Recognizing and responding to a suicide crisis.

Data from therapists who were treating 26 patients when they committed suicide were utilized to identify signs that warned of a suicide crisis. Three factors were identified as markers of the suicide crisis: a precipitating event; one or more intense affective states other than depression; and at least one of three behavioral patterns: speech or actions suggesting suicide, deterioration in social or occupational functioning, and increased substance abuse. Problems in communication between patient and therapist were identified as factors interfering with crisis recognition. Evaluation of the identified affects and behaviors may help therapists recognize a suicide crisis.

Recognizing and responding to a suicide crisis.

Data from therapists who were treating 26 patients when they committed suicide were utilized to identify signs that warned of a suicide crisis. Three factors were identified as markers of the suicide crisis: a precipitating event; one or more intense affective stats other than depression; and at least one of three behavioral patterns: speech or actions suggesting suicide, deterioration in social or occupational functioning, and increased substance abuse. Problems in communication between patient and therapist, often originating in therapeutic anxiety over the patient's possible suicide, were identified as factors interfering with crisis recognition. Evaluation of the identified affects and behaviors may help therapists recognize a suicide crisis.

Therapists' reactions to patients' suicides.

OBJECTIVE: The authors wished to obtain information from therapists about their reactions to the suicides of patients in their care. METHOD: Therapists for 26 patients who committed suicide completed a semistructured questionnaire about their reactions, wrote case narratives, and participated in a workshop to discuss their cases. The therapists discussed what they would do differently, the impact of the death on their treatment of suicidal patients, their interaction with patients' relatives after the suicides, and the reactions of their colleagues and supervisors. RESULTS: Shock, grief, guilt, fear of blame, self-doubt, shame, anger, and betrayal were the major emotional reactions. In 21 out of 26 cases, therapists identified at least one major change they would have made in their patients' treatments; most frequently mentioned were changes in medication, hospitalization of the patients, and consultation with the patients' previous therapists. Nineteen of the therapists saw the patients' relatives after the suicides; in almost all cases the relatives were not critical of them. Some of the therapists were reluctant to accept subsequent suicidal patients into their practices. Although colleagues were supportive, institutional responses and case reviews were rarely helpful, offering either blame or false reassurance that the suicide was inevitable. CONCLUSIONS: Clinicians felt they learned from participating in the project and that it was therapeutic for them. Review of such cases by a disinterested independent group with no institutional ties to the therapists seems desirable.

Suicide prevention in young adults (age 18-30).

The rate of suicide in young adults has more than doubled since 1950. This paper presents some explanations for this rise and analyzes the diagnoses and population groups whose high rates of suicide contribute most of this increase. The factors leading to suicide are presented for each group, and preventative interventions are developed from the analyses. Groups that can be readily affected by suicide reduction measures are discussed, and methods for reducing their suicide rates are proposed.