood Stabilizer Studies on Anti-suicidal Efficiency of Neuroleptics in Psychotic Disorders Studies on the Promotion of Suicidality by Antidepressants Antidepressants and Suicidality in Adolescents and Young Adults Antidepressants and Suicidality in Psychiatric Clinics Suicides and Suicide Attempts at the Beginning of Treatment Suicides and Suicide Attempts During Long-Term Treatment with Antidepressants Summary Recommendations Pharmacotherapy of Suicidality in Psychotic and Depressive Disorders Acute Treatment [8] Long-Term Treatment [56] EBM Criteria Evidence Criteria of the Abovementioned Pharmacological Studies [8, 9] Evidence Criteria of the International Guidelines Lithium Mood Stabilizers Antidepressants Neuroleptics References 64 Psychotherapy for Suicide Prevention Introduction Cognitive Behavioral Therapy for Suicide Prevention Cognitive Therapy for Suicide Prevention Brief Cognitive-Behavioral Therapy for Suicide Prevention Problem Solving Therapy Problem Adaptation Therapy Psychodynamic Therapies Mentalization-Based Treatment Interpersonal Psychotherapy Transference-Focused Psychotherapy Attachment-Based Family Therapy Third Generation Therapies Dialectical Behavior Therapy Schema-Focused Therapy Mindfulness-Based Approaches Mindfulness-Based Cognitive Therapy Mindfulness-Based Stress Reduction Acceptance and Commitment Therapy Other Treatments Complicated Grief Therapy Brief Interventions Collaborative Assessment and Management of Suicidality Teachable Moment Brief Intervention Motivational Interviewing Attempted Suicide Short Intervention Program Internet-Based Interventions Conclusion and Future Perspectives References 65 Community Prevention: Improving Suicide Prevention Through the Creation of Local Suicide Prevention Action Networks Introduction Community Prevention Single Prevention Interventions Have Only Small Effects Multilevel Approaches to Prevent Suicide Multilevel Approach in the Netherlands: SUPRANET Community Level 1: The Public Awareness Campaign Level 2: Training Local Gatekeepers Level 3: Targeting High-Risk Groups Level 4: Support of Professionals in the General Practice Evaluation of SUPRANET Community Evaluation 1: A Repeated Cross-Sectional Design Studying Attitudinal Changes in the General Public in SUPRANET Regions Compare... Evaluation 2: A Qualitative Study Providing Insights on How Primary Care Professionals (PCPs) Evaluate the SUPRANET Interventi... Conclusion References 66 Assessment of Infrastructure Relating to Suicide Prevention Introduction Definitions of Infrastructure Supporting Prevention Example Infrastructure Assessments for State-Level Systems Impacts of the 2013 Infrastructure Survey 2020 Follow-Up Infrastructure Assessment Challenges for Assessing State-Level Infrastructure Conclusions References 67 The Evolution of Charcoal Burning Suicides in Hong Kong, 1997-2018 Introduction Methods Data Source and Procedures Statistical Analysis Results Trends of Charcoal Burning Suicide in Hong Kong, 1997-2018 Characteristics of the Charcoal Burning Users, 2002-2017 Discussion References 68 The Police Negotiation Cadre of the Hong Kong Police Introduction The Police Negotiation Cadre of the Hong Kong Police Crisis Intervention in Theory The Revised Behavioral Influence Stairway Model (BISM-2) in Crisis Negotiation The Revised Behavioral Influence Stairway Model (BISM-2) Stage 1: Core Active Listening Skills Supplemental Listening Skills Stage 2: Empathy Stage 3: Rapport-Trust Stage 4: Influence Stage 5: Behavioral Change Special Considerations During Suicide Crisis Negotiations Uniqueness About Crisis Negotiation with Suicides-by-Jumping A Real Case Study in Hong Kong The Sad News and the Need for Post-Crisis Suicide Prevention Work Conclusion References 69 Suicidal Behavior from a Complex System Perspective: Individual, Dynamical, and Contextual Introduction Times Are Changing Complex Systems Are Everywhere Both a Symptom and the Result of the Interaction of Symptoms Vulnerability for Psychopathology as the Result of Network Structure The Role of the Most Central Symptom Using Networks to Test Theory Ecological Momentary Data Suddenly or Gradually? The Move from Networks to Complexity Critical Transitions Context Bringing It All Together References 70 Military Suicide: Theoretical Understandings and Responses Military Suicide: Theoretical Understandings and Responses Brief History of Suicide in the Military Theories and Understandings of Suicide in the Military Programmatic Resolutions DoD Approaches Branch Differences Army Marines Air Force Navy Other Initiatives General Feedback The Use of Community Resources by Service Members Community Service Organizations for Service Members and Their Families Military OneSource Give an Hour Fisher House Foundation Operation Care and Comfort and Operation Gratitude Tragedy Assistance Program for Survivors (TAPS) Recommendations and Considerations Conclusion References 71 The Role of Social Workers in Suicide Prevention Among Military Veterans Introduction Suicide Is a Social and Medical Problem Suicide Among Military Veterans The Role of Social Workers in Mental Healthcare Including Suicide Prevention Social Work Labor Force Social Work Education Evidence-Based Practice in Mental Health Including Suicide Prevention Education on Military Veterans Social Work Research Mental Health Studies Including Research on Suicide Research on Military Veterans The Role of Social Workers in Mental Healthcare Diagnosis of Mental Disorders Psychotherapy for Mental Disorders Social Workers and Suicidal Persons Social Workers´ Involvement in Mental Healthcare and Psychosocial Help with Military Veterans Social Workers Provide Psychotherapy to Military Veterans Social Workers Provide Psychosocial Help and Reduce Suicidality in Military Veterans Care Coordination and Case Management Housing Assistance Vocational Rehabilitation and Job Placement Legal Assistance Family Services Social Work with Elderly Veterans Social Workers and Suicide Prevention Among Military Veterans Social Workers and Acutely Suicidal Veterans Social Workers Can Provide Psychotherapy to Suicidal Veterans Gatekeepers Postvention Conclusion Cross-References References 72 Access to Lethal Means, Firearms, and Suicide Suicide and Firearm Prevalence Lethal Means Restriction Lethal Means Restriction and Suicide Lethal Means Restrictions and the Practicing Clinician Recommendations for the Practicing Clinician References 73 Suicide Terrorism Types of Suicide Terrorism Lone-Wolf Terrorism Mass Shooters and Rampage Shooter Cults Suicide Bombers Recruiting Motivation and Factors Contributing to Radicalization Psychological Factors Plans for Deradicalization Conclusion References 74 Differences in Suicide Risk Assessment and Management Between Mental Health Professions Suicidal Acts and Deaths A Possible Classification System for Self-Injurious Thoughts and Behavior Suicide Statistics Recommendations Assessments for Risk of Suicide How Different Settings Approach Suicide Management Hospital Inpatient/Outpatient Correctional Community Settings Influence Training Has on Suicide Risk Assessment and Management The Standardization of Suicide Assessment Tools Conclusion References 75 Inpatient Versus Outpatient Management of Suicide Risk: Clinical and Ethical Considerations Standards of Outpatient Care Standards of Inpatient Care Identifying Risk Factors to Inform Treatment Decisions Determining Imminent Risk Medical and Psychosocial Risk Factors Psychiatric and Medical History Proximal Risk Factors Psychosocial and Environmental Factors Clinician Factors that May Influence Decision-Making Ethical Considerations Conclusions References 76 Current Innovations in Suicide Prevention Among Military Veterans Introduction History and Development Current Innovations The VA and DoD Other Organizations and Initiatives Clinical Approaches Assessment Treatment Considerations for Future Research: Veterans with Intersectional Identities Ethno-cultural Minorities Gender and Sexual Minorities The Need for Cultural Consideration Conclusion References Part VI: Survivors 77 Bereavement by Suicide Among Family Members Introduction The Aftermath of Suicide Case Description Family History of Suicide Case description Limitations Conclusions References 78 #Not6: Expanding the Scope of Suicide Exposure Historical Context Difficulties Associated with Suicide Loss The Continuum Model of Suicide Exposure Correlates of Exposure Exposure in Specific Groups Veterans Gender and Sexual Minority Adults Children Occupational Exposure Why Not 6? Conclusion References Part VII: Legal Issues 79 Accountability and Malpractice in Suicidality Introduction Accountability in Suicide The ``Suicidal Trajectory´´ The Need for the Diagnostic Entity ``Suicidal Behavior Disorder´´ and Its Contribution in Defining an Accountability Framework The Negligence of Addressing Suicidal Behavior As a Public Health Issue Proposals Mental Health Services The Role of the Suicidal Patient´s Family and Familiar Persons Up-to-Date Surveillance and Data Availability Interventions for the Prevention of Suicides in Inpatient Settings Addressing Suicidal Behaviors with Specific Target Groups (e.g., Prisoners and Security Forces) The Role of the Media Early Life Mental Health Education Addressing the Stigma in the Society and in Mental Health Services Hotspots and the Role of Local Government Authorities The Lack of National Suicide Prevention Strategies, a Barrier to Suicide Prevention Conclusions References 80 Ethical and Legal Frameworks in the Suicidology Field Introduction Bioethics of Suicidology Why Is It Relevant to Think About the Bioethics of Suicide? Legal Aspects for Consideration Suicidology Legal Frameworks in Argentina Mental Health National Law: Law No. 26657 National Law for the Prevention of Suicide. Law No. 27130 Proposals References 81 Psychopathy and Suicide: A Reexamination of Cleckley´s Criterion Defining Psychopathy Clinical Origins Current Research Suicide: Theory and Research Contemporary Models of Suicide Suicide and Psychopathy An Integrative Approach to Psychopathy and Suicide Combining Contemporary Models of Suicide and Psychopathy Implications Discussion Cross-References References Index