Recognizing and Reacting to Risk Signs for Patient Suicide

Abstract

Evidence-based suggestions for developing an effective clinician-client relationship built upon trust and honesty will be shared, as well as a review of relevant scope of practice issues for audiologists. Audiologists need to be prepared if a patient threatens self-harm. Many patients do not spontaneously report their suicidal thoughts and intentions to their care providers, so we need to be alert to warning signs. Information about the strongest predictors of suicide, how to ask about suicidal intentions, and how to assess the risk of suicide will be presented. Although it is our responsibility to recognize suicidal tendencies and have a plan for preventive intervention, it is not our responsibility to conduct a suicide evaluation. Tips for collecting critical information to be provided to qualified professionals will be shared, as well as additional information about how and to whom to disclose this information. A list of suicide warning signs will be reviewed as well as some additional suggestions for how to react when a patient discloses his or her suicidal intent. A review of available resources (for both the patient and the clinician) will be provided, along with instructions for how and when it is appropriate to access them.

Keywords

Suicide - self-harm - risk signs - crisis resources

• References

• 1 American Foundation for Suicide Prevention. Suicide. 2017. Available at: afsp.org/about-suicide/suicide-statistics/ . Accessed August 10, 2017
• 2 Sneha J, Prakash C, Vinay S. Unexpected death or suicide by a child or adolescent: improving responses and preparedness of child and adolescent psychiatry trainees. Innov Clin Neurosci 2011; 8 (11) 15-19
• 3 Ganzini L, Denneson LM, Press N. , et al. Trust is the basis for effective suicide risk screening and assessment in veterans. J Gen Intern Med 2013; 28 (09) 1215-1221
• 4 Orf R. Factors that promote and inhibit client disclosure of suicidal ideation [doctoral dissertation]. Keene, NH: Antioch University New England; 2014
• 5 Vannoy SD, Fancher T, Meltvedt C, Unützer J, Duberstein P, Kravitz RL. Suicide inquiry in primary care: creating context, inquiring, and following up. Ann Fam Med 2010; 8 (01) 33-39
• 6 Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract 1998; 47 (03) 213-220
• 7 Clark JG. The audiology counseling growth checklist for student supervision. Semin Hear 2006; 27 (02) 116-126
• 8 English K, Mendel LL, Rojeski T, Hornak J. Counseling in audiology, or learning to listen: pre- and post-measures from an audiology counseling course. Am J Audiol 1999; 8 (01) 34-39
• 9 Martin FN, Krall L, O'Neal J. The diagnosis of acquired hearing loss. Patient reactions. ASHA 1989; 31 (11) 47-50
• 10 Ciorba A, Bianchini C, Pelucchi S, Pastore A. The impact of hearing loss on the quality of life of elderly adults. Clin Interv Aging 2012; 7: 159-163
• 11 Huang CQ, Dong BR, Lu ZC, Yue JR, Liu QX. Chronic diseases and risk for depression in old age: a meta-analysis of published literature. Ageing Res Rev 2010; 9 (02) 131-141
• 12 Monzani D, Galeazzi GM, Genovese E, Marrara A, Martini A. Psychological profile and social behaviour of working adults with mild or moderate hearing loss. Acta Otorhinolaryngol Ital 2008; 28 (02) 61-66
• 13 Pinto PCL, Marcelos CM, Mezzasalma MA, Osterne FJV, de Melo Tavares de Lima MA, Nardi AE. Tinnitus and its association with psychiatric disorders: systematic review. J Laryngol Otol 2014; 128 (08) 660-664
• 14 Jüris L, Andersson G, Larsen HC, Ekselius L. Psychiatric comorbidity and personality traits in patients with hyperacusis. Int J Audiol 2013; 52 (04) 230-235
• 15 Schröder A, Vulink N, Denys D. Misophonia: diagnostic criteria for a new psychiatric disorder. PLoS One 2013; 8 (01) e54706
• 16 Furman JM, Jacob RG. A clinical taxonomy of dizziness and anxiety in the otoneurological setting. J Anxiety Disord 2001; 15 (1-2): 9-26
• 17 Staab JP. Chronic dizziness: the interface between psychiatry and neuro-otology. Curr Opin Neurol 2006; 19 (01) 41-48
• 18 Riccio CA, Hynd GW, Cohen MJ, Hall J, Molt L. Comorbidity of central auditory processing disorder and attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1994; 33 (06) 849-857
• 19 Iliadou V, Iakovides S. Contribution of psychoacoustics and neuroaudiology in revealing correlation of mental disorders with central auditory processing disorders. Ann Gen Hosp Psychiatry 2003; 2 (01) 5
• 20 Hawton K, Casañas I Comabella C, Haw C, Saunders K. Risk factors for suicide in individuals with depression: a systematic review. J Affect Disord 2013; 147 (1–3): 17-28
• 21 LeardMann CA, Powell TM, Smith TC. , et al. Risk factors associated with suicide in current and former US military personnel. JAMA 2013; 310 (05) 496-506
• 22 National Suicide Prevention Lifeline. We can all prevent suicide. Available at: suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/ . Accessed August 10, 2017
• 23 Cukrowicz KC, Duberstein PR, Vannoy SD, Lin EH, Unützer J. What factors determine disclosure of suicide ideation in adults 60 and older to a treatment provider?. Suicide Life Threat Behav 2014; 44 (03) 331-337
• 24 Husky MM, Zablith I, Alvarez Fernandez V, Kovess-Masfety V. Factors associated with suicidal ideation disclosure: results from a large population-based study. J Affect Disord 2016; 205: 36-43
• 25 Matthews K, Milne S, Ashcroft GW. Role of doctors in the prevention of suicide: the final consultation. Br J Gen Pract 1994; 44 (385) 345-348
• 26 Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?. Psychol Med 2014; 44 (16) 3361-3363
• 27 Rudd MD, Berman AL, Joiner Jr TE. , et al. Warning signs for suicide: theory, research, and clinical applications. Suicide Life Threat Behav 2006; 36 (03) 255-262
• 28 Hirschfeld RM, Russell JM. Assessment and treatment of suicidal patients. N Engl J Med 1997; 337 (13) 910-915
• 29 Suicide Prevention Resource Center. Suicide Screening and Assessment. Waltham, MA: Education Development Center, Inc.; 2014
• 30 Flasher L, Fogle P. Counseling Skills for Speech-Language Pathologists and Audiologists. Nelson Education; 2011
• 31 U.S. Department of Health and Human Services. 520-Does HIPAA permit a provider to disclose PHI about a patient if the patient presents a serious danger to self or others. Available at: www.hhs.gov/hipaa/for-professionals/faq/520/does-hipaa-permit-a-health-care-provider-to-disclose-information-if-the-patient-is-a-danger/index.html . Accessed August 14, 2017
• 32 Ottawa Suicide Prevention Coalition. Suicide: association for suicide prevention. Available at: www.ottawasuicideprevention.com/suicide-first-aid-guidelines.html . Accessed August 14, 2017
• 33 Crisis Call Center. Suicide prevention—crisis call center. 2017. Available at: crisiscallcenter.org/suicide-prevention/ . Accessed August 14, 2017
• 34 National Suicide Prevention Lifeline. Home. Available at: suicidepreventionlifeline.org/ . Accessed August 14, 2017
• 35 National Suicide Prevention Lifeline. Help someone else. Available at: suicidepreventionlifeline.org/help-someone-else/ . Accessed August 14, 2017
• 36 National Suicide Prevention Lifeline. Deaf, hard of hearing. Available at: suicidepreventionlifeline.org/help-yourself/for-deaf-hard-of-hearing/ . Accessed August 14, 2017
• 37 National Suicide Prevention Lifeline. Veterans. Available at: suicidepreventionlifeline.org/help-yourself/veterans/ . Accessed August 14, 2017
• 38 UPMC. Re:Solve Crisis Services. Available at: www.upmc.com/Services/behavioral-health/Pages/resolve-crisis-network.aspx . Accessed August 17, 2017
• 39 Carrigan CG, Lynch DJ. Managing suicide attempts: guidelines for the primary care physician. Prim Care Companion J Clin Psychiatry 2003; 5 (04) 169-174
• 40 Hendin H, Haas AP, Maltsberger JT, Szanto K, Rabinowicz H. Factors contributing to therapists' distress after the suicide of a patient. Am J Psychiatry 2004; 161 (08) 1442-1446
• 41 Hendin H, Lipschitz A, Maltsberger JT, Haas AP, Wynecoop S. Therapists' reactions to patients' suicides. Am J Psychiatry 2000; 157 (12) 2022-2027
• 42 Ellis TE, Patel AB. Client suicide: what now?. Cognit Behav Pract 2012; 19 (02) 277-287
• 43 American Association of Suicidology. Clinician Survivors. 2017. Available at: www.suicidology.org/suicide-survivors/clinician-survivors . Accessed August 17, 2017
• 44 Ellis TE, Dickey TO. Procedures surrounding the suicide of a trainee's patient: a national survey of psychology internships and psychiatry residency programs. Prof Psychol Res Pr 1998; 29 (05) 492
• 45 Puttagunta R, Lomax ME, McGuinness JE, Coverdale J. What is the prevalence of the experience of death of a patient by suicide among medical students and residents? A systematic review. Acad Psychiatry 2014; 38 (05) 538-541