In addition to asking about risky behaviors, she said, psychologists should also identify sources of resilience within the Black community. Engaging in criminal or violent acts, for example, could result in someone else shooting an adolescent. “They may engage in more aggressive kinds of behaviors that draw harm or fire,” said Robinson. L., et al., Journal of Community Psychology, Vol. LaVome Robinson, PhD, a psychology professor at DePaul University in Chicago (Robinson, W. Instead of harming themselves outright, they may put themselves in harm’s way because they are willing to die, said W. Take Black adolescents, whose rate of suicide has escalated in recent years. Plus, suicidality can look different in different populations. Administering that scale alongside the Patient Health Questionnaire-9 (PDF, 40KB) depression screener improved the identification of patients most likely to progress to suicidal behavior in the next month, Bryan and colleagues found ( Annals of Family Medicine, Vol. “But there’s increasing recognition that there are different trajectories toward suicide.” Some people may progress through the sequence in a matter of hours others may not follow the sequence at all.Ī scale Bryan and colleagues developed called the Suicide Cognitions Scale asks questions that get at emotions that can render people vulnerable, such as feeling that people would be better off without you or that no one can help you solve your problems. “The traditional approach is to think about suicidal ideation as the gateway to suicidal behaviors,” said Bryan, author of Rethinking Suicide: Why Prevention Fails, and How We Can Do Better (Oxford University Press, 2021). But these and other traditional assessments ask the wrong questions, said Craig Bryan, PsyD, ABPP, who directs the Suicide Prevention Program at The Ohio State University College of Medicine. Psychologists often use one of two screening instruments to assess suicidality: the Ask Suicide-Screening Questions tool or the Columbia-Suicide Severity Rating Scale (PDF, 181KB). Psychologists are also harnessing technology to help patients who are suicidal and shifting from top-down approaches to more collaborative ones. Today, said Knapp, there are three treatments that are well supported by outcome research-brief cognitive behavioral therapy (BCBT), dialectical behavior therapy (DBT), and Collaborative Assessment and Management of Suicidality (CAMS)-as well as other promising but less replicated strategies. And treatment has progressed far beyond what was once the standard of care but has now been proven ineffective-asking people to sign a contract promising not to harm themselves. The field has come a long way since assessment consisted only of asking people if they were depressed and thinking of harming themselves and going no further, said Knapp. But that is usually not the best approach, he said. All too often, Knapp said, psychologists feel the best way to respond to a patient who is suicidal is to send them to the emergency room and get them on antidepressants as soon as possible. Part of the problem is that seeing patients who are suicidal can be both challenging and disconcerting, acknowledged Samuel Knapp, EdD, ABPP, author of Suicide Prevention: An Ethically and Scientifically Informed Approach (APA, 2020). “It’s exasperating to know that there is rigorous clinical trial research providing effective suicide-focused interventions…, yet most practicing psychologists don’t know about them.” “Psychologists don’t know how much evidence we’ve produced and that clinical practice is lagging behind what works,” said Jobes. “Suicide ideation is the bigger challenge lurking under the water.”Īnd what is frustrating, he said, is that practicing psychologists too often are failing to take advantage of recent advances in clinical research on what works best when it comes to detecting suicide risk and treating patients with proven suicide-focused care. Jobes, PhD, ABPP, who directs the Suicide Prevention Lab at The Catholic University of America in Washington, D.C. “Suicide deaths and attempts are the tip of the iceberg,” said psychology professor David A. É., et al., Morbidity and Mortality Weekly Report, Vol. That said, suicidal ideation is up, with about twice as many adults in 2020 reporting that they had seriously considered suicide in the previous month than in 2018 (Czeisler, M. C., et al., Vital Statistics Rapid Release, No. Centers for Disease Control and Prevention show a 5% decrease from the 2018 peak in suicides (Curtin, S. After rising steadily for 15 years, the suicide rate in the United States dipped in 2019 and again in 2020.
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