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Warning Signs of Suicide

Warning Signs of Suicide. Lanny Berman, Ph.D., ABPP Executive director American Association of Suicidology Screening for Mental Health Teleconference September 24, 2007. Risk Factors for Suicidal Behavior.

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Warning Signs of Suicide

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  1. Warning Signs of Suicide Lanny Berman, Ph.D., ABPP Executive director American Association of Suicidology Screening for Mental Health Teleconference September 24, 2007

  2. Risk Factors for Suicidal Behavior • A measurable characteristic, variable, or hazard that increases the likelihood of development of an adverse outcome. • A risk factor precedes the outcome in time.

  3. Risk Factors for Suicidal Behavior • Perpetuating risk factors • Family history (violence, suicide, mental disorder requiring hospitalization) • Skill deficits (social, cognitive…) • Multiple/chronic personal losses • Early trauma/abuse • Prior suicidal behavior

  4. Risk Factors for Suicidal Behavior • Predisposing risk factors • Poor self-esteem/Self-concept • Psychiatric illness • e.g. depression • Co-morbidity • Chemical dependency • Physical illness • Exposure to suicidal behavior • Impulsivity/aggression

  5. Risk Factors for Suicidal Behavior • Precipitating risk factors • Loss of social support (friends, family) • Loss of identity/meaning (job, career); loss of attachments • Threat of/actual loss of job/financial loss • Acute psychiatric symptoms (psychosis, depression, panic…) • Loss of hope/Sense of failure • Acute disappointments • Embarrassments, humiliations, threat to status • Threat of legal action/incarceration • Availability of means • Anniversary reaction

  6. Warning Signs • Early detection, referral, treatment model • Health care workers • Mental health providers • First responders • Public health awareness model • To lay public • To gatekeepers, etc.

  7. Evidence-based Suicide Prevention Programs Case Finding Strategies: • Suicide awareness curricula • Gatekeeper training • Screening • Crisis centers and hotlines

  8. Warning Signs on the Internet (Mandrusiak et al, 2006) • Google search: “warning signs” and “suicide” • 183,000 hits • Tabulation of 1st 50 of randomly selected 200 sites • 138 distinct warning signs • 18 signs posted on > 30% of sites • 63 were unique to one site • Of 200 web sites sampled • 3266 warning signs categorized from all 200 sites

  9. Web Site Warning Signs • Messages: • Lack consensus • Are inconsistent • Lack empirical support (e.g. giving away prized possessions – on 86% of 50 sites) • Are non-specific (e.g., “visiting or calling people one cares about; “neurotransmitters”)

  10. WARNING SIGNS FOR SUICIDE A Working Conference Sponsored by the American Association of Suicidology With generous support from the Annenberg Sunnylands Trust, the Suicide Prevention Resource Center, and the National Institutes of Mental Health November 9-11, 2003 The Center for Executive Education Babson College, Wellesley, MA

  11. Chairs/Facilitator Co-Chairs: • M. David Rudd, Ph.D. Baylor University • Lanny Berman, Ph.D. American Association of Suicidology Facilitator Matthew Nock, Ph.D. Harvard University

  12. Participants • Gregory Brown, Ph.D. University of Pennsylvania • Dana Carr, Ph.D. U. S. Department of Education • David Chambers, Ph.D. NIMH • Yeates Conwell, M.D. University of Rochester Medical Center • Jan Fawcett, M.D. University of New Mexico • Keith Hawton, M.D. University of Oxford, UK • Thomas Joiner, Ph.D. Florida State University • Karen Clapper Morris American Heart Association • James Overholser, Ph.D. Case Western Reserve University • Mitch Prinstein, Ph.D Yale University • David Shaffer, M.D. Columbia University College of Physicians and Surgeons • Peter Sheras, Ph.D. University of Virginia • Morton M. Silverman, M.D. Education Development Center Co-chairs: • M. David Rudd, Ph.D. Lanny Berman, Ph.D. Baylor University American Association of Suicidology • Facilitator: Matthew Nock, Ph.D., Harvard University

  13. Essential Questions • What defines a “warning sign”? • What time-frame best defines imminent or acute risk? • Is this a reasonable definition of a “warning sign”?

  14. Essential Questions • How are warning signs to be differentiated from risk factors? • Do we have empirically-based warning signs of suicide and, if so, are there different signs for different outcomes (suicide, nonfatal attempts…?)

  15. Essential Questions (cont’d) • Can we consensually agree on a list of warning signs most appropriate for public information campaigns? • If not, should we produce public education information that defines something other than “warning signs,” e.g., “guidelines”?

  16. Essential Questions • Can we agree on how such a common set or list should be disseminated? • Can we identify future research needs/questions to address areas of insufficient knowledge regarding warning signs?

  17. Immediate Goals • Consensus Recommendations • More consistent (and valid) public education message

  18. Warning SignsKey Messages Are you or someone you love at risk of suicide? Get the facts and take appropriate action. Get help now by contacting a mental health professional or calling 1-800-273-TALK for a referral should you witness, hear, or see anyone exhibiting any one or more of the following: □ Someone threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself. □ Someone looking for ways to kill him/herself by seeking access to firearms, available pills, or other means. □ Someone talking or writing about death, dying or suicide, when these actions are out of the ordinary for the person.

  19. Warning Signscontinued Seek help by contacting a mental health professional or calling 1-800-273-TALK for a referral should you witness, hear, or see anyone exhibiting any one or more of the following: • Hopelessness • Rage, uncontrolled anger, seeking revenge • Acting reckless or engaging in risky activities, seemingly without thinking • Feeling trapped – like there’s no way out • Increasing alcohol or drug use • Withdrawing from friends, family and society • Anxiety, agitation, unable to sleep or sleeping all the time • Dramatic mood changes • No reason for living; no sense of purpose in life

  20. Red Flags (Mnemonic) • IS PATH WARM?

  21. Red Flags • I Ideation/threatened or communicated • S Substance Abuse/excessive or increased • P Purposeless/no reasons for living • A Anxiety, Agitation/Insomnia • T Trapped/feeling no way out • H Hopelessness • W Withdrawal from friends, family, society • A Anger(uncontrolled)/rage/seeking revenge • R Recklessness/risky acts - unthinking • M Mood changes (dramatic)

  22. Evaluating Warning Signs: 1st Stages Suicide and Life-Threatening Behavior, Summer 2006 • Public education • Is this information harmful, upsetting to people? • vs. WS for heart attack and diabetes, no difference in emotional impact • Is it retainable? • vs. WS for heart attack and diabetes, as easy to recall after exposure • Will it change behavior?

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