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Suicide Risk
and Assessment / Self-harm
| Question | Answer |
|---|---|
| The Ask Suicide Screening Questions (ASQ) | a brief, evidence-based suicide risk screening tool developed by the National Institute of Mental Health (NIMH). It consists of four yes/no questions designed to quickly identify suicide risk in medical and behavioral health setting; youth |
| If a respondent answers "yes" to any of the initial questions on the ASQ, a fifth question assesses immediate safety concerns. T/F | True |
| Where to access the ASQ | National Institute of Mental Health website (see ASQ toolkit) |
| Immediate steps to take when someone has suicidal ideation, even if the threat is not immediate: | Validate Jordan’s feelings, ensure their safety, involve their support system, and develop a safety plan. |
| Ensure safety means | Stay with them and continue the conversation, reinforcing that they are not alone. |
| Involve a support system | contacts their guardian and arranges for a mental health referral. |
| Develop a safety plan | helps them identify coping strategies, safe individuals to reach out to, and ways to remove access to potential means of self-harm. |
| Provide crisis resources | shares the 24/7 Crisis Text Line (Text "HOME" to 741-741) and the National Suicide Prevention Lifeline (1-800-273-TALK). |
| Warning signs (4) | 1) verbal cues (statements about being a burden/people better off without them) 2) behavioral changes (withdrawn) 3) emotional changes (hopeless/irritable) 4) physical changes (sleep/eating habits) |
| Common Risk Factors (4) | 1) Mental health concerns 2) Social isolation 3) Life stressors 4) Access to means |
| Access to means requires: | Immediate attention |
| Some Protective Factors that could help | a) Strong social support b) Access to Mental Healthcare c) Healthy coping skills |
| T/F: A safety plan should be developed collaboratively with the individual to ensure they have clear, actionable steps to follow during moments of crisis. | True |
| Triggers and warning signs | feeling overwhelmed by expectations/pressure, increasing withdrawal from family/friends, frequent thoughts of hopelessness and self-criticism, engaging in self-harm as coping mechanism |
| Healthy coping mechanisms | mindfulness exercises, creative outlets, walking outside, listening to music, mood-tracking app to recognize patterns/intervene early |
| Building support network | Identify trusted individuals who can provide immediate support (e.g., friends/family/school counselor/therapist |
| Accessing professional help | School counselor during school hours, Crisis text line (HELLO for support), National Suicide Line 988, emergency 911 if immediate intervention needed |
| Reducing access to means | medication (giving those not currently taking to family/friends), sharp objects (removing from room), replacing self-harm behaviors |
| To reinforce protective factors, have individual list reasons want to stay alive: | examples: little sister/brother who looks up to them, career dreams, joys felt when doing something they love, love they receive from close friends/supportive family |
| Interventions strategies | CBT (including Cognitive Restructuring, Behavioral Activation, Problem-solving Skills) |
| Cognitive Restructuring | challenging negative thoughts like "I'm a burden" and replacing them with balanced perspectives |
| Behavioral Activation | Scheduling daily activities that brought joy, such as drawing, playing music, etc |
| Problem-solving skills | Identifying specific challenges (e.g., academic stress) and brainstorming actionable solutions |
| Strengths-based Approach includes: | building their resilience and self-worth (e.g., encouraging participation in school art clubs to connect with like-minded peers; Recognizing and reinforcing personal strengths; Helping set realistic goals to regain sense of accomplishment) |
| Role of Families | learn about suicide risk and safety planning (e.g., practice active listening and provide emotional support w/o judgement; regular check-ins about feelings) |
| Role of Schools | Make teachers aware and include flexible deadlines for assignments; promote mental health awareness programs and peer support groups; teacher remain primary point of contact for ongoing support |
| Role of Communities | where youth can find accepting and understanding peers through participation in local groups; free community-based therapy programs to ensure long-term care |
| Pivotal steps | a) create safety plan b) utilize EBIs (evidence-based interventions) c) engage family, schools, community resources |
| DBT can effectively address: | emotion dysregulation, self-harm, and suicidal behaviors in youth |
| DBT was originally developed for | adults with borderline personality disorder |
| DBT targets ___________ ______________as the primary cause of suicidal and self-harm behaviors. | emotional dysregulation |
| The idea behind DBT is that people become suicidal or engage in non-suicidal self-injury when they are experiencing very, very _______ ____________ ___________ and they feel desperate to feel better and reduce those emotions. | intense negative emotions |
| The focus of DBT is: | teaching many skills for safely and effectively regulating emotions (to reduce self-harm and build life worth living) |
| DBT is a multi-component treatment. T/F | True |
| DBT has these four components: | 1) individual therapy for teens 2) multi-family skills group 3) phone coaching 4) therapist consultation team (not DBT w/o all four!) |
| What does multi-family skills group mean? | Parents and adults come together to group (run like class) where learn lots of skills on how to regulate emotions, parents also learn them |
| Why do parents learn skills to regulate emotions in multi-family skills groups? | To regulate their own emotions when dealing with their teens in crisis and to be able to help their kids use the skills. |
| How does the phone component of DBT work? | Both parents/teens have access to telephone coaching form therapist 24/7 so can apply what learning to real-life crises. |
| What does team consultation look like? | Therapists have to be team where all therapists treating all patients in DBT program meet together every week to support each other to make sure everyone staying adherent to treatment and share across team what's going on to enhance effectiveness |
| For adolescents a DBT program would consist of: | individual psychotherapy, multi-family groups skills training, the therapist meeting or the DBT team, the phone consultation; also do DBT family therapy and parent sessions as needed on safety planning |
| It is important when working with families using DBT to convey that teens will not go to them for help when they are feeling suicidal unless: | they feel they will get validated and nonjudgemental response from parents (these are tools taught in DBT) |
| the CARE study stands for: | the Collaborative Adolescent Research on Emotions and Suicide study |
| What is the CARE study? | It is the largest study that has been done on DBT with adolescents |
| DBT has been shown to significantly decrease thoughts of self-harm. T/F | True |
| DBT is designed around treatment for suicidality. T/F | True |
| With DBT and suicidality, there appears to be a period of remission over the first three months but for some kids: | that does not last. |
| Suicide prevention requires careful attention to ethical and cultural considerations, as mental health professionals navigate complex dilemmas related to ______________, __________________, and culurally __________________ ________________-. | autonomy, confidentiality, and culturally responsive care. |
| Ethical principles such as _____________, _______________, and ______________ guide interventions, ensuring that individuals receive appropriate support while respecting their rights and identities. | beneficence, nonmaleficence, and justice |
| Cultural beliefs about ___________ ________, help-seeking behavior, and family involvement shape how individuals experience and respond to crises. | mental health |
| Trauma-informed and culturally responsive approaches are essential in __________ ____________, __________ ___________, and creating interventions that align with an individual’s background and needs. | building trust, reducing stigma |
| Ethical considerations clinicians must balance when assessing and intervening in suicide risk include (4): | 1) autonomy 2) Nonmaleficence 3) Beneficence 4) Justice |
| Autonomy | Respecting an individual’s right to make informed decisions while ensuring they understand their options. |
| Nonmaleficence | Prioritizing safety by minimizing harm, which can include crisis intervention when necessary. |
| Beneficence | Taking proactive steps to support well-being, using interventions grounded in evidence-based practices. |
| Justice | Providing fair and equitable treatment, ensuring that all individuals—regardless of identity or background—receive appropriate care. |
| Common Ethical Dilemmas (3) | 1) Confidentiality vs Safety 2) Involuntary Treatment 3) Cultural Sensitivity |
| Confidentiality vs Safety | When an individual is at high risk, professionals must decide when to break confidentiality to protect them. |
| Involuntary Treatment | If a person refuses care but remains at risk, ethical considerations around autonomy and the least restrictive intervention come into play. |
| Cultural Sensitivity | Professionals must tailor interventions to align with cultural beliefs and avoid assumptions that could alienate the individual. |
| Cultural perspectives on mental health, suicide, and help-seeking behavior (4): | a) Stigma and Shame b) Religious/Spiritual Beliefs c) Family/Community roles d) Help-seeking barriers |
| Stigma and Shame | Some cultures discourage open discussions about mental health, making it harder for individuals to seek help. |
| Religious and Spiritual Beliefs | Spiritual coping mechanisms may influence how a person perceives suicidal thoughts and treatment options. |
| Family and Community Roles | In collectivist cultures, family approval and involvement may be critical in decision-making. |
| Help-Seeking Barriers | Language, distrust in healthcare, and limited access to culturally competent care can all affect a person’s willingness to seek support. |
| Trauma-Informed and Culturally Responsive Approaches to Crisis Intervention (2): | 1) Trauma-Informed Care 2) Culturally Responsive Care |
| Trauma-Informed Care | Ensuring physical/emotional safety; Building trust through transparent communication; Providing choices and empowering individual in decision-making |
| Culturally Responsive Care | Developing cultural awareness & humility; Tailoring interventions to be culturally appropriate; Engaging community leaders/family when appropriate and with consent |
| Professionals must navigate difficult decisions that balance ____________-, __________________, and respect for ______________. | safety, confidentiality, identity |
| By applying ethical ___________, recognizing cultural ____________, and using trauma-__________ _____________, mental health providers can offer compassionate and effective support tailored to each individual’s unique needs. | principles; influences; -informed care |
| The intent of self-injurious behavior for most individuals is to ___________ ____________ and __________ ____________. | decrease distress; negative emotions |
| ___________, the most common form of self-injury, accounts for only 2% or fewer of completed suicides. | Cutting |
| Upward of ____% or more attempted and completed suicides, in fact, are due to gunshots, hanging, overdose, poisoning, and jumping from heights; methods that are never employed in self-injury. | 90 |
| Individuals who self-injure typically report feeling _________, a decrease in __________ _________, and sometimes positive feelings after engaging in the behavior | relief; negative emotions |
| Nonlethal suicide attempts often result in more _______ ___________ symptoms and continued __________ ___________. | severe depressive; suicidal behavior |
| Most adolescent attempts, are by __________ (76%), but most completed suicides among this age group are due to ________ (72%; Freda, 2010). | overdose; firearms |
| Risk factors for suicide should be assessed when interviewing all young adults, particularly those who present with psychosis, mood instability, severe anxiety, externalizing disorders (especially males with conduct disorder), and _________ ______ ____. | substance use disorders |
| More than 90% of youth who complete suicide have at least one psychiatric diagnosis, __________ being the most common. | depression |
| In relation to suicide, the psychiatric factors of greatest concern are: | hopelessness, anhedonia, impulsivity, and high emotional reactivity |
| _________ __________ ___________ are one of the key predictors of future attempts | Prior suicide attempts |
| T/F: A family history of suicide confers additional risk, doubling the probability for those with a first-degree relative who died by suicide. | True |
| Adolescents whose parents suffer from _______ and ___________ _______, as well as those who have been physically or sexually abused, are also at increased risk | depression; substance abuse |
| Frequent __________ use among youth is yet another significant risk factor for subsequent suicidal ideation and attempts during young adulthood | cannabis |
| _____________ and ________ victimization, including cyberbullying, have come to light as important risk factors for adolescent and young adult suicide. | Bullying; peer |
| ____________ ___________ or copycat behavior is a well-recognized risk factor for youth suicide. | Suicide contagion |
| Gay, lesbian, and bisexual adolescents are especially vulnerable, particularly when learning about: | the suicides of other sexual marginalized youth |
| __________ _________ is the most likely explanation for the increases in suicidal thoughts and attempts among sexual marginalized youth. | Minority stress |
| Suicide rates among Black youth aged 10–19 years have risen by ____% over the past two decades | 60 |
| Minority strain | is accounted for by socioeconomic strain, perceived discrimination, stigma, neighborhood disorganization and violence, and interpersonal and family conflict |
| __________ ____________ and practices, as well as a general sense of spirituality, are associated with a decreased likelihood of suicide attempts. | Religious beliefs |
| The perception of _________ ____________ is also associated with a reduction in suicidal behavior | family support |
| Other possible protective factors include: | academic achievement, strong peer relations, good coping skills, impulse control, having responsibilities for others (e.g., pets, younger siblings), help-seeking behaviors (e.g., asking advice from others), and access to mental health care. |
| A suicide attempt is influenced by many factors, including access to a means by which to complete the suicide, the presence of medical and/or mental illness, substance abuse, family history, prior suicidal behavior: | gender, sexual orientation, physical or sexual abuse, religious and/or spiritual beliefs and practices, and family support. |
| Firearms remain the most common means by which people die by suicide in the United States, accounting for over half of all deaths. T/F | True |
| Most youth who attempt suicide have experienced some psychiatric symptoms for over _ _______ before the attempt. | a year |
| Common warning signs of depression in youth include: | changes in eating/sleeping, worsening school performance, impaired concentration, feelings of worthlessness /guilt, overreaction to criticism, hopelessness, sadness, low self-esteem, lack motivation, drug/alcohol use, thoughts of death, withdrawal. |
| Stressful events may precede a suicide attempt, such as the death of a family member or close friend, loss of a good friend or romantic relationship, loss of a parent through divorce or separation, loss of a pet or treasured object: | fear of punishment, physical or sexual abuse, unwanted pregnancy, poor academic performance, embarrassment or humiliation, and confusion about one’s gender and sexual orientation. |
| Many teens act impulsively and provide no warning of: | an impending suicide attempt. |
| During the assessment of a child or adolescent, several direct questions relating to __________ should be asked. | suicide |
| One study found that a response of “yes” to any of the first four questions identified ___% of youth aged 10 to 21 years at risk for suicide | 97 |
| The fifth question is asked if the patient answers “yes” to any one of the first four questions and is intended to determine: | imminent risk |
| ___% of adults who attempt suicide do not express suicidal ideation in the month prior to the attempt | 75 |
| Suicide Crisis Syndrome | proposed as an acute state lasting hours to days during which time an individual is at high risk and intervention is indicated. |
| frantic hopelessness and entrapment | the most important and weighted at value equal to the following 4facto rs combined: (2) lack of affective control (e.g., dysphoria, panic, mood swings, and anhedonia); (3) loss of cognitive control (e.g., feeling unable to control o |
| even though most individuals who self-injure do not intend to commit suicide, suicide is more frequent among those who self-injure; in fact, suicide has been reported to occur ____ times more often. | 10 |
| One alternative to the no-suicide contract is the commitment to treatment statement, which requires individuals to: | pledge to regular treatment instead of pledging not to harm themselves. |
| Typical components of a commitment to treatment statement include an agreement to: | attend sessions, set treatment goals, express feelings honestly, be involved in sessions, complete homework assignments, take medication , try new behaviors, consider alternative cognitions, and implement the crisis response plan when necessary. |
| Safety or crisis plans can be embedded within commitment to treatment statements or can stand alone. T/F | True |
| Safety plans include a list of warning signs that a suicide attempt may be ____________, in addition to __________ __________ and sources of support. | imminent; coping skills |
| Safety plans should be written down and easily accessible for patients in multiple locations (e.g., a written card in their wallet or purse, a note in their cellphone, etc.). T/F | True |
| The final aspect of a safety plan is what to do in: | case of an imminent risk of a suicide attempt (e.g., let someone know you’re in distress, call 988 or 911, etc.) |
| a few specific treatments have shown benefit in suicide prevention. | Both cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) have proven utility in experimental studies. |
| 12-week intervention; focuses on reducing adolescent suicidality by strengthening socially supports (family, peers, community. Utilizes 2-therapist model (for youth, for family) to provide followup, inhome sessions, and training in coping skills | The Safety Program |
| The only medication approved by the FDA to reduce suicide risk is ____________ for use with individuals with __________. | clozapine (Clozaril); schizophrenia |
| ____________ can reduce acute suicidal behavior in adults for up to one week. | Ketamine |
| Although not all studies agree, most research shows that __________ has some protective effects against suicide. | lithium |
| Nonsuicidal self-injurious behavior is defined as: | the purposeful destruction of body tissue without suicidal intent. |
| The average age of onset for nonsuicidal self-injurious behavior is: | 13-14 years |
| The most common form of self-injury is: | skin cutting, which is employed by more than 70% of adolescents who self-injure |
| Other methods of nonsuicidal self-injury in addition to cutting include: | scratching the skin, burning, hitting oneself, biting, and head banging |
| The most commonly injured areas of the body are the (5): | arms, hands, wrists, thighs, and stomach. |
| T/F: Most youth who engage in self-injury do so only once or a few times. | True |
| Only a minority of youth continue to ______-_________ chronically. | self-injure |
| In regards to self-injury women are more likely to ________ and men are more likely to _______ or ______ themselves. | cut; burn; hit |
| As with suicide, nonsuicidal self-injury is considerably more common among _______ youth. | LGBT |
| Some patients report that they often feel so “numb” and apart from themselves and others that they engage in self-injury in order to feel “something. T/F | True |
| The general goal of self-injurious behavior is to relieve ___________ and decrease __________ __________. | distress; negative emotions |
| Self-injury also results in varying levels of reinforcement because: | it relieves distress or gives them a positive feeling. (reinforced later as well if they receive attention from others for the behavior or if they are allowed to avoid punishment or doing something they find unpleasant, attending school/doing homework) |
| It is likely that a good share of the reason that youth engage in nonsuicidal self-injury is to substitute physical pain (which is more easily tolerated) for the _____ ________ (of social exclusion or hurt) that they feel. | emotional pain |
| All teens should be assessed for self-injurious behavior during a clinical evaluation. T/F | True |
| T/F: Asking to see physical evidence of self-injury is one of the best ways to assess the intensity of the behavior and how recent it is, while establishing a baseline so that further self-injury can be monitored. | True; examiners will almost always have to be explicit in their request to see the mutilation (e.g. are there any scars left, can i see them?) |
| _________ is often the first-line of treatment for adolescents experiencing both suicidal ideation and ______________. | CBT; depression |
| ________ is often the first-line of treatment for adolescents experiencing both _______-_________ and suicidal ideation. | DBT; self-harm |
Created by:
hdemerly