The author offers a sequential protocol for the evaluation and care of suicidal behavior in emergency settings. This protocol contains the following components: 1) a review of the limitations of clinical and demographic risk factors; 2) an exploration of frequent negative reactions that arise during the suicidal encounter in clinicians; 3) an objective schema for grading suicidal behavior; 4) an understanding of chronic suicidal behavior; and 5) a flexible treatment approach. Pertinent literature on suicide evaluation and management is reviewed with an emphasis toward the clinical applicability in emergency settings.
Get full access to this article
View all access options for this article.
References
1.
Vital Statistics of the United States, 1978, 29: 6, Supplement (2) Final Mortality Statistics, National Center for Health Statistics, Hyattsville, Maryland, 1978.
2.
FrederickC.Current Trends in Suicidal Behavior in the United States, Amer. J. Psychother., 32, pp. 172–201, 1978.
3.
GersonS. and BassukE. L.Psychiatric Emergencies: An Overview, Amer. J. Psychiat., 137, pp. 1–11, 1980.
4.
MyersonA. I.GlickR. A. and KievA., Suicide, in Psychiatric EmergenciesGlickR. A.MyersonA. I. (eds.), Gruen & Stratton, Inc., New York, pp. 89–108, 1976.
5.
LeffS.SengerM.JacobsD., Staff Judgements of Service Needs in a Psychiatric Emergency Service, 1981, in preparation.
6.
PerryC. J. and JacobsD.Clinical Applications of the Amytal Interview in Psychiatric Emergency Settings, Amer. J. Psychiat., 139, pp. 552–559, 1982.
7.
MilesC. P.Conditions Predisposing to Suicide: A Review, J. Nerv. Ment. Dis., 164, pp. 231–246, 1977.
8.
MottoJ. A.Recognition, Evaluation, and Management of Persons at Risk for Suicide, Personnel and Guidance Journal, 26, pp. 537–543, 1978.
9.
MackJ. E., Vivienne: The Life and Suicide of an Adolescent Girl, Little Brown and Company, Boston, 1981.
10.
TuckmanJ. and YoungmanW. F.A Scale for Assessing Suicidal Risk in Attempted Suicide, J. Clin. Psychiat., 24, pp. 17–19, 1968.
11.
RichC. L. and PittsF. W.Suicide by Psychiatrists: A Study of Medical Specialists Among 18,730 Consecutive Physician Deaths During a Five-Year Period, 1967–1972, J. Clin. Psychiat., 4, pp. 261–263, 1980.
12.
RoseD. K., and RosowI.Physicians Who Kill Themselves, Arch. Gen. Psychiat., 29, pp. 800–805, 1973.
13.
RobinsE.The Communication of Suicidal Intent: A Study of 134 Consecutive Cases of Successful (Completed) Suicide, Amer. J. Psychiat., 115, pp. 724–733, 1959.
14.
MarisR. W., Pathways to Suicide: A Survey of Self-Destructive Behaviors, The Johns Hopkins University Press, Baltimore, 1981.
15.
WeissmanM. W.The Epidemiology of Suicide Attempts, 1960–1971, Arch. Gen. Psychiat., 30, pp. 737–746, 1974.
16.
WexlerL.WeissmanM. and KaslS. V.Suicide Attempts 1970–75: Updating a United States Study and Comparisons with International Trends, Brit. J. Psychiat., 132, pp. 180–185, 1978.
17.
O'BrienJ. P., Increase in Suicide Attempts by Drug Ingestion. The Boston Experience, 1967–1974, Arch. Gen. Psychiat.34, pp. 1165–1169, 1977.
18.
RobinsL. W.WestP. A. and MurphyG. E.The High Rate of Suicide in Older White Men: A Study Testing Ten Hypotheses, Social Psychiat., 12, pp. 1–20, 1977.
19.
PeckM. L.LitmanR. E., Current Trends in Youthful Suicide, in Suicide in Blacks, BushJ. (ed.), Fenon Research Development, pp. 13–27, 1975.
20.
MurphyL. E.Clinical Identification of Suicidal Risk, Arch. Gen. Psychiat., 27, pp. 356–359, 1972.
21.
FawcettJ.LeffM. and BunneyW. E., Suicide: Clues from Interpersonal Communication, Arch. Gen. Psychiat.21, pp. 129–137, 1969.
22.
RingelE.The Presuicidal Syndrome, Suicide and Life-Threatening Behavior, 6, pp. 131–149, 1976.
23.
MottoJ. A.Suicide Attempts: A Longitudinal View, Arch. Gen. Psychiat., 13, pp. 516–520, 1976.
24.
BuieD. H. and MaltsbergerJ. T., “The Psychology and Assessment of Suicide, presentation at the First Annual Cambridge Hospital Suicide Symposium”, Cambridge Massaschusetts, January 29, 1981.
25.
LitmanR. E., Prediction Models of Suicidal Behaviors, in The Prediction of Suicide, BeckA. T.ResnickL. O. P., and LettieriD. J. (eds.), The Charles Press Publisher, Inc., pp. 141–162, 1974.
26.
MaltsbergerJ. T. and BuieD. H.Countertransference Hate in the Treatment of Suicidal Patients, Arch. Gen. Psychiat., 30, pp. 625–633, 1974.
27.
AdlerG.Helplessness in the Helpers, Brit. J. Med. Psychol., 45, pp. 315–326, 1972.
28.
MenningerK., Man Against Himself, Harcourt, Brace and World, Inc., New York, 1938.
29.
DresslerD.Clinician Attitudes Toward the Suicide Attempter, J. Nerv. Dis., 160, pp. 146–155, 1975.
30.
SifneosP. E.Manipulative Suicide, Psychiat. Quart., 40, pp. 525–537, 1986.
31.
PokornyA. D., A Scheme for Classifying Suicidal Behaviors, in The Prediction of Suicide, BeckA. T.ResnikH. L. P. and LettieriD. J. (eds.), The Charles Press Publisher, Inc., Bowie, Maryland, pp. 29–44, 1974.
32.
BeckA. T.BeckR. and KovacsM.Classification of Suicidal Behaviors: I Quantifying Intent and Medical Lethality, Amer. J. Psychiat., 132, pp. 285–287, 1975.
33.
BeckA. T.SchuylerD. and HermanI., Development of Suicidal Intent Scales, in The Prediction of Suicide, BeckA. T.ResnikH. L. P., and LettieriD. J. (eds.), The Charles Press Publisher, Inc., Bowie, Marlyand, pp. 45–56, 1974.
34.
WeismanA. D. and WordenW.Risk-Rescue Rating in Suicide Assessment, Arch. Gen. Psychiat., 26, pp. 553–560, 1972.
35.
MorganH. G.Deliberate Self-Harm: A Follow-Up Study of 279 Patients, Brit. J. Psychiat., 128, pp. 361–368, 1976.
36.
FoxK., and WeissmanM.Suicide Attempts and Drugs: Contradiction Between Method and Intent, Social Psychiat., 10, pp. 331–38, 1975.
37.
RosenD.The Serious Suicide Attempt: Five-Year Follow-up Study of 886 Patients, J.A.M.A., 235, pp. 2105–2109, 1976.
38.
Sterling-SmithR. S., A Medical Toxicology Index, An Evaluation of Commonly Used Suicidal Drugs, in The Prediction of Suicide, BeckA. T.ResnikH. L. P., and LettieriD. J. (eds.), The Charles Press Publisher, Inc., Bowie, Maryland, pp. 214–220, 1974.
39.
SkodolA. E.Crisis in Psychotherapy: Principles of Emergency Consultation and Intervention, Amer. J. Orthopsychiat., 49, pp. 585–597, 1979.
40.
GrunebaumH. and KlermanG. L.Wrist Slashing, Amer. J. Psychiat., 124, pp. 527–534, 1967.
41.
RosenthalR. J.KinzlerL.WallshN.Wrist Cutting Syndrome, The Meaning of a Gesture, Amer. J. Psychiat., 128, pp. 1363–1368, 1972.
42.
ClendeninW. W. and MurphyG. E.Wrist Cutting: New Epidemiological Findings, Arch. Gen. Psychiat., 25, pp. 465–469, 1971.
43.
WeissmanM. M.Wrist Cutting: Relationship between Clinical Observations and Epidemiological Findings, Arch. Gen. Psychiat., 32, pp. 1166–1171, 1975.
44.
SimpsonM. A., Self-Mutilation and Suicide, in Suicidology: Contemporary Development, ShneidmanE. (ed.), Grune & Stratton, New York, pp. 286–315, 1976.
45.
PlathS., Ariel, Harper & Rowe Publishers, New York, 1965.
46.
MayfieldD. G., and MontgomeryM. D.Alcoholism, Alcohol Intoxication and Suicide Attempts, Arch. Gen. Psychiat., 27, pp. 349–353, 1972.
47.
MurphyG. E.Suicide and Alcoholism: Interpersonal Loss Confirmed as Predictor, Arch. Gen. Psychiat., 36, pp. 64–69, 1979.
48.
MendelsonJ. and MelloN.Biologic Concomitants of alcoholism, New Engl. J. Med., 301, pp. 912–921, 1979.
49.
SchwartzD. A.The Suicidal Character, Psychiat. Quart., 5, pp. 64–70, 1979.
50.
VaillantG. E., Adaptation to Life, Little Brown, Boston, 1979.
51.
BrownH. N. and VaillantG. E.Hypochondriasis, Arch. Intern. Med., 141, pp. 723–726, 1981.
52.
MottoJ. A., The Recognition and Management of the Suicidal Patient, in Nature and Treatment of Depression, FlachF. F. and DraghiS. C. (eds.), John Wiley & Sons, New York, pp. 229–254, 1975.
53.
LitmanR.Acutely Suicidal Patients: Management in a General Medical Practice, California Medicine, 104, pp. 168–174, 1966.
54.
FreudS., Psychoanalysis and Faith, Basic Books, New York, pp. 101–102, 1963.
