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Thomas E. Joiner - One of the best experts on this subject based on the ideXlab platform.
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Routinized categorization of Suicide Risk into actionable strata: Establishing the validity of an existing Suicide Risk assessment framework in an outpatient sample.
Journal of Clinical Psychology, 2020Co-Authors: Austin J. Gallyer, Kelly M. Klein, Jazmine R. Quintana, Corinne N. Carlton, Sean P. Dougherty, Thomas E. JoinerAbstract:OBJECTIVE The Suicide Risk Assessment and Management Decision Tree (DT) is a clinician-administered assessment that leads to Risk categorizations that correspond with actionable strata. This study investigated the construct validity and test-retest reliability of the DT Risk categories across two time points. METHOD Outpatients (N = 731) completed a battery of self-report measures. Spearman's correlations were used to examine the relationships between DT Suicide Risk level and suicidal symptoms, theory-based Risk factors, psychiatric correlates, and DT Suicide Risk level at Timepoint 2. Correlations were analyzed for significant differences to examine the divergent validity of the DT. RESULTS Results, overall, were in line with hypotheses, with the exception of depression and thwarted belongingness. CONCLUSIONS Findings provide evidence for the reliability, convergent validity, and discriminant validity of the DT. This clinician-administered Suicide Risk assessment may be useful for standardization of the assessment and management of Suicide Risk in outpatient clinical settings.
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Routinized Categorization of Suicide Risk into Actionable Strata: Establishing the Validity of an Existing Suicide Risk Assessment Framework in an Outpatient Sample
2019Co-Authors: Austin J. Gallyer, Kelly M. Klein, Sean P. Dougherty, Jazmine Quintana, Corinne Carlton, Thomas E. JoinerAbstract:Objective: The Suicide Risk Assessment and Management Decision Tree (DT) is a clinician-administered assessment that leads to Risk categorizations that correspond with actionable strata. This study investigated the construct validity and test-retest reliability of the DT Risk categories across two timepoints. Method: Outpatients (N = 731) completed a battery of self-report measures. Spearman’s correlations were used to examine the relationships between DT Suicide Risk level and suicidal symptoms, theory-based Risk factors, psychiatric correlates, and DT Suicide Risk level a timepoint 2. Correlations were analyzed for significant differences to examine the divergent validity of the DT. Results: Results, overall, were in line with hypotheses, with the exception of depression and thwarted belongingness. Conclusions: Findings provide evidence for the reliability, convergent validity and discriminant validity of the DT. This clinician-administered Suicide Risk assessment may be useful for standardization of the assessment and management of Suicide Risk in outpatient clinical settings.
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Who are we missing? Nondisclosure in online Suicide Risk screening questionnaires.
Psychological Assessment, 2015Co-Authors: Matthew C. Podlogar, Megan L. Rogers, Bruno Chiurliza, Mirela Tzoneva, Thomas E. JoinerAbstract:The use of self-report surveys for Suicide Risk screening is a key first step in identifying currently suicidal individuals and connecting them with appropriate follow-up assessment and care. Online methods for Suicide Risk screening are becoming more common, yet they present a number of complexities compared with traditional methods. This study aimed to assess whether forcing item responses may unintentionally hide or misrepresent otherwise useful missing Suicide Risk data. We investigated in secondary analyses of 3 independent samples of undergraduates (ns = 1,306; 694; 172) whether participants who chose not to respond specifically to current Suicide Risk screening items (i.e., Nondisclosers) scored significantly different from other Risk response groups (i.e., Deniers, Lower-Risk Endorsers, and Higher-Risk Endorsers) on auxiliary measures related to suicidality. Multivariate Analysis of Variance (MANOVA) tests for each sample revealed that Nondisclosers were rare (ns = 7, 6, 7) and scored significantly higher than Deniers and similarly to Endorsers on Suicide Risk related measures. In 1 sample, Nondisclosers tended to score higher than all groups on Suicide Risk related measures. These findings suggest that nondisclosure for Suicide Risk screening questions is a preferred option for a distinct group of respondents who are likely at elevated Suicide Risk. Allowing for and flagging Nondisclosers for follow-up Suicide Risk assessment may be an ethical and feasible way to enhance the sensitivity of online Suicide Risk screenings for weary respondents, who if forced, may choose to underreport their Suicide Risk and misrepresent data. (PsycINFO Database Record Language: en
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Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update
Journal of Clinical Psychology, 2015Co-Authors: Kelly M. Klein, Jennifer M. Buchman-schmitt, Christopher R. Hagan, Thomas E. JoinerAbstract:OBJECTIVE: Empirically informed Suicide Risk assessment frameworks are useful in guiding the evaluation and treatment of individuals presenting with suicidal symptoms. Joiner et al. (1999) formulated one such framework, which has provided a concise heuristic for the assessment of Suicide Risk. The purpose of this review is to ensure compatibility of this Suicide Risk assessment framework with the growing literature on Suicide-related behaviors. METHODS: This review integrates recent literature on Suicide Risk factors and clinical applications into the existing model. Further, we present a review of Risk factors not previously included in the Joiner et al. (1999) framework, such as the interpersonal theory of Suicide variables of perceived burdensomeness, thwarted belongingness, and capability for Suicide (Joiner, 2005; Van Orden et al., 2010) and acute symptoms of suicidality (i.e., agitation, irritability, weight loss, sleep disturbances, severe affective states, and social withdrawal). RESULTS: These additional indicators of Suicide Risk further facilitate the classification of patients into standardized categories of Suicide Risk severity and the critical clinical decision making needed for the management of such Risk. CONCLUSIONS: To increase the accessibility of empirically informed Risk assessment protocols for Suicide prevention and treatment, an updated Suicide Risk assessment form and decision tree are provided. Language: en
V. Pérez - One of the best experts on this subject based on the ideXlab platform.
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Social withdrawal and Suicide Risk: A descriptive study
European Psychiatry, 2020Co-Authors: A Malagon, L Molla, M Bellsola, David Corcoles, Antoni Bulbena, D. Van Den Berge, L M Martin, E Perez, A. Gonzalez, V. PérezAbstract:IntroductionSocial withdrawal is a major health problem that has been related with higher morbidity and mortality rates. There are few studies about the relationship between suicidal behavior and social isolation.AimTo describe the existence of suicidal Risk in subjects with social isolation.MethodParticipants were 187 subjects referred to a Crisis Resolution Home Treatment because of social isolation. The inclusion criteria were: home isolation, avoiding of social situations and relationships, for at least 6 months. Suicide Risk was assessed by the item of the Severity of Psychiatric Illness, dividing in four groups (from absence to high Suicide Risk). Socio-demographic and clinical data were also analysed.ResultsMost cases (n = 132, 70.5%) had absence of Suicide Risk. They were predominantly young males in all groups. There were no statistically significant differences in sociodemographic or clinical variables. The mean age at onset of social isolation was lower in the high Suicide Risk group, having lower socially withdrawn period. This group had also lower rates of child abuse and Suicide attempt history. The more frequent diagnosis in all groups was psychotic, affective and anxiety disorders. Those cases with mild and high Suicide Risk needed more frequently hospitalization.ConclusionsSocial isolated people attended by CRHT do not have high frequency of Suicide Risk. Cases with higher Suicide Risk are younger and have a shorter period of isolation. The absence of child abuse history or previous Suicide attempts contrasts with previous suicidal behavior research. These data can be influenced by the characteristics of functioning of CRHT and the small sample size.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Social withdrawal and Suicide Risk: A descriptive study
European Psychiatry, 2016Co-Authors: A Malagon, L Molla, M Bellsola, David Corcoles, Antoni Bulbena, D. Van Den Berge, L M Martin, E Perez, A. Gonzalez, V. PérezAbstract:Introduction Social withdrawal is a major health problem that has been related with higher morbidity and mortality rates. There are few studies about the relationship between suicidal behavior and social isolation. Aim To describe the existence of suicidal Risk in subjects with social isolation. Method Participants were 187 subjects referred to a Crisis Resolution Home Treatment because of social isolation. The inclusion criteria were: home isolation, avoiding of social situations and relationships, for at least 6 months. Suicide Risk was assessed by the item of the Severity of Psychiatric Illness, dividing in four groups (from absence to high Suicide Risk). Socio-demographic and clinical data were also analysed. Results Most cases (n = 132, 70.5%) had absence of Suicide Risk. They were predominantly young males in all groups. There were no statistically significant differences in sociodemographic or clinical variables. The mean age at onset of social isolation was lower in the high Suicide Risk group, having lower socially withdrawn period. This group had also lower rates of child abuse and Suicide attempt history. The more frequent diagnosis in all groups was psychotic, affective and anxiety disorders. Those cases with mild and high Suicide Risk needed more frequently hospitalization. Conclusions Social isolated people attended by CRHT do not have high frequency of Suicide Risk. Cases with higher Suicide Risk are younger and have a shorter period of isolation. The absence of child abuse history or previous Suicide attempts contrasts with previous suicidal behavior research. These data can be influenced by the characteristics of functioning of CRHT and the small sample size.
Alan L. Berman - One of the best experts on this subject based on the ideXlab platform.
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Training for Suicide Risk Assessment and Suicide Risk Formulation
Academic Psychiatry, 2014Co-Authors: Morton M. Silverman, Alan L. BermanAbstract:Suicide and suicidal behaviors are highly associated with psychiatric disorders. Psychiatrists have significant opportunities to identify at-Risk individuals and offer treatment to reduce that Risk. Although a Suicide Risk assessment (SRA) is a core competency requirement, many lack the requisite training and skills to appropriately assess for Suicide Risk. Moreover, the standard of care requires psychiatrists to foresee the possibility that a patient might engage in suicidal behavior, hence to conduct a Suicide Risk formulation (SRF) sufficient to guide triage and treatment planning. An SRA gathers data about observable and reported symptoms, behaviors, and historical factors that are associated with Suicide Risk and protection, ascertained by way of psychiatric interview; collateral information from family, friends, and medical records; and psychometric scales and/or screening tools. Based on data collected via an SRA, an SRF is a process whereby the psychiatrist forms a judgment about a patient’s foreseeable Risk of suicidal behavior in order to inform triage decisions, safety and treatment plans, and interventions to reduce Risk. This paper addresses the need for a revised training model in SRA and SRF, and proposes a model of training that incorporates the acquisition of skills, relying heavily on case application exercises.
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Suicide Risk assessment and Risk formulation part I: a focus on Suicide ideation in assessing Suicide Risk.
Suicide and Life Threatening Behavior, 2014Co-Authors: Morton M. Silverman, Alan L. BermanAbstract:The main procedure used by clinicians to determine whether an individual may be at Risk of suicidal behaviors is the Suicide Risk assessment (SRA). The purpose of the SRA is to identify Risk and protective factors that then provide the data for the formulation of Suicide Risk. The Suicide Risk formulation (SRF) assigns a level of Suicide Risk that ideally leads to triage and treatment deemed appropriate for that level of Risk. Some of the problems with the SRA are explored here, with an emphasis on addressing the over reliance on communicated Suicide ideation, and recommendations are made for improvements. Part II of this article (Berman & Silverman, 2013, also appears in this issue of STLB) examines the process of an SRF and, similarly, makes recommendations to improve clinical practice toward the desired end of saving lives.
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Suicide Risk Assessment and Risk Formulation Part II: Suicide Risk Formulation and the Determination of Levels of Risk
Suicide and Life Threatening Behavior, 2013Co-Authors: Alan L. Berman, Morton M. SilvermanAbstract:The Suicide Risk formulation (SRF) is dependent on the data gathered in the Suicide Risk assessment. The SRF assigns a level of Suicide Risk that is intended to inform decisions about triage, treatment, management, and preventive interventions. However, there is little published about how to stratify and formulate Suicide Risk, what are the criteria for assigning levels of Risk, and how triage and treatment decisions are correlated with levels of Risk. The salient clinical issues that define an SRF are reviewed and modeling is suggested for an SRF that might guide clinical researchers toward the refinement of an SRF process. Language: en
Morton M. Silverman - One of the best experts on this subject based on the ideXlab platform.
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Training for Suicide Risk Assessment and Suicide Risk Formulation
Academic Psychiatry, 2014Co-Authors: Morton M. Silverman, Alan L. BermanAbstract:Suicide and suicidal behaviors are highly associated with psychiatric disorders. Psychiatrists have significant opportunities to identify at-Risk individuals and offer treatment to reduce that Risk. Although a Suicide Risk assessment (SRA) is a core competency requirement, many lack the requisite training and skills to appropriately assess for Suicide Risk. Moreover, the standard of care requires psychiatrists to foresee the possibility that a patient might engage in suicidal behavior, hence to conduct a Suicide Risk formulation (SRF) sufficient to guide triage and treatment planning. An SRA gathers data about observable and reported symptoms, behaviors, and historical factors that are associated with Suicide Risk and protection, ascertained by way of psychiatric interview; collateral information from family, friends, and medical records; and psychometric scales and/or screening tools. Based on data collected via an SRA, an SRF is a process whereby the psychiatrist forms a judgment about a patient’s foreseeable Risk of suicidal behavior in order to inform triage decisions, safety and treatment plans, and interventions to reduce Risk. This paper addresses the need for a revised training model in SRA and SRF, and proposes a model of training that incorporates the acquisition of skills, relying heavily on case application exercises.
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Suicide Risk assessment and Risk formulation part I: a focus on Suicide ideation in assessing Suicide Risk.
Suicide and Life Threatening Behavior, 2014Co-Authors: Morton M. Silverman, Alan L. BermanAbstract:The main procedure used by clinicians to determine whether an individual may be at Risk of suicidal behaviors is the Suicide Risk assessment (SRA). The purpose of the SRA is to identify Risk and protective factors that then provide the data for the formulation of Suicide Risk. The Suicide Risk formulation (SRF) assigns a level of Suicide Risk that ideally leads to triage and treatment deemed appropriate for that level of Risk. Some of the problems with the SRA are explored here, with an emphasis on addressing the over reliance on communicated Suicide ideation, and recommendations are made for improvements. Part II of this article (Berman & Silverman, 2013, also appears in this issue of STLB) examines the process of an SRF and, similarly, makes recommendations to improve clinical practice toward the desired end of saving lives.
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Suicide Risk Assessment and Risk Formulation Part II: Suicide Risk Formulation and the Determination of Levels of Risk
Suicide and Life Threatening Behavior, 2013Co-Authors: Alan L. Berman, Morton M. SilvermanAbstract:The Suicide Risk formulation (SRF) is dependent on the data gathered in the Suicide Risk assessment. The SRF assigns a level of Suicide Risk that is intended to inform decisions about triage, treatment, management, and preventive interventions. However, there is little published about how to stratify and formulate Suicide Risk, what are the criteria for assigning levels of Risk, and how triage and treatment decisions are correlated with levels of Risk. The salient clinical issues that define an SRF are reviewed and modeling is suggested for an SRF that might guide clinical researchers toward the refinement of an SRF process. Language: en
A Malagon - One of the best experts on this subject based on the ideXlab platform.
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Social withdrawal and Suicide Risk: A descriptive study
European Psychiatry, 2020Co-Authors: A Malagon, L Molla, M Bellsola, David Corcoles, Antoni Bulbena, D. Van Den Berge, L M Martin, E Perez, A. Gonzalez, V. PérezAbstract:IntroductionSocial withdrawal is a major health problem that has been related with higher morbidity and mortality rates. There are few studies about the relationship between suicidal behavior and social isolation.AimTo describe the existence of suicidal Risk in subjects with social isolation.MethodParticipants were 187 subjects referred to a Crisis Resolution Home Treatment because of social isolation. The inclusion criteria were: home isolation, avoiding of social situations and relationships, for at least 6 months. Suicide Risk was assessed by the item of the Severity of Psychiatric Illness, dividing in four groups (from absence to high Suicide Risk). Socio-demographic and clinical data were also analysed.ResultsMost cases (n = 132, 70.5%) had absence of Suicide Risk. They were predominantly young males in all groups. There were no statistically significant differences in sociodemographic or clinical variables. The mean age at onset of social isolation was lower in the high Suicide Risk group, having lower socially withdrawn period. This group had also lower rates of child abuse and Suicide attempt history. The more frequent diagnosis in all groups was psychotic, affective and anxiety disorders. Those cases with mild and high Suicide Risk needed more frequently hospitalization.ConclusionsSocial isolated people attended by CRHT do not have high frequency of Suicide Risk. Cases with higher Suicide Risk are younger and have a shorter period of isolation. The absence of child abuse history or previous Suicide attempts contrasts with previous suicidal behavior research. These data can be influenced by the characteristics of functioning of CRHT and the small sample size.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Social withdrawal and Suicide Risk: A descriptive study
European Psychiatry, 2016Co-Authors: A Malagon, L Molla, M Bellsola, David Corcoles, Antoni Bulbena, D. Van Den Berge, L M Martin, E Perez, A. Gonzalez, V. PérezAbstract:Introduction Social withdrawal is a major health problem that has been related with higher morbidity and mortality rates. There are few studies about the relationship between suicidal behavior and social isolation. Aim To describe the existence of suicidal Risk in subjects with social isolation. Method Participants were 187 subjects referred to a Crisis Resolution Home Treatment because of social isolation. The inclusion criteria were: home isolation, avoiding of social situations and relationships, for at least 6 months. Suicide Risk was assessed by the item of the Severity of Psychiatric Illness, dividing in four groups (from absence to high Suicide Risk). Socio-demographic and clinical data were also analysed. Results Most cases (n = 132, 70.5%) had absence of Suicide Risk. They were predominantly young males in all groups. There were no statistically significant differences in sociodemographic or clinical variables. The mean age at onset of social isolation was lower in the high Suicide Risk group, having lower socially withdrawn period. This group had also lower rates of child abuse and Suicide attempt history. The more frequent diagnosis in all groups was psychotic, affective and anxiety disorders. Those cases with mild and high Suicide Risk needed more frequently hospitalization. Conclusions Social isolated people attended by CRHT do not have high frequency of Suicide Risk. Cases with higher Suicide Risk are younger and have a shorter period of isolation. The absence of child abuse history or previous Suicide attempts contrasts with previous suicidal behavior research. These data can be influenced by the characteristics of functioning of CRHT and the small sample size.
