Suicide Measures

The second component of a comprehensive evaluation involves the administration of suicide measures. We briefly review three clinically useful mea sures for the assessment of suicide ideation and hopelessness. For a comprehensive review of suicide assessment measures for adults and older adults, see Brown (2002).

Suicide ideation at the time of evaluation has been considered a potential predictor of suicide. Two commonly used interviewer-administered rating instruments for suicide ideation include the Scale for Suicide Ideation (SSI; Beck, Kovacs, & Weissman, 1979) and the Scale for Suicide Ideation— Worst (SSI-W; Beck, Brown, Steer, Dahlsgaard, & Grisham, 1999). The SSI assesses the severity of a patient's current suicidal ideation, intent, and plan, whereas the SSI-W assesses suicide ideation at the worst point in the patient's life. Evidence of the predictive validity of the SSI and the SSI-W for suicide has been found; however, the assessment of suicide ideation at its most severe point has been found to be a stronger risk factor for suicide than the assessment of current ideation (Beck et al., 1999).

In addition, hopelessness is one of the most commonly recognized and validated risk factors for suicide behavior. A recent study on patients with treatment-resistant depression indicated that more than half reported significant hopelessness or despair (Papakostas et al., 2003). The Beck Hopelessness Scale (BHS; Beck & Steer, 1988), a self-report instrument, comprises 20 true-false statements designed to assess the level of positive and negative beliefs about the future. Patients with scores of 9 and above on the BHS are approximately 11 times more likely to commit suicide than patients with scores of 8 or below (Beck et al., 1990).

Dahlsgaard et al. (1998) reported hopelessness to be significantly higher and more stable for suicide completers than for a control group. Empirical literature supports the notion that hopelessness should be assessed over time. Young et al. (1996) reported that stable levels of hopelessness in patients with remitted depression are more predictive of future suicide attempts than high levels at any one point. Similar findings have been reported for older adult patients whose high levels of persistent hopelessness after the remission of depression were related to suicide behavior (Szanto, Reynolds, Conwell, Begley, & Houck, 1998).

The three assessment instruments briefly reviewed here provide clinicians with cost-effective methods of identifying depressed patients at high risk for suicide. We know that nonresponsiveness to treatment and high scores on suicide ideation measures (e.g., SSI-W), in combination with consistently elevated BHS scores, are strong predictors of eventual suicide in psychiatric outpatients. Clinicians are cautioned that all suicide-screening measures are subject to response bias. Whereas some patients may conceal their suicide ideation and demonstrate low scores, others may report more chronic or elevated levels of ideation than what is experienced in actuality.

Although these assessment tools serve a function, they should never be used exclusively to determine a patient's level of risk.

Exploring EFT

Exploring EFT

EFT stands for Emotional Freedom Technique. It works to free the user of both physical and emotional pain and relieve chronic conditions by healing the physical responses our bodies make after we've been hurt or experienced pain. While some people do not carry the effects of these experiences, others have bodies that hold onto these memories, which affect the way the body works. Because it is a free and fast technique, even if you are not one hundred percent committed to whether it works or not, it is still worth giving it a shot and seeing if there is any improvement.

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