This chapter explores the relationship between personality disorders (PDs) and risk of suicidality. It gives special attention to the borderline PDs (BPD). Although significantly fewer, a small number of protective factors have been identified among individuals with BPD that serve to reduce the risk of suicide. These include: (1) Lower levels of impulsivity; (2) Greater emotional stability; and (3) Reward-dependent attachment style. Psychotherapy has been found to be effective for addressing the elevated risk of suicide within the context of BPD. Dialectical behavior therapy (DBT) is one of the main empirically supported treatments for reducing suicide attempts and nonsuicidal self-injury among individuals with BPD. To engage, develop a therapeutic alliance, and effectively treat individuals with BPD at risk of suicide, it is essential for clinicians to become informed of not only the risk and protective factors but also their own personal and professional beliefs regarding the disorder.
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Serving in the military presents many challenges, opportunities, and risks. Recently, the suicide rates among military service members and veterans have trended upward and reached unprecedented levels. Research has found that the primary motive for suicide attempts among military personnel is a desire to reduce or alleviate emotional distress, similar to motives reported by those in nonmilitary samples. This chapter highlights the individuals who are currently serving or have served in the military as they are specific populations due to their importance and distinct vulnerability. It explores the statistics, epidemiology, and trends in active military personnel and veteran suicide. In addition, the chapter draws specific risk factors (psychiatric, sociodemographic, interpersonal, and other associated factors) for military personnel and veterans from evidence-based research. The chapter also presents protective factors identified in literature for military service members and veterans. Finally, it explores treatment considerations and interventions for active military personnel and veterans.
This chapter examines the relationship between substance-related disorders and risk of suicidality. Substance abuse is a significant concern across cultures and societies. Research has identified that individuals with alcohol use disorders are nearly 10 times more likely to die by suicide, and individuals who inject drugs are approximately 14 times more likely to commit suicide. The mental health impacts of substance abuse are significant. Alcohol and drug use and abuse have a strong association with major depression and suicidality. It is essential for clinicians to recognize their personal and professional values regarding substance abusers. A number of treatments are available for individuals with a substance use disorder; however, treatment access can be limited by recent client suicidality. The main treatment modalities used to address suicidality among alcohol and substance abusers are alcoholics/narcotics anonymous, cognitive-behavioral therapy, motivational enhancement therapy, and psychopharmacological treatment.
Several diverse and unique groups within society are at an elevated risk for suicidality. These at-risk groups are frequently isolated from the larger society, either through stigma, being disenfranchised, separateness, exclusion, and/or sociodemographic characteristics. Although a number of at-risk populations exist, this chapter focuses on three groups: the homeless, Native Americans, and incarcerated individuals. It highlights the prevalence of risk for each of these populations as compared to the larger societal norms. The chapter draws population-specific risk and protective factors from evidence-based research. Membership in at-risk groups poses additional issues and complications for individuals experiencing suicidality. In addition, mental health professionals working with individuals need to become aware of the unique risk and protective factors that may exert further influence on these groups. Professional and personal awareness is essential for mental health clinicians engaging, assessing, and treating members of these and other at-risk populations.
Interpersonal psychotherapy (IPT) has been demonstrated as an effective evidence-based practice (EBP) for depression in randomized controlled and open trials. The efficacy of IPT has further been demonstrated as superior to treatment-as-usual (standard treatment provided by an organization) or wait-list controls (a comparison group of individuals not currently receiving treatment but awaiting service provision). This chapter outlines the IPT approach and its adaptation as an emergent model of intervention with individuals experiencing suicidality, specifically adolescents and older adults. The core elements and strategies of IPT are examined, along with evidence on the effectiveness of this EBP. Finally, this chapter provides core recommendations for clinical practice with IPT. Current and future research may yield IPT as an effective future evidence-based treatment in the area of suicidality. Clinicians are encouraged to keep up-to-date on this intervention’s positive and ongoing progress and developments in the treatment of suicidality.
Assessment is the cornerstone of effective treatment for individuals with suicidality. Every individual presenting for clinical treatment should be assessed for risk of suicide at some level. Effective suicide risk assessment needs to be individualized based on the person, presenting issues, and personal and family history. Although there is no one universal assessment format, there are a number of key components essential to every suicide assessment. This chapter provides a comprehensive structure for assessing suicide risk including specific questions and recommendations for consideration. There are a number of well-known psychiatric rating scales for assessing suicidality with established psychometric properties. While suicide rating scales can never replace a fundamental suicide assessment, they can enhance a clinician’s determination of suicide risk. The most comprehensive assessment is, at best, an assessment of risk at that moment. Therefore, clinicians should continually monitor clients for any changes in risk level.
This chapter presents dialectical behavioral therapy (DBT) as a treatment model for working with suicidal individuals. DBT was originally developed by Marsha Linehan in 1987 as a treatment for borderline personality disorder (BPD; Linehan, 1987). In recent years, a strong evidence base has been established for the use of DBT for individuals experiencing suicidality. The chapter explores the theory behind DBT. Additionally, it presents a thorough description of the key components and strategies of DBT. It then explores research examining the effectiveness of DBT across psychiatric disorders and settings. Lastly, the chapter provides recommendations for clinical practice when implementing DBT. DBT is successful at reducing self-harm via teaching clients’ skills and adaptive techniques to experience their emotions, modulate affect and emotion, improve interpersonal relationships, and manage stressful life experiences. Supervision, training, and consultation are essential for any clinician practicing DBT.
Accurate identification and assessment of suicide risk requires an understanding of the influence of culture, ethnicity, and race in relation to suicidality. This chapter explores culturally relevant risk and protective factors for suicide, and presents epidemiological data and contextual findings on suicidality across cultures and nationalities. It examines international trends regarding suicide prevalence, as well as the impact of immigration, acculturation, and assimilation on suicide risk. The chapter also describes a model of culturally relevant suicide intervention and prevention strategies, and the differences in attitudes toward suicide and suicide acceptability across cultures. Despite improved treatments for the psychiatric illnesses most associated with suicidal behavior, suicide continues to be a growing problem in the United States and the world. Intervention efforts should stem from a culturally competent approach, and prevention efforts should be guided by culturally relevant risk and protective factors for suicide and attitudes toward suicide among the target population.
This chapter presents motivational interviewing (MI) as a treatment model to address suicidal individuals. MI was originally conceived of as a treatment for individuals struggling with alcohol use disorders. However, in recent years, an evidence base has been growing for the use of MI with individuals experiencing suicidality. The chapter explores the theory behind MI and provides a thorough description of the key components and strategies of MI. It reviews research examining the effectiveness of MI among individuals experiencing suicidality and recommendations for clinical practice when implementing MI. MI is a directive, client-centered counseling style for eliciting behavior change by helping clients explore and elicit their own intrinsic motivation to change. Ongoing and future research may demonstrate that MI will become an effective future evidence-based treatment in the area of suicidality. Clinicians are recommended to monitor MI’s development in the field of suicidality.
This chapter presents a focused review of the suicide risk associated with schizophrenia. Special attention to suicide within schizophrenia is critical as the rate of suicide among individuals with schizophrenia is among the highest of all psychiatric illness. Research into the treatment of schizophrenia has highlighted the efficacy of psychopharmacological treatment, specifically atypical antipsychotic medications. The majority of individuals diagnosed with a psychotic disorder do not complete suicide. However, those with a psychotic disorder diagnosed are at an elevated risk for suicide ideation, attempts, and completions. It is important to recognize the unique risk and protective factors associated with suicide among those with schizophrenia or psychotic disorders. It is also important to be vigilant regarding the potential impact of personal assumptions and bias in working with this population. Individuals managing these serious mental illnesses have a wide range of strengths and abilities that can effectively be supported and enhanced.